What is Benign Prostatic Hypertrophy (BPH)?

Benign prostatic hyperplasia (BPH), also known as prostate gland enlargement, is a common condition that affects older men. The prostate gland is a small, walnut-sized gland located just below the bladder and in front of the rectum. Its main function is to produce fluid that nourishes and transports sperm.

As men age, the prostate gland often enlarges. This enlargement can gradually compress the urethra, the tube that carries urine from the bladder out of the body. When the urethra is compressed, it can cause various urinary symptoms, collectively known as lower urinary tract symptoms (LUTS). These symptoms can include:

  1. Frequent urination: Needing to urinate more often, especially at night (nocturia).
  2. Urgency: Feeling a sudden and strong urge to urinate.
  3. Weak urine stream: Difficulty starting urination or a weak urine stream.
  4. Incomplete emptying: Feeling like the bladder doesn't empty completely.
  5. Dribbling: After urination, dribbling or leaking of urine.

BPH is a non-cancerous condition, but it can still significantly impact a man's quality of life if left untreated. While the exact cause of BPH is not fully understood, it is believed to be primarily influenced by hormonal changes associated with aging, particularly the hormone dihydrotestosterone (DHT).

Diagnosis of BPH typically involves a medical history review, physical examination, and possibly additional tests such as a digital rectal exam (DRE),  and if necessary an ultrasound.

How is BPH Treated?

Treatment options for BPH vary depending on the severity of symptoms and the individual's health status. Lifestyle changes, such as limiting fluid intake before bedtime and avoiding caffeine and alcohol, may help alleviate mild symptoms. Medications, such as alpha-blockers and 5-alpha reductase inhibitors, can also be prescribed to relax the muscles of the prostate gland or reduce its size.

In more severe cases or when other treatments fail to provide relief, surgical procedures such as transurethral resection of the prostate (TURP) or laser therapy may be recommended to remove or shrink excess prostate tissue. Regular check-ups with a healthcare provider are important for monitoring symptoms and adjusting treatment as needed to manage BPH effectively.

Lifestyle Options

Lifestyle modifications can play a significant role in managing the symptoms of benign prostatic hyperplasia (BPH). Here are some lifestyle options that may help alleviate symptoms:

  1. Fluid Management:
    • Limiting fluid intake, especially before bedtime, can reduce the frequency of nighttime urination (nocturia).
    • Avoiding excessive consumption of caffeine and alcohol, as these substances can irritate the bladder and increase urinary urgency.
  2. Bladder Emptying:
    • Taking the time to completely empty the bladder during urination can help reduce the sensation of incomplete emptying.
    • Double voiding, which involves urinating, then waiting a few moments and trying to urinate again, may help empty the bladder more fully.
  3. Healthy Diet:
    • Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall prostate health.
    • Some studies suggest that foods high in antioxidants, such as tomatoes, berries, and green tea, may have a protective effect on the prostate.
  4. Regular Exercise:
    • Engaging in regular physical activity, such as walking, swimming, or cycling, can help maintain a healthy weight and reduce BPH symptoms.
    • Exercise may also help improve bladder function and reduce urinary symptoms.
  5. Bladder Training:
    • Practicing bladder control techniques, such as scheduled voiding and delaying urination when experiencing the urge to go, can help improve bladder function and reduce urinary urgency.
  6. Stress Management:
    • Stress can exacerbate urinary symptoms, so finding effective stress-reduction techniques such as deep breathing, meditation, or yoga may help alleviate symptoms.
  7. Smoking Cessation:
    • Quitting smoking can improve overall urinary health and reduce the risk of developing or worsening BPH symptoms.
  8. Pelvic Floor Exercises:
    • Strengthening the pelvic floor muscles through exercises such as Kegels may help improve bladder control and urinary symptoms.
  9. Avoiding Certain Medications:
    • Some medications, such as decongestants and antihistamines, can worsen urinary symptoms in men with BPH. Avoiding these medications or discussing alternatives with a healthcare provider may be beneficial.

Incorporating these lifestyle modifications into daily routines can complement other BPH treatments and improve overall quality of life for men experiencing urinary symptoms. However, it's important for individuals to consult with a healthcare provider before making significant changes to their lifestyle or starting any new exercise or dietary regimen.

