Enlarged prostate (BPH)

What is BPH?

The prostate is a small gland that sits just below the bladder and wraps around the urethra, the tube that carries urine out of the body. As men get older, the prostate gradually enlarges — a process called benign prostatic hyperplasia, or BPH (also known as benign prostate enlargement, BPE).

BPH is not cancer, and having it does not increase your risk of prostate cancer. However, because the prostate wraps around the urethra, an enlarged gland can squeeze this tube and make it harder to pass urine.

Common symptoms

• Getting up one or more times a night to urinate (nocturia)
• A weak or slow urine stream
• Taking a while to start (hesitancy)
• Feeling that your bladder hasn't fully emptied
• Needing to go more often, or more urgently, than before
• In more severe cases, a sudden inability to pass urine at all (acute retention)

How it's diagnosed

Assessment usually includes a discussion of your symptoms, a urine flow test, and sometimes an ultrasound scan to measure the size of your prostate and check your bladder is emptying properly. A PSA blood test is often done at the same time, partly to help rule out other causes for your symptoms.

Treatment options

Treatment is tailored to how much your symptoms are bothering you, your prostate size, and your general health. Options usually progress through the following stages:

1. 1
   Lifestyle measures

   Simple changes to fluid intake and timing can meaningfully ease mild symptoms.

2. 2
   Medication

   Tablets that relax the muscle around the prostate (alpha-blockers) or gradually shrink the gland (5-alpha reductase inhibitors) are often tried first.

3. 3
   HoLEP, TURP or other surgical options

   HoLEP is a laser operation that suits prostates of any size and has a short hospital stay. Read more about HoLEP →
   
   

   Transurethral resection of the prostate (TURP) is a long-standing operation for BPH: the obstructing central part of the prostate is telescopically removed, creating a wider channel.
   
   

   The NHS has created a comprenhasive decision-making tool that is accesible here: Making a decision about enlarged prostate (BPE)→

Mr Swallow will talk you through which option best fits your individual circumstances — there is rarely a single "right" answer, and the choice is always made together with you.

Information on this page follows patient guidance published by the British Association of Urological Surgeons (BAUS).