Prostate enlargement - Treatment 

Treating prostate enlargement 

Prostate enlargement animation

Prostate enlargement or benign prostatic hyperplasia (BPH) is a common condition in older men. This animation explains what the prostate gland is and how it functions. It also highlights the importance of seeing your GP to check for prostate cancer.

Media last reviewed: 04/03/2014

Next review due: 04/03/2016

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for prostate enlargement

If you have an enlarged prostate, your treatment plan will be determined by how severe your symptoms are.

If your symptoms are mild to moderate, you will receive no immediate medical treatment but will be given regular check-ups to carefully monitor your prostate. This is often referred to as "watchful waiting".

You will probably also be advised to make changes to your lifestyle to see if they improve your symptoms. These lifestyle changes are explained below, along with the training and treatments than can later be tried, if necessary.

Lifestyle changes

You may be advised to:

  • Stop drinking any liquids for one to two hours before going to bed. This will help to prevent nocturia (waking up during the night to pass urine).
  • If you've been prescribed medication (see below), experiment with the time you take this. For example, taking it at 7pm may help prevent nocturia.
  • Stop drinking alcohol and caffeine, or limit your consumption of them. They can irritate your bladder and make your symptoms worse.
  • Exercise regularly. Research has shown that moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms (although it is unclear exactly why this is). Read more information on ways to get regular exercise.
  • Join a patient support group (your doctor should be able to recommend one), which may help you manage mild symptoms without the need for medication.

Bladder training

Bladder training is an exercise programme to increase the time between urination and to increase the amount of urine your bladder can hold.

You will be given a target, such as waiting for at least two hours between each time you urinate. It's a good idea to use a bladder training chart, which allows you to record each time you pass urine and record the volume of urine passed (you'll need a plastic jug to measure this). Your doctor should give you a chart to take home.

You will also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.

Over time, your target time will be increased and at the end of the programme you should find that you are able to go for longer without urinating.

Bladder training should only be tried under medical supervision.

Medication

Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of prostate enlargement.

Finasteride or dutasteride

Finasteride and dutasteride are widely used to treat prostate enlargement. They block the effects of a hormone called DHT (see causes of prostate enlargement) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.

If you are prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you'll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year.

Use condoms if you are sexually active, because both finasteride and dutasteride can have an adverse affect on your sperm. If you get a woman pregnant, there is a risk the baby could develop birth defects.

Side effects can also include:

  • impotence (inability to get an erection)
  • little or no sperm when you ejaculate

In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you.

Alpha blockers

Alpha blockers help relax the muscles of your bladder, making it easier to pass urine.

You may be given alpha blockers as your primary treatment or in combination with finasteride.

Tamsulosin and alfuzosin are two alpha blockers commonly used to treat prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include:

  • dizziness
  • headaches
  • weakness
  • little or no sperm when you ejaculate

You should only begin taking alpha blockers over a restful weekend when you're not planning to drive, as there's a risk these could cause low blood pressure and fainting.

Generally, if you experience dizziness while on this medication, avoid driving or operating heavy machinery until it has passed.

Surgery

Surgery is usually only recommended for moderate to severe symptoms of prostate enlargement that have failed to respond to medication.

Trans-urethral resection of the prostate (TURP)

Trans-urethral resection of the prostate (TURP) is a surgical procedure where excess prostate tissue is removed to reduce the pressure on your bladder.

The surgeon will insert a small instrument into your urethra (the tube through which urine passes). An electric wire loop heated by radio waves is moved across to slice away excess tissue.

TURP is not painful because it is performed using either a general anaesthetic (where you are asleep) or a regional anaesthetic (where you are awake, but the lower half of your body is numbed).

Most men are well enough to leave hospital two to three days after the operation.

A common complication of TURP is that you will no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It results in sperm going into your bladder rather than out of your penis during ejaculation.

However, you will still experience the physical pleasure associated with ejaculation (the climax).

Alternative techniques

There are a number of newer surgical techniques that may lead to fewer side effects, or a quicker recovery, than a TURP.

