What is benign prostatic enlargement (BPE)?
BPE is non-cancerous overgrowth of the prostate gland. The prostate forms the first part of the water pipe exiting the bladder. Overgrowth of the prostate narrows the channel through which urine passes when the bladder is emptied.
What are the symptoms of BPE?
Mild and moderate symptoms include frequency (urinating too often), urgency (having to rush to the toilet) and a poor urinary flow. There may be a feeling of incomplete bladder emptying. Severe symptoms can be very bothersome and include urinary tract infections and a complete inability to pass urine necessitating the insertion of a bladder catheter to drain the urine.
What causes BPE?
BPE affects almost all men. However, it doesn’t cause symptoms in all men. The reason why some men with enlarged prostates do not have symptoms whilst some with smaller prostates do have symptoms, is not well understood.
What tests help to diagnose BPE?
You may need a number of tests to finalise your diagnosis of BPE causing obstruction the urinary flow. A medical history will be taken, an examination of the prostate using a finger in the rectum will be performed in most cases and a urinary flow test will likely be recommended. Other tests including blood tests, ultrasound or pressure testing (urodynamics) may be required.
What is the treatment?
Initial treatment for mild symptoms may involve some guidance on lifestyle measures. There are several medical treatments available which can relax the prostate/bladder neck, shrink the prostate or relax the bladder – depending on the nature of your condition. These include medications such as Tamsulosin, Finasteride and Solifenacin. In severe cases where the BPE causes retention of urine – either self-catheterisation of an indwelling catheter may be required.
Symptoms can be treated with surgery. Surgical treatement is almost always needed for patients in retention who want to get catheter free. There are a large number of different surgical treatments available, please see our procedures page for more information. With this choice of procedures the best treatment will vary from person to person and will depend on patient choice, the size of the prostate and how well the bladder is emptying - a detailed discussion with your urologist will help you select the best procedure for you.
More information is available on the BAUS website and two decision aids have been developed to help men decide which options may be best for them - one by the NHS, and one by the Canadian Association of Urology.