Dr. CARLO A. BRAVI Urologist and Andrologist
What is Prostate Enlargement?
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly affects men over the age of 50. As the prostate enlarges, it can press against the urethra and interfere with normal urinary flow.
Common Symptoms of Prostate Enlargement
These symptoms occur because the enlarged prostate obstructs the urethra, affecting urination:
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Difficulty starting or stopping urination
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Dribbling of urine after urination (post-void dribbling)
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Weak or interrupted urine stream
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Frequent or urgent need to urinate, especially at night (nocturia) and occasional incontinence
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Blood in the urine (hematuria)
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Pain in the perineal area (between the scrotum and anus)
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Feeling of incomplete bladder emptying
Note: These symptoms can also be caused by other serious conditions like prostate or bladder cancer—so it’s important to consult a doctor if any occur. If you’re concerned about these symptoms or risks, contact a healthcare provider to assess the prostate and rule out more serious conditions.
If left untreated, prostate enlargement may lead to potential complications such as painful urinary retention, urinary tract infection (UTIs), bladder stones, interrupted sleep from frequent nighttime urination, reduced quality of life due to inconvenience and embarrassment and kidney damage from back pressure if urine can’t exit the bladder.
Diagnosis and Assessment
The diagnosis of prostate enlargement involves a combination of history-taking, physical examination, lab tests, and possibly imaging or specialized urological studies. These help distinguish prostate enlargement from other conditions like prostate cancer or urinary tract infections.
Dr. Bravi’s approach begins with a detailed evaluation of medical history and urinary symptoms (frequency, urgency, nocturia, weak stream) as well as a thorough review of lifestyle and medications. A physical examination might be required, including a digital rectal exam if needed.
Among laboratory tests, you might be requested a urinalysis (to rule out infection or blood in the urine), a PSA (Prostate–Specific Antigen) test to exclude prostate cancer or other blood tests to assess kidney function.
Other specialised tests (if indicated) may include:
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Uroflowmetry: measures the flow rate of urine and postvoid residual volume (urine left in the bladder at the end of urination)
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Cystoscopy: visual inspection of the bladder and urethra with a camera
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Prostate ultrasound (Transrectal): US scan of the prostate, mainly used to determine its dimension
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Urodynamic studies: to evaluate bladder pressure and function
Treatments
Treatment options for prostate enlargement/BPH vary depending on the severity of symptoms, prostate size, and the presence of complications.
The initial approach typically involves lifestyle and behavioral modifications such as reducing fluid intake before bedtime, limiting caffeine and alcohol, bladder training techniques and regular physical activity. If these are not effective, pharmacological treatment is usually the next step. There are different drug families that can be prescribed based on symptoms profile and patient’s characteristics.
When medical therapy proves ineffective or is not well tolerated, surgical intervention may be considered. In such cases, various procedures aimed at reducing prostate size are available, with a primary focus on minimally invasive endoscopic techniques that do not require external surgical incisions. More detailed information on surgical interventions for prostate enlargement/BPH are available here.