However, as these treatments are still fairly new they may not be available and their long-term effectiveness is not always clear.

These alternative techniques are explained below.

  • Bipolar transurethral resection of the prostate - different instruments are used to perform the procedure, which allow saline water to be pumped into the urethra rather than a fluid called glycine. This is thought to lead to a lower risk of TURP syndrome (see risks of a TURP).
  • Holmium laser enucleation of the prostate - a laser is used to remove excess prostate tissue using a similar route to a TURP. The procedure has shown good results in medium-term follow up (five to seven years) and is emerging as a promising alternative. It does not use glycine and hence there is no risk of TURP syndrome.
  • KTP laser vaporisation - a small tube known as a cystoscope is inserted into your urethra. The cystoscope fires pulses of laser energy to burn away prostate tissue.

Open prostatectomy

This procedure may be more effective than a TURP if you have severe prostate enlargement.

However, open prostatectomy is now very rarely used, even for larger prostates, due to the development of other techniques such as holmium laser enucleation of the prostate (see above).

The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence. There is also a greater chance these complications will become permanent than if they occur following a TURP.

During an open prostatectomy, an incision is made in your abdomen and the outer portion of your prostate is removed.

Preventing prostate enlargement

There is evidence to suggest that eating a diet high in protein and vegetables and low in red meat and fat may reduce your risk of developing an enlarged prostate.

Foods that are a good source of protein include:

  • eggs
  • milk
  • soya
  • tofu
  • fish
  • cheese
  • chicken

Page last reviewed: 27/03/2013

Next review due: 27/03/2015

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Comments

The 19 comments posted are personal views. Any information they give has not been checked and may not be accurate.

DHJ said on 06 October 2013

I am 62 years old & have suffered from BPH for a number of years. My medication consists of Dutasteride & Tamsulosin. My symptoms seem to have got progressively worse such that my GP is considering referring me for surgery ( Turps? ).
I am reluctant to go down this route but recently learned of a less invasive option - UroLift - which appears to offer a more acceptable solution.
Is this available through NHS & if so how can I progress this?

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notalwaystheprostate said on 10 September 2013

I am in the urology business and found these contributions very useful. I hope these comments help as well!
Firstly, TURP can be brilliantly effective and safe if the prostate is enlarged and causing obstruction but - its not always the prostate causing the problems! In many younger men the urinary problems are due to muscular problems in the bladder itself or at the neck of the bladder - which is why 'bladder neck incision" can work so well for them and has less risk of upsetting ejaculation.
Second, orgasm and the process of ejaculation is different in everyone. Some men don't need the ejaculation as much as others, some need it for full orgasm. Every man needs ejaculation for fertility. Try an alpha blocker drug 1st to see how it suits you and your ejaculation/orgasm (and your partner) before any operation that may permanently damage these processes.
Thirdly, many of us are interested in preserving ejaculation and orgasmic sensation. Operations can be "customised" to reduce or even avoid this damage completely but you need to find an interested surgeon. Ask them! Also Urolift has been designed to avoid damage to ejac/orgasm and is likely to be approved by NICE for NHS use shortly.
Fourthly, Cialis (tadalafil) helps both urinary and sexual difficulties. This benefit was discovered in the UK and licenced for both uses in the UK but is caught out by the restrictions brought in when Viagra 1st came out so GPs won't offer it in a hurry unfortunately. You may have to pay for it - or have an expensive and possibly avoidable operation- after which you can get an NHS prescription more easily! NHS arrangements don't always make sense!!
Finally, Gat-Goren. We need evidence. My patients who wanted to try it also found it difficult to make the arrangements in Israel. Their health system is similar to ours so if it works they should have scientific results to show the world by now but I have not yet seen convincing data.

