Prostate

Benign Prostatic Enlargement

Frequently Asked Questions about Benign Prostatic Enlargement

Here is a list of the most frequently asked questions about BPE. You can read the different sections of EAU Patient Information on Benign Prostatic Enlargement for more information.

This section offers general information benign prostatic enlargement and diagnosis or treatment can vary in different countries.

What is BPE?

Benign prostatic enlargement is a common condition in older men. The prostate slowly grows and compresses the urethra at the outlet of the bladder. This is caused by hormonal changes. BPE may affect the way you normally urinate and may have a negative effect on your quality of life as it results in lower urinary tract symptoms (LUTS). It is the most frequently diagnosed condition in urology.

What does the prostate do?

The prostate is a gland which produces the fluid which carries semen. It contains smooth muscles which help to push out the semen during ejaculation. The prostate is located directly below the bladder and around the urethra.

More information?

You can read more in the section Benign Prostatic Enlargement.

What are the possible symptoms in men with BPE?

BPE can make your flow of urine very slow, it may cause your urine flow to stop and start several times while emptying your bladder, or you may need to wait and push (strain) before you can start urinating.

BPE may cause you to urinate often during the day and may wake you up at night to empty your bladder (known as nocturia). It may also cause urgency and can sometimes lead to involuntary loss of urine (known as incontinence).

You may also feel that your bladder did not completely empty after urination. Your stream of urine may end with dribbling. Urine sometimes dribbles into your underwear when you leave the toilet after urinating.

What are LUTS?

The symptoms associated with BPE are sometimes called male LUTS (lower urinary tract symptoms). LUTS can be due to other conditions which affect the urinary system.

Are LUTS an indication to look for early prostate cancer?

BPE is not cancer and does not cause cancer. However, both BPE and prostate cancer can develop as you grow older. If you have never been screened for prostate cancer, your urologist may screen for it when you come in for your prostate symptoms.

More information?

You can read more in the section Symptoms.

Which tests are done to diagnose BPE?

The doctor will take your medical history and do a physical examination, including a digital rectal examination (DRE) of the prostate. During DRE the doctor uses a finger to feel the size, shape, and consistency of the prostate. Your symptoms will be carefully evaluated, blood and urine tests are done, and the speed of your flow of urine is measured during uroflowmetry.

Why is PSA tested in case of symptoms caused by BPE?

The level of PSA (prostate-specific antigen) in your blood may be tested because BPE and prostate cancer can occur in the same age group. PSA can also be used to estimate your prostate volume and it can be used to estimate the risk of the BPE symptoms getting worse.

What is the purpose of urinalysis and urine culture?

Urinalysis is used to rule out that you have a urinary tract infection, which causes similar symptoms. If you do have an infection, urine culture is used to confirm this and to select the best antibiotic treatment for the infection.

What is the purpose of uroflowmetry?

Uroflowmetry measures the speed of the flow of urine. This test is done to see if the prostate obstructs the urine flow.

Why is post void residual (PVR) measured?

The amount of urine left in the bladder after urination is measured to see whether the bladder is able to empty completely. High PVR is a sign that the bladder is not functioning well or that there is a blockage to the urethra. This may increase the risk of urinary tract infections.

What is the purpose of an ultrasound of the bladder and prostate?

Ultrasonography of the bladder can be used to diagnose possible other causes of the symptoms. It can also see if you have other conditions that coexist with BPE which may make the symptoms worse or have an effect on selecting the best treatment option for you.

Prostate ultrasound is used to measure prostate volume. This may be important to confirm the diagnosis of prostate enlargement and to decide which treatment option is best for you.

More information?

You can read more in the section Diagnosis.

When do you need treatment for the lower urinary tract symptoms associated with BPE?

You will get treated for the symptoms caused by BPE if they are bothersome and your quality of life has been affected by them.

What is Watchful Waiting?

If you have mild LUTS you will generally not need drugs or surgery. Instead, the urologist will closely observe your condition over the following months or years and will start different treatment when needed. The urologist will explain your condition to you, how it can develop, and how you can adjust your lifestyle to reduce your symptoms and cope with them.

How can lifestyle changes help when you suffer from the lower urinary tract symptoms associated with BPE?

Some easy lifestyle changes can help to improve the symptoms caused by BPE. For instance, you can drink less in the evening which helps to reduce nocturia. Drink less alcohol, coffee, or tea to avoid bladder irritation.

For some men it helps to empty the bladder completely if they urinate while sitting down. If you still feel your bladder is not completely empty, you can try again after 5-10 minutes.

Encourage yourself to “hold on” longer when you feel the urgency to urinate. This will train your bladder to keep more urine so that you will need to urinate less often.

What types of drugs are used to relieve the symptoms caused by BPE?

