Benign Prostatic Hyperplasia (BPH)
Understanding & Treating an Enlarged Prostate
What is Benign Prostatic Hyperplasia (BPH)?
Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, is a common and natural part of ageing in men.
As the prostate grows, it can compress the urethra (which runs through the middle of it) leading to bothersome urinary symptoms.
While BPH is not cancerous, it can still have a major impact on quality of life by making urination difficult, disrupting daily activities and keeping you awake through the night. Fortunately, a wide range of effective treatments is available - from medications and minimally invasive procedures to surgery.
The right treatment should be tailored to your symptoms, lifestyle, and personal goals. Dr Ross takes a patient-centred approach, working closely with you to understand your concerns and guide you toward the most effective option -maximising symptom relief while minimising any impact on other parts of life.
Symptoms of BPH
BPH symptoms occur when an enlarged prostate presses on the urethra, making it harder for urine to flow. Over time, the bladder works harder to push urine through, which can lead to changes in bladder function.
Symptoms can range from mild to severe and often worsen if left untreated:
✔ Frequent urination
✔ Needing to wake up more often to urinate (nocturia)
✔ Weak or slow urine stream
✔ Difficulty starting urination (Hesitancy)
✔ Feeling of incomplete bladder emptying
✔ Dribbling at the end of urination
✔ Sudden, urgent need to urinate
✔ Leakage of urine while you’re rushing to the toilet
✔ Straining to urinate
✔ In severe cases: urinary retention, bladder infections, or kidney problems
If you’re experiencing these symptoms, don’t ignore them. Early treatment doesn’t only prevent complications, it can significantly improve your quality of life.
What causes BPH?
BPH is a normal part of ageing and is primarily driven by hormonal changes and your genetics.
Key factors include:
Age: BPH affects 50% of men over 50 and 90% of men over 80.
Hormone Health: While Dihydrotestosterone (DHT), a byproduct of testosterone, plays a role in prostate growth, studies show that testosterone replacement therapy in men with low testosterone does not significantly alter prostate size or aggravate prostate related symptoms.
Genetics: A family history of BPH increases the risk.
Metabolic Health: Obesity, diabetes, and heart disease may worsen symptoms.
While BPH isn’t always preventable and may not need immediate treatment, addressing it early can help manage symptoms more effectively with less invasive options. Proactive management can also prevent bladder changes that lead to the most bothersome symptoms, which can become harder to treat if left unchecked.
Treatment options for BPH
The right treatment depends on your symptoms, prostate size, risk for prostate cancer, and lifestyle needs.
Dr Ross offers personalised care to help you choose the most effective option.
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1. Medications for BPH
For mild to moderate symptoms, medications can relax the prostate or shrink its size:
1. Alpha-Blockers (e.g., Tamsulosin, Alfuzosin, Silodosin)
Relax smooth muscle in the prostate to improve urine flow.
Work quickly, but do not shrink the prostate.
Cause loss of ejaculation
2. 5-Alpha Reductase Inhibitors (e.g., Finasteride, Dutasteride)
Work by blocking DHT production, gradually shrinking the prostate.
Most effective for larger prostates but can take 3–6 months to show results.Generally avoided by Dr. Ross due to potential sexual side effects, including reduced libido and erectile changes.
Can be useful for reducing prostate vascularity in cases of bleeding.
3. Combination Therapy
Combining the two medications can be more effective for men with moderate to severe BPH who do no wish to have intervention.
4. PDE5 Inhibitors (e.g., Tadalafil / Cialis)
Improve both urinary symptoms and erectile function.
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As an alternative to medication or if medications aren’t providing enough relief, minimally invasive treatments can shrink the prostate or widen the urethra while preserving sexual function.
1. UroLift® (Prostatic Urethral Lift)
Lifts and holds prostate tissue away from the urethra using tiny implants—no cutting or heating.
Sexual function-preserving—negligible risk of erectile dysfunction (ED) or changes in ejaculation
Quick recovery—same-day procedure with minimal downtime.
2. Rezum™ (Water Vapour Therapy)
Injects steam into prostate tissue, causing it to shrink naturally.
Minimally invasive with low risk to sexual function.
Best for moderate BPH—urinary symptoms improve within weeks to months.
3. iTind (Temporary Implant for Prostate Reshaping)
A small device widens the urethra over 5-7 days, then is removed.
Fast recovery, minimal downtime, and preserves ejaculation.
4. Prostate Artery Embolization (PAE)
Blocks blood supply to the prostate, causing it to shrink.
Best for men who cannot have surgery due to medical reasons.
Minimally invasive procedures offer a faster recovery and a lower risk of sexual side effects compared to traditional surgery.
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For severe symptoms or failed prior treatments, surgery offers long-term relief:
1. Transurethral Resection of the Prostate (TURP) (Gold Standard Surgery)
Removes prostate tissue using a small electric loop inside the urethra.
Highly effective but has a higher risk of retrograde ejaculation.
Best for: Moderate to severe BPH.
2. HoLEP (Holmium Laser Enucleation of the Prostate)
Uses a laser to remove excess prostate tissue with precision.
Less bleeding than TURP, good for very large prostates.
3. Robotic Simple Prostatectomy
Best for extremely large prostates (>100g).
Longer recovery time.
When should I see a doctor?
Book a consultation with Dr Ross if you are experiencing:
✔ Frequent or urgent urination disrupting your sleep or daily life
✔ Difficulty urinating (weak stream, hesitation, dribbling)
✔ Bladder doesn’t feel empty after urination
✔ Recurrent urinary infections or complete urinary retention
Ask Dr Ross.
If you are not ready to make an appointment, but would like to ask a question or get some more information, we are here for you.
BOOK A CONSULTATION WITH DR ROSS
Get personalised sexual function friendly care for your prostate health.
Contact us to book a confidential consultation today.