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treadstone said on 15 July 2013

I would not have TURP or HOLEP unless the surgeons agree to do the bladder neck incision.
In the USA there are big problems now with Retrograde Ejaculation issues . The Orgasms are not the same after surgery and can make you fell ill in some cases.
Surgeons need to look at bladder neck incisions which give you a 70% chance of proper ejaculations.
Yes you may be back in 5 years as the prostate closes up or refills but who cares.
In operation terms it is minor day case surgery.
Taking away the men's quality of conjugal life is nearly as bad as giving 16 year old ladies breast augmentation.
Where is the fairness or parity in healthcare to men, we hardly use the NHS in comparison to women.
There does appear to be a butchers philosophy blundering all the way with surgery in prostate terms
However high PSA levels are an issue, that do contraindicate this.
Please surgeons either pair the lower lobes away and leave the upper bladder neck intact or think about bladder neck incision.
Thank you chaps.

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andyaction said on 20 May 2013

Sf, sorry for the time it has taken me to respond....I'd be pleased to talk to you or anyone else regarding the Gat Goren treatment.

Also go to talkinghealth forums - gat goren, to be in touch with several others who have had the procedure and for a lot of info on the procedure.

As for UK Urologists..... it appears they are entrenched in turp and green light land.

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User753347 said on 05 March 2013

I am 50 and had/have a chronic but not severely inflamed prostate, it caused me to pass water frequently disturbed my sleep and my left hand throbbed due to me being desperate to go. My Doctor gave me 10mg alfuzosin which helps a bit a night but leaves me with a weak flow and not emptying my bladder properly.

I've recently been sufferin from blepharitis (inflamed eyelids) and my doctor eventually gave me 500mg of Oxytetracycline twice a day to treat the blepharitis. I had been taking the tablets for nearly 3 weeks when I noticed a significant improvement in my flow-rate when passing water, I stopped taking the alfuzosin as an experiment and my prostate symptoms have not got worse and are still improving,

I will visit my doctor this evening and ask to continue the antibiotics to try to see if the Oxytetracycline will cure my infection/inflammation.

I wish the doctors would look at this to see if it could help other people who may be suffering, treatment has cost 2 presriptions so far or less than £15 and significantly improved my qualityof life.

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sf100 said on 13 February 2013

I am 63 and have been offered TURP for BHP.
My symptoms are slight but investigations show urine retention in my bladder and my flow is way too slow i am told.
I did not think i had any real problems with passing urine either frequency or flow but the flow test said i did.
The only other symptom which i guess may be related is a gradual but significant reduction in the amount of semen over the course of the past few years and far less satisfying orgasm - i guess i put that down to "age".
I am due for the TURP operation in April 2013 and was fairly resigned to it as the only option and my reasoning is to get this done sooner rather than later if it is going to be required eventually
However on reading about the Gat Goren procedure i would be very interested to speak to anyone who has had it as it sounds like an good alternative.
If anyone who has had the GAT Goren procedure would be willing to chat with me about there experience.

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onenoodles said on 12 February 2013

Hi
Been suffering from this for many years now and I am now 53, been on Tamsulosin for years as well but lately the lower pelvic pain has become stubborn and relief is brief. I moved home and have a new consultant now and he is very good and basically we have started a fresh. Undergone the scan again and an endoscopy and basically no sign of anything worse than an enlarged prostate so that's good. He is going to try me on new drugs (new for me anyway) for a few months then said that if that doesn't do it then maybe the surgery?
I have read about the Gant Goren clinic but the obvious question is the cost? if anyone has undergone this treatment and doesn't mind sharing the information that would be great.
Thanks

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JamesHarrington said on 03 February 2013