There are five categories of drugs:

  • Herbal drugs: These drugs are made of plant extracts which may help to relieve the symptoms caused by BPE. The quality of herbal drugs can vary greatly.  Because there are so many herbal drugs available, no specific recommendations about their use can be made.
  • Alpha-blockers: This group of drugs relaxes the smooth muscle of the prostate which relieves the symptoms. This is the most commonly recommended group of drugs for men with BPE.
  • 5-alpha reductase inhibitors (5ARIs): These drugs slowly reduce the prostate size and improve the symptoms. They are often used in combination with alpha-blockers.
  • Muscarinic receptor antagonists (MRAs): These drugs reduce abnormal bladder contractions and can relieve bothersome storage symptoms. They can be used alone or in combination with alpha-blockers.
  • Phosphodiesterase 5 inhibitors (PDE5Is): These drugs were developed for the treatment of erectile dysfunction but they also relieve symptoms caused by BPE. Tadalafil is the only PDE5I which is licenced in Europe for the treatment of BPE. PDE5Is are usually not covered by insurance companies or the national health service.

What is the main purpose of surgery for BPE?

The main purpose of surgery is to relieve the symptoms associated with BPE and to improve the flow of urine.

What is the most common surgery for BPE?

The most recommended surgical treatment for the symptoms of BPE is transurethral resection of the prostate (TURP). The aim is to remove the part of the prostate which causes the symptoms (the adenoma). The procedure is done through the urethra without making an incision in your lower abdomen, which is known as minimally invasive treatment. TURP offers optimal improvement of the symptoms caused by BPE. After TURP you may have retrograde ejaculation.

BPE can also be treated by other types of surgery:

  • Transurethral incision of the prostate (TUIP): During TUIP, the doctor cuts into the prostate through the bladder neck to improve the flow of urine. This procedure is rarely used for the treatment of BPE because similar results can be achieved with drug treatment.
  • Open prostatectomy: This procedure removes the adenoma in a way similar to TURP or laser enucleation, but it is done by making an incision in the abdomen. It is recommended for men with very large prostates.
  • Laser treatment: The laser uses intensive light to cut (enucleate) or vaporize the prostate tissue. During the procedure, only a small amount of blood is lost.
  • Prostate stents: Stents are used to keep the urethra open and improve the flow of urine. They are mainly recommended for men who are not fit for surgery.
  • Transurethral needle ablation (TUNA): This is a minimally invasive procedure which uses heat (radiofrequency energy) to harden parts of the prostate tissue. The aim is to reduce the prostate volume and to improve the symptoms.
  • Transurethral microwave therapy (TUMT): This is a minimally invasive procedure which uses microwave energy to harden parts of the prostate tissue. The aim is to reduce the prostate volume and to improve the symptoms.

What is retrograde ejaculation?

This means that the semen will not go through the urethra during orgasm but it will be projected into the bladder and leaves your body afterwards when you urinate. You may have retrograde ejaculation after surgery for BPE. It is also associated with some types of drug treatment.

Is there a relationship between surgical treatment and erectile dysfunction?

In most cases, surgery will not cause erectile dysfunction.

What if you are unable to urinate (urinary retention)?

If urinary retention develops and you are not able to urinate, an indwelling catheter is inserted for a few days until you can urinate on your own. Depending on how health care is organized in your country, the catheter is placed by your family doctor, the urologist, or at the emergency unit of the hospital.

More information?

You can read more about the different treatment options for BPE in the following sections:

How can I cope with lower urinary tract symptoms associated with BPE?

BPE is a very intimate and private condition. However, there are many ways to keep the symptoms associated with BPE under control. They should not stop you from being happy in your relationships and participating in the social, cultural, and economic life of your community.

Seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist.

More information?

You can read more in the section Living with BPE.

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Asymptomatic stones

Stones that do not cause any symptoms. They are usually found during imaging tests done for another condition.

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Bladder

Organ which collects urine from the kidneys.

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Calculi

Stones.

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Computed tomography (CT)

Imaging technique that makes a series of x-ray images of the body.

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Conservative treatment

Monitoring the progress of the stone disease or treatment with medication to ease the natural passing of stones.

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Contraindication

A symptom or condition that makes a certain treatment option undesirable.

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Decompression

Relieving pressure in the kidneys. A nephrostomy tube is placed directly in the kidney through the skin so that urine can leave the body.

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Endoscope

A tube-like instrument to examine the inside of the body. Can be flexible or rigid.

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Fragments

Pieces of the stone broken during a procedure.

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Intravenous urography

An imaging technique where x-ray contrast agent is injected into the vein, usually in the arm.

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JJ-stent

A tube that is temporarily placed in the ureter to make sure urine can flow from the kidney to the bladder.

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Kidneys

Two bean-shaped organs in the back of the abdomen that filter the blood and produce urine.

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Medical Expulsive Therapy (MET)

Medication that makes the natural passing of stones easier and less painful.

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Metabolic evaluation

Series of blood and urine tests for patients who have a high risk of forming stones.

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Nephrostomy tube

A tube placed directly into the kidney through the skin. This allows the urine to leave the body.

