Prostatomegaly (Enlarged Prostate): Understanding BPH, Symptoms, Diagnosis & Treatment

As men age, changes in the prostate gland are common. One of the most frequently encountered conditions is Benign Prostatic Hyperplasia (BPH), also known as Prostatomegaly or enlargement of the prostate gland. While not cancerous, an enlarged prostate can significantly affect urinary function and quality of life if left untreated.

The prostate is a walnut-sized gland found only in men. It is located just below the urinary bladder and surrounds the upper portion of the urethra, the tube that carries urine from the bladder out of the body.

Because the prostate surrounds the urethra, any enlargement of the gland can put pressure on the urinary passage and interfere with the normal flow of urine.

The prostate plays an important role in the male reproductive system. It produces a milky fluid that forms a significant portion of semen and helps transport and nourish sperm.

This contribution to semen production continues throughout much of a man's life, allowing many men to maintain fertility even in their later years.

The prostate remains small during childhood and begins growing during puberty. Around the age of 45, the gland commonly starts enlarging again due to age-related hormonal changes. In many men, this growth continues throughout life.

The enlargement itself is not harmful; however, as the prostate increases in size, it may compress the urethra, much like squeezing a straw. This narrowing can obstruct urine flow and lead to bothersome urinary symptoms.

Importantly, BPH is not prostate cancer and does not increase the risk of developing prostate cancer.

BPH is one of the most common conditions affecting aging men.

• Approximately 4 out of 10 men over the age of 55 experience symptoms.
• Nearly 7 out of 10 men in their 70s are affected.
• By age 80, an even greater proportion of men develop symptoms related to prostate enlargement.

The severity of symptoms varies greatly from person to person.

An enlarged prostate can cause a range of urinary complaints, including:

Storage Symptoms

• Frequent urination
• Frequent nighttime urination (Nocturia)
• Sudden and urgent need to urinate
• Urinary incontinence

Voiding Symptoms

• Weak urine stream
• Difficulty starting urination
• Straining while passing urine
• Interrupted urine flow
• Prolonged urination

Post-Void Symptoms

• Feeling that the bladder is not completely empty
• Dribbling after urination

Complications

• Blood in the urine
• Recurrent urinary tract infections
• Urinary retention (inability to pass urine)
• Bladder stones
• Kidney damage in severe untreated cases

If these symptoms begin affecting daily activities, sleep, social life, or overall wellbeing, medical evaluation is recommended.

A thorough evaluation helps determine the severity of prostate enlargement and rule out other urinary conditions.

Medical History

Your urologist will assess:

• Urinary symptoms
• Previous illnesses
• Current medications
• Lifestyle factors

Physical Examination

A Digital Rectal Examination (DRE) allows the doctor to assess the size and consistency of the prostate.

Urine Analysis

This helps detect:

• Urinary infection
• Blood in urine
• Other urinary abnormalities

Uroflowmetry

A simple test measuring:

• Urinary flow rate
• Strength of urine stream
• Degree of obstruction

Ultrasound Examination

Ultrasound provides information regarding:

• Prostate size
• Residual urine after urination
• Bladder health
• Kidney function

Additional Investigations

When required:

• PSA (Prostate Specific Antigen)
• Urodynamic studies
• Cystoscopy
• X-rays or advanced imaging
• Prostate biopsy (if cancer is suspected)

No.

The presence of an enlarged prostate alone does not necessarily require treatment.

Many men with mild enlargement and minimal symptoms can be safely monitored with regular follow-up.

Treatment becomes necessary when:

• Symptoms are bothersome
• Urine flow is significantly obstructed
• Recurrent infections occur
• Urinary retention develops
• Kidney function becomes affected

Treatment depends on:

• Severity of symptoms
• Prostate size
• Patient age
• Overall health condition

Your urologist will recommend the most appropriate treatment based on your individual needs.

Medications are generally useful for men with mild to moderate symptoms.

Alpha-Blockers

These medications relax the muscles around the prostate and bladder neck, improving urine flow and reducing symptoms.

5-Alpha Reductase Inhibitors

These drugs gradually shrink enlarged prostates over time and are particularly beneficial in larger glands.

Tadalafil

This medication may help improve urinary symptoms and is especially useful in men who also have erectile dysfunction.

Medical therapy can provide significant symptom relief but usually requires long-term use and regular follow-up.

For patients with severe symptoms or significant obstruction, surgery remains the most effective treatment.

TURP (Transurethral Resection of the Prostate)

TURP is considered the gold standard surgical treatment for BPH.

During the procedure:

• An endoscope is passed through the urethra.
• The obstructing inner portion of the prostate is removed.
• The urinary passage is widened.
• No external incision is required.

Most patients experience excellent improvement in urinary flow and quality of life following TURP.

Like all surgical procedures, TURP has certain possible effects and complications.

Retrograde Ejaculation

The most common postoperative effect is retrograde ejaculation, where semen enters the bladder instead of exiting through the penis during ejaculation.

Urinary Leakage

Temporary urinary control issues can occur, while permanent leakage is uncommon.

Erectile Function

Most men maintain erectile function after surgery. Erectile dysfunction directly related to TURP is relatively uncommon.

Urethral Stricture

A small percentage of patients may develop narrowing of the urethra following endoscopic procedures.

Recurrence

In a minority of cases, prostate tissue may regrow over time, requiring additional treatment.

No.

The tissue removed during TURP is always sent for laboratory examination to confirm its benign nature. Occasionally, cancer may be discovered incidentally.

Since prostate cancer typically arises from a different part of the gland than the tissue removed during TURP, surgical treatment for BPH does not eliminate the future risk of prostate cancer.

Therefore, periodic prostate evaluation and follow-up remain important even after successful surgery.

Seek expert consultation if you experience:

• Weak urine stream
• Frequent urination
• Difficulty passing urine
• Nighttime urinary frequency
• Blood in urine
• Recurrent urinary infections
• Sudden inability to pass urine

Early diagnosis and timely treatment can prevent complications and significantly improve quality of life.

Providing comprehensive diagnosis and advanced treatment for:

• Enlarged Prostate (BPH)
• Kidney Stones
• Urethral Stricture Disease
• Urinary Tract Disorders
• Male Urological Health
• Endourology & Minimally Invasive Urological Surgery