Medication Options

Several medications are commonly used to treat benign prostatic hyperplasia (BPH), each with its own mechanism of action, benefits, and potential side effects. Here are some of the medications used for BPH treatment:

  1. Alpha-Blockers:
    • Examples: Tamsulosin (Flomax), Alfuzosin (Uroxatral), Terazosin (Hytrin), Doxazosin (Cardura).
    • How They Work: Alpha-blockers relax the muscles in the prostate and bladder neck, making it easier to urinate by improving urine flow and reducing symptoms such as urinary hesitancy and urgency.
    • Pros:
      • Rapid onset of action, providing quick relief of symptoms.
      • Can improve urine flow and decrease symptoms such as incomplete emptying and nocturia.
      • Generally well-tolerated with few serious side effects.
    • Cons:
      • Possible side effects include dizziness, headache, fatigue, and nasal congestion.
      • May cause orthostatic hypotension (sudden drop in blood pressure upon standing), especially with the first dose or when starting treatment.
  2. 5-Alpha Reductase Inhibitors (5-ARIs):
    • Examples: Finasteride (Proscar), Dutasteride (Avodart).
    • How They Work: 5-ARIs block the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to prostate enlargement. By reducing DHT levels, these medications shrink the prostate gland, relieving urinary symptoms over time.
    • Pros:
      • Can reduce the size of the prostate gland and improve urinary symptoms, including urinary frequency, urgency, and weak urine stream.
      • Long-term use may help prevent disease progression and the need for surgery.
    • Cons:
      • Slow onset of action, with noticeable symptom improvement typically taking several months.
      • Potential side effects include decreased libido, erectile dysfunction, and decreased ejaculate volume.
      • Regular monitoring of prostate-specific antigen (PSA) levels is necessary, as 5-ARIs can lower PSA levels, which may mask the detection of prostate cancer.
  3. Combination Therapy:
    • Some patients may benefit from using both an alpha-blocker and a 5-ARI simultaneously to target different aspects of BPH pathophysiology.
    • Combination therapy can provide more significant symptom relief and may reduce the risk of disease progression compared to monotherapy.
    • However, combination therapy may also increase the risk of side effects associated with each medication.
  4. Phosphodiesterase-5 (PDE5) Inhibitors:
    • Example: Tadalafil (Cialis) - Approved for both BPH and erectile dysfunction.
    • How They Work: PDE5 inhibitors relax smooth muscle in the bladder and prostate, improving blood flow and reducing symptoms such as urinary urgency and frequency.
    • Pros:
      • Can improve urinary symptoms and erectile function simultaneously.
      • May be preferred in men with both BPH and erectile dysfunction.
    • Cons:
      • Possible side effects include headache, flushing, back pain, and nasal congestion.
      • Contraindicated in patients taking nitrates for chest pain, as it can cause a dangerous drop in blood pressure.

It's essential for individuals with BPH to discuss medication options with their healthcare provider to determine the most appropriate treatment based on their symptoms, prostate size, overall health, and preferences. Regular follow-up visits are important for monitoring treatment efficacy and managing potential side effects.

Surgical Options

Several surgical options are available for treating benign prostatic hyperplasia (BPH), each with its own pros and cons. Here's an overview:


Several surgical options are available for treating benign prostatic hyperplasia (BPH), each with its own pros and cons. Here's an overview:

  • Prostatic Urethral Lift (UroLift).:  The UroLift procedure involves placing tiny implants to hold the enlarged prostate tissue away from the urethra, improving urine flow. It's done through the urethra using a scope, without cutting or removing tissue. It's usually done under local anesthesia and doesn't require overnight hospital stay.
    • Pros:
      • Minimally invasive outpatient procedure.
      • Preserves sexual function.
      • Quick recovery with minimal downtime.
    • Cons:
      • Not suitable for all prostate sizes and shapes.
      • Potential for temporary urinary symptoms such as discomfort or urgency.
      • Limited long-term data on effectiveness compared to traditional surgical options.