Hello to all, I had H.O.L.E.P. Prostate internal reduction surgery three years ago.
Unfortunately, although I can go to the toilet and void my urine very well, in fact I have never been able to void so well so far as one can remember. I am 52 ish.
The big problem for me is the Retrograde Ejaculation: My Orgasms are truly awful and after three years it is affecting my sex life quite prolifically:
Before surgery my ejaculations were explosive and the feeling was really wonderful and quite powerful. After surgery you Orgasm first and then the Ejaculation if any at all, is a dribble. Most of the ejaculate back flushes into your bladder and it feels rather hot and somewhat gushing into you.
It is extremely un natural and the feeling is quite unfulfilled:
I feel somewhat sad a considerably depressed about the loss of function. I can no longer have any children if I choose to do so.
Further to this these hot flush ejaculations that double back into you can be quite painful at times.
I would have gladly paid up to £25,000 for any prostate surgeon to save my Bladder Neck Muscle to stop the Retrograde Ejaculation if I had known this was going to happen to me.
If there is any hope that the bladder neck muscle can be repaired or restored this would be a great help to all of us, especially those that have prostate issues at such a young age.
I would advise anyone, to stay on medication for as long as possible and avoid surgery, unless there is a guarantee that Retrograde Ejaculation can be avoided it is not natural: If there is a surgeon out there that can reverse bladder neck issues, or perform the operation without the loss of the bladder neck function, then it would be great if we could hear from you.
James Harrington:

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John Vencato said on 29 January 2013

The letter I published on the 27th Of January 2013. Here on this site medium. Was in response to the interesting letter provided by poster and commenter martinv in this site listing:
This note is just a clarification of the purpose of my comment, on this interesting new subject matter.
Mr John Vencato:

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John Vencato said on 27 January 2013

This is certainly an interesting article on the subject matter that is appearing on the web in regards to Prostate issues and BPH.
If these two Dr's Gat & Goren have found a way forward in alleviating some negative side effects of the problem then sure this should be shared with other medical professionals around the world.
At the moment there is this blunderbuss mentality within urology circles especially in the UK. Having said this the urology team where I reside are stalwart and excellent professionals of a superlative character and nature:
Men in our world and system do NOT get a fair crack of the whip where medical issues and treatment are concerned, unfortunately our ladies get too much of the cake in this area.
Prostate concerns are a major bone of contention to men of today, this one issue will bring men,s male medical problems to the fore in how we wish to be cared for in the future.
Men are already being demasculated in society by politics and the causes by women's feminist lobby groups.
This current and ever growing scourge on men and male's across the board in society, needs to be addressed the issue of retrograde performance after surgery needs to be researched and alleviated by pioneers such as Messrs Gat & Goren. If they have found a way forward then that knowledge must be shared for the sake of the sanity of all of us.
There is no need for men in society to be exposed to this level or type of predicament:
The prevention of the destruction of the Bladder Neck Muscle during these procedures needs to be investigated:
I would like to add the waiting list times for these procedures is unacceptable and their needs to be a Judicial Review on wait times of between 5 and 7 months whilst being placed on Catheterization systems:
A personal thank you to the person who created this site system and allowed us to speak on this matter and give opinion Mr John Vencato.

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genkidesu said on 22 January 2013

I had a small enlargement but the effect on me was large , bedwetting and frequent urination .Medication was ineffective and eventually the retention of urine caused a problem with my kidneys cleaning my blood .
I had the TURP operation which did not cause any pain but was uncomfortable at times . The bedwetting problem ceased immediately , the urine flow became much fuller and the time between urinating is now 6 to 8 hours but 10 or even 12 hours is not unusual .
Before this operation I was always thirsty and drank fruit juices ,milk or anything that was cold .Now I rarely become thirsty and just drink tea sometimes up to 12 cups a day.

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User723690 said on 04 November 2012

I underwent a full series of tests about two years ago but declined the offer to have the TURP procedure and instead opted to control the problem with the usual medication. Whilst there has been some improvement I still have to make regular trips to the toilet during the night.

Due to go back and see my consultant this coming Thursday but whilst doing some more research about other surgical treatments I came upon the Gat Goren method.

Andyaction - can you advise what the costs were? I'm covered by private medical insurance but unlikely to get any cooperation from the insurance provider if I step outside their standard package.

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martinv said on 17 August 2012

Just returned from the Gat Goren Clinic. It was an easy procedure. ..much better than having your prostate reamed out...and most importantly it gets to the cause of the problem rather than the symptom. I am anticipating the volume of my prostate will decrease in half, zero visits to the bathroom at night, and a much higher level of free testosterone. The cause of BPH is failure of the internal spermatic vein valves which result in backward hydrostatic pressure of free testosterone into the prostate causing hyperplasia and hypertrophy.

