Enlarged prostate/BPH/LUTS

Benign prostatic hyperplasia (BPH) is the most common cause of urinary problems in men. It is caused by benign enlargement of the prostate; it is not related to prostate cancer. As the prostate grows it can squeeze the urethra (water pipe) and slow down the flow of urine, make bladder emptying more difficult and cause bladder irritation (overactivity). It typically causes “LUTS” (lower urinary tract symptoms) such as:

• Slow urine flow
• Stop/start urinary stream
• Difficulty starting to pass urine or having to strain
• Need to pass urine more frequently and rush to the toilet
• Increasing need to pass urine at night
• Dribbling of urine after passing urine
• If severe, an enlarged prostate can prevent men from passing urine – this is urinary retention and a catheter must be inserted into the bladder to allow urine to drain.

By the age of 65 half of men will have enlarged prostates due to BPH and this gets even more common as men get older. However, an enlarged prostate does not always cause symptoms so men will only need treatment if it causes problems such as urinary symptoms (LUTS), urine infections or retention of urine.

Treatment for symptoms due to an enlarged prostate include:

• Lifestyle changes
• Medications (Alpha blockers, 5 Alpha reductase inhibitors, Anticholinergics, daily PDE5i)
• Minimally invasive treatments: Urolift, Rezum and PAE 
• Surgery: HoLEP, Aquablation, TURP, laser vaporisation (put in links for the surgical treatments)

Generally, prostate enucleation (HoLEP, ThuLEP) is the most effective treatment as it removes more tissue than other procedures so is better at improving urinary symptoms and bladder emptying, it also a quicker recovery than the traditional TURP. Some men may prefer a minimally invasive procedure (Rezum, Urolift, PAE) due to lower potential side effects, but they are less good at improving symptoms and bladder emptying compared with HoLEP and TURP. Aquablation is another good option that has similar results to TURP but has fewer sexual side effects (such as retrograde ejaculation).

Men with LUTS need a thorough assessment to make sure there are no other issues (such as prostate cancer). If a diagnosis of benign prostate enlargement (BPH) is confirmed Mr Brewin will discuss your treatment options to help you decide the best treatment for your individual situation. The surgical treatment options depend on the size of your prostate, severity of your symptoms but most men will have a number of treatment options. This decision aid by NHS England can be helpful when considering these options.

For men in retention of urine, where the prostate has caused enough blockage to completely prevent passing urine, a catheter needs to be inserted. To treat this and allow men to get catheter free, HoLEP or TURP are the most effective treatments (although in some situations men may opt for Aquablation or a minimally invasive procedure).

For more information on BPH/LUTS the BAUS website and the Mayo Clinic website are both excellent sources of information.