Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)
Consultant Urological Surgeon · Medically reviewed:
Most men with BPH experience symptoms that can be managed without surgery — through lifestyle adjustment or oral medication. For others, symptoms progress, medication is no longer enough, or complications develop. The role of a specialist assessment is to characterise the size and shape of the prostate, the way the bladder is responding, and the goals the man himself has for treatment — and then to match an option from a wide range of established treatments to the specific picture.
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.
Book a consultation with Mr Jai Seth
Private appointments available at Nuffield Health Parkside Hospital, Wimbledon, and other consulting locations across London.
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