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rig1963 said on 11 June 2012

I have just been told i have BHP i am 49yrs old.At the moment i have a catherter fitted to help empty my bladder and have been told i will have to take Tamsulosin first before they will look at surgury some comments as to how it affects you would be greatly recieved.
I know that this usually affects older men and that is why i am somewhat concerned, but any information would be appeciated, My GP is not very helpful and i am waiting for the renal outreach team to come and visit.

with thanks

dave

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60boy said on 07 May 2012

I had a TURP op last October and now, 7 months later, feel absolutely fine. I can now pee like a racehorse. I do suffer from retrograde ejaculation but it hasn't affected my sex life at all.
Aged 62 I really couldn't give a damn about it in fact and my wife certainly doesn't!
I was told I'd been suffering from BPH for years but hadn't taken any notice of the symptoms. Only when I couldn't urinate at all and had to be rushed to hospital, did I find out.
I don't know how the drugs used work because I never had them. But I can thoroughly recommend TURP as a pretty painless way of returning to normal.

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Lindbergh said on 09 April 2012

Hi andyaction, can you report on the success or otherwise of your Gat Goren procedure in a future post. I was also diagnosed with BPH, was on Finasteride and Tamsulosin Hydrochloride for around 2 years with no side effects other than retrograde e (which I occasionally was able to overcome). I have just recently undergone a TURP on the recommendation of my urologist. So far it seems that I am not suffering from either impotence or incontinence but I wait to see whether I will continue to experience retrograde e. One other procedure which has recently come to light is called urolift, but I only found out about it the day after my op and it seems likely that one's anatomy may determine whether it is suitable or not for a specific individual and of course my urologist told me that mine would not have been.

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andyaction said on 28 March 2012

Guys, you are banging your heads against a brick wall. The NHS and others with a commercial interest will not listen to you or I. Why should they what expertise do we have in the area?

i was diagnosed with BPH and TURPS was suggested. I didn't want side effects so after checking out my options, I went to Israel and had the Gat goren procedure. This is a simple procedure with a very high success rate in reducing BPH and even a small number of men with PCa found the cancer went away. Based on this wouldn't you think the NHS and other experts would want to investigate? Not a hope.

The Gat Goren procedure may fail for me, time will tell but if it does, then its cost me a few bob. I can resort to TURPS or whatever then if symptoms don't improve.

With Gat Goren, there is no retrograde e, there is no dribling and you can wean yourself of the drugs controlling your BPH...

Drs are educated Doctors practining in israel and the World renowmed Weizmann Institute. they lecture all over the world and it appears have developed a simple procedure to deal with a worldwide problem.

Naturally, expect the drug companies and equipment makers to start squirming and putting out misinformation to put people off the track - par for the course.

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dancermo said on 10 November 2011

I was diagnosed with BPH about 6 months ago. the treatment i was given was finasteride and tamsulosin after a few days maybe a week after starting with this treatment, i experienced probably the worst of the side (to my mind) I am sexually active and i found the retrograde ejaculation very disturbing, and i might add painful.. so thats the sex life gone.. that got sorted out within 3 weeks when erectile dysfunction got so bad that i couldn't anyway...
after 2months on these tablets without any noticable benefit for the original problems.. I stopped taking the tablets.. It has taken 2 months to recover any of the lost functions.. I have taken to the Gym and i have a rigorous abdominal and back regime which has helped somewhat..i am however looking at alternative treatments. It seems that Green Laser Treatment may be the answer, has anyone any experience of this treatment....

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User610150 said on 26 October 2011

A possible side effect of the drugs to control an enlarged prostate is impotence. In the US Cialis is now a treatment for the symptoms of an enlarged prostate and obviously deals with the erectile dysfunction as well! Why is this not being offered in the UK as a treatment for benign prostate enlargement where the drug that controls the symptoms can also cause erectile dysfunction. It deals with both problems and adds to our quality of life. Is is cost?

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