Guide · 7 min read

Understanding your enlarged prostate (BPH)

Last updated: 3 May 2026 · Reviewed by Mr Sanjay Rajpal, Consultant Urological Surgeon · GMC 6106646

An enlarged prostate is common, but the symptoms can become intrusive: slow flow, urgency, broken sleep and the sense that your bladder never quite empties. The aim of assessment is simple: confirm the cause, protect the bladder and kidneys, and choose the smallest treatment that reliably solves the problem.

Key point: BPH is benign prostate enlargement. It is not prostate cancer, but it can cause bladder obstruction and should be assessed when symptoms affect daily life, sleep, infections, urine retention, or kidney function.

What BPH means

BPH stands for benign prostatic hyperplasia. The prostate sits below the bladder and surrounds the urethra, the water pipe that carries urine out. As the gland enlarges, it can narrow the channel and make the bladder work harder. Some men have a large prostate with mild symptoms; others have a modest enlargement that causes severe obstruction. That is why treatment should be based on symptoms, flow, bladder emptying and prostate anatomy, not size alone.

Symptoms worth taking seriously

Typical symptoms include hesitancy, a weak stream, stopping and starting, dribbling after passing urine, frequency, urgency and waking at night to urinate. These symptoms are often grouped as lower urinary tract symptoms, or LUTS. You should seek prompt assessment if you cannot pass urine, see visible blood, develop recurrent infections, have severe pain, or are told your kidney function has changed.

What happens at the first appointment

A private urology consultation usually starts with a careful history: symptoms, fluid intake, medications, previous operations, sexual function, sleep pattern and any prior PSA tests or scans. Examination may include an abdominal examination and, where appropriate, a prostate examination. Mr Rajpal will normally review or arrange tests that show how well the bladder empties and whether there is a blockage.

Urine test: checks infection, blood and other abnormalities.
PSA blood test: may be used to assess prostate cancer risk in context.
Flow test: measures speed and pattern of urination.
Bladder scan: checks residual urine left behind after voiding.
Ultrasound or cystoscopy: used when anatomy or bladder health needs clarification.

Treatment options: from tablets to laser surgery

Mild symptoms can often be managed with fluid timing, reducing evening caffeine or alcohol, reviewing medications and monitoring. Tablets may relax the prostate channel or gradually shrink the gland, although side effects such as dizziness, reduced ejaculation, or sexual function changes need to be discussed openly.

When tablets are not enough, modern BPH care offers several options. Tissue-preserving approaches such as UroLift, Rezum and iTIND may suit selected men who want symptom improvement with lower risk to ejaculation. Aquablation uses a robotic water-jet to remove tissue in a controlled way. Greenlight laser vaporises prostate tissue and can suit men where reduced bleeding risk is important. HoLEP removes the obstructing prostate tissue with a holmium laser and is particularly useful for larger glands or durable relief.

How to choose the right procedure

The right treatment depends on prostate size, shape, middle-lobe anatomy, bladder function, anticoagulant medication, sexual priorities, recovery time and how severe the obstruction is. A good consultation should make the trade-offs explicit: symptom improvement, catheter time, bleeding risk, retreatment risk, effect on ejaculation and likely hospital stay.

Questions to ask before surgery

What is causing my symptoms: prostate obstruction, bladder overactivity, or both?
How much urine am I leaving behind after I pass urine?
What are the options that preserve ejaculation, and are they suitable for my anatomy?
What is the chance I will need another procedure in the future?
How long will I need a catheter, and when can I drive or return to work?

When to book a review

If urinary symptoms are disturbing sleep, limiting travel, causing anxiety, or failing to respond to medication, a specialist review is reasonable. Earlier review is important if you have infections, visible blood in the urine, bladder stones, retention, or abnormal kidney tests. The goal is not to rush into surgery; it is to understand the cause and choose a plan before the bladder is damaged by long-standing obstruction.