Skip to main content
    Mr Jai Seth

    Enlarged Prostate

    An enlarged prostate, known medically as benign prostatic hyperplasia (BPH) or benign prostatic enlargement, is the gradual, non-cancerous growth of the prostate gland that affects the majority of men as they age. The prostate sits around the urethra, the tube that carries urine out of the bladder, and as it grows it can compress that channel and slow the flow of urine. BPH is not prostate cancer and does not become cancer.

    Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)

    Consultant Urological Surgeon · Last updated:

    In short

    What it is
    Non-cancerous growth of the prostate that narrows the urethra
    Usual signs
    Weak stream, hesitancy, incomplete emptying, going often, waking at night
    How common
    A majority of men over 50, and most men over 70
    Not cancer
    BPH is not prostate cancer and does not become cancer
    First steps
    Lifestyle changes and tablets; most men need nothing more
    If that is not enough
    HoLEP, TURP, UroLift, Rezum or Aquablation, matched to prostate size
    What suits you
    Depends on prostate size, how well the bladder empties, and whether keeping ejaculation matters to you
    See a doctor today if
    You cannot pass urine, see blood in your urine, or have a fever with pain
    Book a consultationor call 020 7971 1125

    Most men with BPH experience symptoms that can be managed without surgery. The self-help BAUS recommends is 1.5 to 2 litres of fluid a day spread evenly, cutting caffeine gradually, not drinking before bed, not going to the toilet 'just in case', giving the bladder time to empty, and keeping the bowels regular; tablets come next. For others, symptoms progress, medication is no longer enough, or complications develop. A specialist assessment measures the prostate, checks how the bladder is coping, asks what the man wants from treatment, and matches one of the options below to that.

    Symptoms of an enlarged prostate

    • A weak or slow urinary stream.
    • Hesitancy: needing to wait before urine starts to flow.
    • A stop-and-start or intermittent stream.
    • Straining to pass urine.
    • Dribbling at the end of urination.
    • A feeling that the bladder has not fully emptied.
    • Needing to pass urine more often than usual during the day (frequency).
    • Waking up more than once at night to pass urine (nocturia).
    • A sudden, hard-to-defer need to pass urine (urgency).
    • Occasional leakage of urine before reaching the toilet (urge incontinence).

    Causes

    • Age. BPH affects a majority of men over 50, and most men over 70. It is part of normal prostate biology, not a disease in itself.
    • Hormonal changes. The balance of testosterone and dihydrotestosterone (DHT) shifts with age, and DHT is the principal driver of prostate growth.
    • Family history. Men whose father or brother had BPH severe enough to require treatment are more likely to develop symptoms themselves.
    • Metabolic factors. Obesity, diabetes and inactivity are associated with more pronounced lower urinary tract symptoms, though the link is correlational rather than strictly causal.

    When to see a specialist

    If you have any of the following, seek a urology opinion rather than waiting for symptoms to improve:

    • Symptoms are affecting sleep, work, or daily activity.
    • First-line medication (alpha-blockers, 5-alpha reductase inhibitors, or a combination) has not controlled symptoms.
    • Symptoms are progressing despite medication.
    • There is recurrent urinary tract infection, blood in the urine, urinary retention (inability to pass urine), or a kidney stone.
    • PSA is raised or rising in a way that requires investigation alongside the BPH picture.
    • See a GP urgently or call NHS 111 if you cannot pass urine at all (acute urinary retention requires same-day catheterisation), see visible blood in your urine, have a fever with painful urination, or develop new severe pain in the side or back.

    How is it diagnosed?

    Treatment options

    HoLEP

    Holmium Laser Enucleation of the Prostate. Removes obstructing tissue as a single piece from inside the prostate capsule. Suitable for prostates of any size, including very large glands. Mr Seth leads the HoLEP programme at St George's and Kingston Hospitals.

    TURP

    Transurethral Resection of the Prostate. Long-established surgical option in which obstructing tissue is removed in small pieces under direct vision. Mr Seth performs the bipolar variant.

    UroLift

    Implant-based prostatic urethral lift. Small implants hold the prostate lobes apart. Day case, no tissue removed, preserves ejaculation in most men. Suitable for smaller-to-moderate prostates without a substantial median lobe.

    Rezum

    Water vapour therapy. Short pulses of steam shrink prostate tissue. Day case, preserves ejaculation in many men. Effect develops over weeks to months.

    Aquablation

    Image-guided water-jet therapy. Removes tissue using a high-pressure water jet under ultrasound mapping. A relatively newer technique.

    Bladder Neck Incision

    A small targeted incision at the bladder neck for primary bladder neck obstruction or small obstructive prostates.

    Mr Seth's published research

    See all publications.

    Further reading

    Book a consultation with Mr Jai Seth

    Private appointments available at Nuffield Health Parkside Hospital, Wimbledon, and other consulting locations across London.

    Book an appointment