  • Water Vapor Ablation (Rezum). In the Rezum procedure, water vapor is injected into the prostate, causing cells to die and shrink. A special device delivers the steam through a scope inserted into the urethra. It's done as an outpatient procedure, often under local anesthesia, to relieve urinary symptoms caused by an enlarged prostate.
    • Pros: 
      • Uses steam to destroy prostate tissue
      • Urination improves over 1-2 months
    • Cons:
      • Must wear a catheter for 5-7 days after
      • Not good for large prostates* or prostates with a tight prostate/bladder junction
      • High recurrence rates 4-10%

  • GreenLight Laser Photoselective Vaporization of the Prostate (PVP):  In GreenLight Laser Photoselective Vaporization (PVP), a laser is used to remove excess prostate tissue. A scope is inserted into the urethra to reach the prostate. The laser energy is directed to vaporize the tissue, improving urine flow. It's typically done as a day surgery, often under general or spinal anesthesia.
    • Pros:
      • Minimally invasive.
      • Results in 2-4 weeks
      • Reduced risk of bleeding compared to TURP.
      • Shorter hospital stay.
    • Cons:
      • May not be as effective for larger prostate glands.
      • Possible side effects include urinary urgency, frequency, and retention.
      • Risk of retrograde ejaculation.
      • Catheter overnight

  • Itra-prostatic devices ( iTind):  Intra-prostatic devices are small implants placed inside the prostate to open the urethra and improve urine flow. They're inserted through the urethra using a scope, without cutting or removing tissue. It's usually done under local anesthesia and doesn't require overnight hospital stay.
    • Pros:
      • Usually no Cather is needed
      • Results seen in 1-2 weeks
      • Good for smaller prostates and some prostates where the bladder prostate junction is tight
    • Cons:
      • Still investigational

  • Holmium Laser Enucleation of the Prostate (HoLEP):  In Holmium Laser Enucleation of the Prostate (HoLEP), a laser is used to remove excess prostate tissue blocking the urethra. A scope is inserted through the urethra to reach the prostate, and the laser breaks up the tissue for removal. It's done under general anesthesia and requires hospitalization. While the Green light laser removes a small portion of the prostate HoLEP employs a holmium laser to remove entire lobes of the prostate. It's particularly suitable for larger prostates and offers comparable efficacy to traditional open surgery but with fewer side effects and a shorter recovery time.  In summary, GreenLight PVP is more suitable for smaller glands, while HoLEP is preferred for larger prostates.
    • Pros:
      • Effective for large prostate glands.
      • Lower risk of bleeding compared to TURP.
      • Can be used in patients on anticoagulant therapy.
    • Cons:
      • Longer operating time compared to other procedures.
      • Requires specialized equipment and training.
      • Risk of retrograde ejaculation.


  • Transurethral Resection of the Prostate (TURP):  In Transurethral Resection of the Prostate (TURP), a scope is inserted through the urethra to reach the prostate. A cutting tool removes excess tissue blocking urine flow. It's done under general or spinal anesthesia and usually requires a short hospital stay.
    • Pros:
      • Highly effective in relieving urinary symptoms.
      • Suitable for medium to large prostate glands.
      • Can provide long-term symptom relief.
    • Cons:
      • Requires hospitalization and general anesthesia.
      • Potential for complications such as bleeding, urinary incontinence, and retrograde ejaculation (semen flowing backward into the bladder).
      • Longer recovery time compared to some other procedures.

  • Prostate Artery Embolization (PAE):  In Prostate Artery Embolization (PAE), a catheter is threaded through an artery in the groin to reach the blood vessels supplying the prostate. Tiny particles are injected to block these vessels, shrinking the prostate and improving urine flow. It's done under local anesthesia and typically as an outpatient procedure.
    • Pros:
      • Minimally invasive, no surgical incision required.
      • Can be performed under local anesthesia.
      • Short hospital stay or outpatient procedure.
    • Cons:
      • Effectiveness may vary, especially in patients with very large prostates.
      • Potential risk of complications such as urinary tract infection, urinary retention, or blood in the urine.
      • Long-term outcomes are still being studied.

  • Open Prostatectomy: In an Open Prostatectomy, a surgical incision is made in the lower abdomen or perineum. The enlarged prostate tissue blocking urine flow is removed. It's done under general anesthesia and requires a hospital stay.
    • Pros:
      • Effective for very large prostates.
      • Can be performed when other procedures are not suitable.
      • Lower risk of needing a repeat procedure.
    • Cons:
      • Invasive surgery with longer recovery time.
      • Higher risk of bleeding, infection, and other complications.
      • Greater risk of urinary incontinence and erectile dysfunction compared to less invasive procedures.

Before deciding on a surgical option, it's essential for patients to discuss their symptoms, prostate size, overall health, and treatment goals with their healthcare provider to determine the most appropriate approach. Each procedure carries its own risks and benefits, and the choice may depend on individual factors such as age, overall health, and preferences.