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Non-contrast-enhanced CT

Type of CT scan with low radiation exposure.

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NSAIDs

A group of medicines used to relieve pain. It is often used to relieve renal colic.

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Oxalate

A component found in many kinds of food which may be related to forming kidney or ureteral stones.

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Percutaneous

Through the skin.

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Percutaneous nephrolithotomy (PNL)

Treatment option to remove stones directly from the kidney by placing a tube through the skin.

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PH-value

A measure between 0.0 and 14.0 to describe if a fluid is acidic or alkaline. pH values close to 7.0 are neutral, anything above is alkaline, anything below is acidic.

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Renal colic

Severe pain in flank, loin, groin, or thigh caused by a stone blocking the normal flow of urine.

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Shock-wave lithotripsy (SWL)

Treatment option to break stones into smaller pieces using high energy sound waves. Stone fragments pass with urine after the procedure.

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Ultrasonography

Imaging technique that uses high-frequency sounds to make an image of the inside of the body (ultrasound).

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Ureter

One of the two tubes through which urine flows from the kidneys to the bladder.

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Ureteroscope (rigid or flexible)

An endoscope used for the urinary tract. It is inserted into the urethra and can move through the bladder, up the ureter, and even into the kidney.

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Ureteroscopy (URS)

Treatment option to remove kidney or ureteral stones. A ureteroscope is inserted into the urinary tract via the urethra to pull out the stone.

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Urethra

The tube which carries urine from the bladder and out of the body.

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Uric acid

A chemical that is created when the body breaks down substances called purines.

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Urinary tract

The organ system which produces and transports urine through and out of the body. It includes two kidneys, two ureters, the bladder and the urethra. The urinary tract is similar in men and women, only men have a longer urethra.

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Urolithiasis

Stone disease.

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Urologist

A doctor specialized in health and diseases of the urinary tract and the genitals.

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LUTS

Lower urinary tract symptoms. A term used for the symptoms caused by BPE which can also point to other diseases affecting the urinary tract (see also Urinary tract).

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Active treatment

Procedures to remove a kidney or ureteral stone.

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Adenoma

The enlarged part of the prostate.

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Anaesthesia (general, spinal, or local)

Before a procedure you will get medication to make sure that you don’t feel pain. Under general anaesthesia you are unconscious and unaware of what is happening to you. Under spinal or local anaesthesia you will not feel pain in the part of your body where the procedure is done. Anaesthesia wears off gradually after the procedure.

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Benign enlargement

Cell growth in the body which is not cancerous.

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Cystoscope

A type of endoscope which is used in the urethra (see also Endoscope, Urethra).

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Erectile dysfunction

The inability to get or keep an erection.

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Indwelling catheter

A tube placed in the urethra and bladder to help you urinate.

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Micturition

Urination.

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Minimally invasive procedure

A surgical procedure where there is no need to make an incision in the body. An endoscope is used to reach the part of the body that needs to be treated through the urethra (see also Endoscope).

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Nocturia

Waking up one or more times during the night because of the need to urinate.

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Physical

Having to do with or affecting the body.

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Post void residual urine (PVR)

The amount of urine left in the bladder after urination.

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Prostate

The gland which produces the fluid which carries semen. It is located in the male lower urinary tract, under the bladder and around the urethra.

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PSA (prostate-specific antigen)

A protein produced by the prostate which may increase in men with a benign prostatic enlargement, prostatic inflammation, or prostate cancer.

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Psychological

Having to do with or affecting the mind.

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Resectoscope

A type of endoscope used for minimally invasive treatment of BPE.

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Retrograde ejaculation

A condition when semen can no longer go through the urethra during orgasm but goes into the bladder instead. The semen later leaves the body during urination.

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Urgency

The sudden need to urinate which is difficult to postpone.

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Urinary incontinence

Involuntary loss of urine.

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Urinary retention

When you are unable to urinate. This condition can be chronic.

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Nocturnal polyuria

When the kidneys overproduce urine at night.

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Peripheral oedema

Oedema means swelling. Peripheral oedema refers specifically to swelling of the ankles and legs.

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Primary polydipsia

The sensation that your mouth is dry which leads you to drink too much.

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Obstructive sleep apnoea

Repetitive pauses in breathing during sleep, despite the effort to breathe, commonly paired with snoring.

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Benign Prostate Enlargement (BPE)

An enlargement of the prostate related to hormonal changes with age.

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Overactive Bladder Symptoms

A collection of urinary storage symptoms, including urgency, incontinence, frequency and nocturia.

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Transurethral resection of the prostate (TURP)

TURP is a standard surgery to treat benign prostatic enlargement (BPE). A part of the prostate is removed to improve the symptoms without making an incision in your lower abdomen. This type of surgery is known as minimally invasive treatment.

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Catheter

A hollow flexible tube to insert or drain fluids from the body. In urology, catheters are generally used to drain urine from the bladder.

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Urinary frequency

The need to urinate more often than usual, generally more than 8 times a day.

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