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Enlarged Prostate (BPH)

Expert diagnosis and treatment of an enlarged prostate in Wrexham, Chester and Shrewsbury

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An enlarged prostate, medically known as benign prostatic hyperplasia (BPH), is extremely common as men get older. It can cause troublesome urinary symptoms including a weak or interrupted stream, difficulty starting urination, frequent trips to the toilet and a feeling that the bladder has not completely emptied.

As a Consultant Urological Surgeon specialising in endourology, I provide assessment and treatment for men with enlarged prostate symptoms across Wrexham, Chester and Shrewsbury, including modern minimally invasive and laser treatment options.

The right treatment depends on the severity of your symptoms, prostate size, bladder function, general health and your individual preferences.

What is an enlarged prostate?

The prostate is a gland located below the bladder and surrounding the urethra, the tube through which urine leaves the body.

As men age, the prostate commonly increases in size. This is called benign prostatic hyperplasia (BPH). Although the prostate becomes enlarged, BPH is not prostate cancer and having BPH does not mean that you have cancer.

However, an enlarged prostate can compress the urethra and interfere with the normal flow of urine.

Symptoms of an enlarged prostate

BPH can cause a combination of urinary storage symptoms and urinary flow or emptying symptoms.

Common symptoms include:

  • Weak or slow urinary stream

  • Difficulty starting urination

  • Needing to strain to pass urine

  • Stopping and starting during urination

  • Feeling that your bladder has not completely emptied

  • Needing to urinate frequently

  • Urgency to pass urine

  • Getting up several times at night to urinate

  • Dribbling after urination

  • Urinary retention or being unable to pass urine

Symptoms vary considerably between men. The size of the prostate does not always correspond directly to the severity of urinary symptoms.

When should you see a urologist?

You should consider assessment if urinary symptoms are persistent, worsening or affecting your sleep, work, travel or quality of life.

Particular symptoms that warrant medical assessment include:

  • Increasing difficulty passing urine

  • A progressively weaker urinary stream

  • Recurrent urinary tract infections

  • Blood in the urine

  • Episodes of urinary retention

  • Bladder stones

  • Increasing residual urine in the bladder

  • Symptoms that are interfering with your quality of life

Sudden inability to pass urine is acute urinary retention and requires urgent medical attention.

How is an enlarged prostate diagnosed?

Assessment of BPH starts with understanding your symptoms and how they affect your daily life.

Depending on your symptoms, investigations may include:

Medical history and urinary symptom assessment

I will discuss your urinary symptoms, their duration and their impact on your quality of life. A validated questionnaire such as the International Prostate Symptom Score (IPSS) can help assess symptom severity and monitor your response to treatment.

Urine tests

A urine test may be recommended to look for infection, blood or other abnormalities that could contribute to urinary symptoms.

PSA blood test

A prostate-specific antigen (PSA) blood test may be appropriate depending on your age, symptoms, prostate examination and individual risk factors.

PSA can be raised for several reasons, including benign prostate enlargement, inflammation and prostate cancer. A raised PSA therefore does not automatically mean that you have prostate cancer.

Examination

A clinical examination may include an abdominal examination and, where appropriate, a digital rectal examination (DRE) of the prostate.

Uroflowmetry and bladder scan

A uroflowmetry test measures the strength and pattern of your urinary flow.

A bladder scan can measure the amount of urine left in the bladder after passing urine, known as the post-void residual.

Prostate imaging

An ultrasound or other imaging may be used to assess prostate size and anatomy. Knowing the prostate volume can be particularly useful when considering surgical treatment.

Treatment options for an enlarged prostate

There is no single treatment that is right for every man.

Treatment depends on your symptoms, prostate size, urinary flow, bladder function, previous treatments and your personal priorities.

Lifestyle and monitoring

Men with mild symptoms may initially benefit from lifestyle measures and monitoring.

These can include:

  • Reducing caffeine and alcohol

  • Reviewing fluid intake, particularly before bedtime

  • Avoiding constipation

  • Reviewing medications that may worsen urinary symptoms

  • Double voiding to help empty the bladder

  • Monitoring symptoms over time

Medication

Several medications can improve urinary symptoms caused by BPH.

Alpha blockers, such as tamsulosin, relax the smooth muscle around the prostate and bladder outlet and can improve urinary flow relatively quickly.

5-alpha reductase inhibitors, such as finasteride or dutasteride, can reduce prostate volume over time and may reduce the risk of urinary retention and the need for surgery in appropriately selected men.

Some men may require a combination of medications.

Medication can be effective, but it does not physically remove the obstructing prostate tissue.

When is surgery considered?

Surgery may be considered when symptoms remain troublesome despite medication, when medication is unsuitable or when BPH has caused complications.

Reasons for considering surgery can include:

  • Recurrent or persistent urinary retention

  • Recurrent urinary tract infections

  • Bladder stones caused by obstruction

  • Significant residual urine

  • Kidney or upper urinary tract problems related to obstruction

  • Persistent bothersome urinary symptoms despite medication

  • A desire for a more definitive treatment

There are several surgical options for BPH. The most appropriate procedure depends partly on prostate size and anatomy.

HoLEP – a modern laser treatment for an enlarged prostate

Holmium Laser Enucleation of the Prostate (HoLEP) is an advanced minimally invasive treatment for BPH.

During HoLEP, the obstructing prostate tissue is separated from the prostate capsule using a holmium laser. The removed tissue is then morcellated and extracted through the natural urinary passage.

HoLEP can be used to treat small, medium and very large prostates, making it a versatile option for men with significant prostate enlargement.

Potential advantages include:

  • Effective removal of obstructing prostate tissue

  • Suitable for large prostates

  • No abdominal incision

  • Usually less bleeding than traditional open prostate surgery

  • Tissue is removed and can be sent for histological examination

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Learn more about HoLEP LASER prostate surgery

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