Living with BPH — A Patient Guide

Understanding your condition

Benign prostatic hyperplasia (BPH) — commonly called an enlarged prostate — is a non-cancerous overgrowth of the prostate gland that naturally develops as men age. The prostate surrounds the urethra (the tube through which urine passes), so as it enlarges it can partially obstruct the urinary flow. BPH is extremely common: it affects around half of men in their fifties and the majority of men by their seventies. Having BPH does not mean you have prostate cancer, and it does not increase your cancer risk.

Common symptoms include:

• A weak or slow urine stream
• Difficulty starting urination (hesitancy)
• Feeling the bladder never fully empties
• Needing to urinate more often during the day and night (nocturia)
• A sudden urgent need to urinate
• Dribbling after urination

What this means for you

BPH is a progressive condition in many men, but the rate of progression varies. For some men, symptoms remain mild and stable for years; for others, they gradually worsen. Left untreated, severe BPH can occasionally lead to complications including urinary tract infections, bladder stones, or, rarely, complete inability to urinate (acute urinary retention).

Lifestyle measures can genuinely help:

• Reduce fluid intake in the evening to limit nocturia.
• Limit caffeine and alcohol, both of which irritate the bladder.
• Double voiding — after urinating, wait a moment and try again to empty the bladder more completely.
• Avoid medications such as antihistamines and decongestants if possible, as these can worsen symptoms.

Medical treatments include alpha-blocker tablets (e.g. tamsulosin, silodosin), which relax the prostate muscle and improve flow usually within days, and 5-alpha reductase inhibitors (e.g. finasteride, dutasteride), which gradually shrink the prostate over several months and are most effective for larger glands.

Surgical options — including HoLEP, TURP, laser vaporisation, and others — are considered when symptoms are severe, medications are not working or not tolerated, or complications arise. Dr Hadjipavlou will discuss which option is best suited to your prostate size, anatomy, and overall health.

Monitoring and follow-up

BPH requires regular review. Your follow-up appointments will typically include:

• IPSS questionnaire: A standardised symptom score that tracks how your symptoms are changing over time.
• Urine flow rate (uroflowmetry): A simple painless test measuring the speed and pattern of your urine flow.
• Bladder scan: An ultrasound scan after urination to measure how much urine is left behind (post-void residual).
• PSA blood test: To monitor prostate health and assist in excluding prostate cancer.
• Renal function: Blood tests to check kidney function are arranged periodically if significant obstruction has been present.

Questions to ask your doctor

• How large is my prostate and how much is it obstructing me?
• Should I start medication, and what are the side effects?
• At what point would surgery become the best option for me?
• Which surgical procedure is best for my prostate size and my lifestyle?
• Will treatment affect my sexual function or fertility?
• How often do I need follow-up and what should I watch for between appointments?