Enlarged Prostate (BPH): Symptoms, Tests and Which Treatment Fits

What Benign Prostatic Hyperplasia Means

The prostate sits directly below the bladder and surrounds the urethra. From around the age of 40 it slowly enlarges under hormonal influence. This growth is not cancer; it is benign prostatic hyperplasia (BPH). The problem is mechanical: the enlarged tissue squeezes the channel urine passes through, and over the years the bladder has to work harder to push against it.

BPH affects roughly half of men over 50 and the large majority over 70. Not every enlarged prostate needs treatment. What matters is not the size of the gland but how much it disturbs your life and whether it is damaging the bladder or kidneys.

The Symptoms

They usually begin quietly and worsen over years, which is why many men dismiss them as "getting older". They fall into two groups:

Obstructive (emptying) symptoms

Irritative (storage) symptoms

Severity is measured with the IPSS (International Prostate Symptom Score), a seven-question form: under 8 is mild, 8-19 moderate, 20 and above severe. Filling it in before your appointment makes the conversation far more precise.

What Happens If It Is Left

Untreated obstruction does more than reduce quality of life. The bladder muscle thickens, then gradually weakens. In advanced cases:

Once any of these appears, treatment is no longer a matter of preference.

The Tests That Matter

1. History and the IPSS questionnaire

2. Digital rectal examination — size, consistency, any suspicious firmness

3. PSA blood test, to rule out prostate cancer

4. Urine analysis

5. Uroflowmetry — a peak flow below 10 ml per second suggests obstruction

6. Ultrasound for prostate volume and post-void residual urine

Together these confirm BPH and separate it from conditions that cause similar symptoms: bladder cancer, urethral stricture, overactive bladder or a neurological cause.

When Medication Is Enough

For moderate symptoms without complications, drugs are the first step.

The two groups are often combined. Where nocturia dominates, limiting evening fluids, caffeine and alcohol helps. Men who also have erectile difficulty may benefit from tadalafil, which addresses both.

When Surgery Becomes the Answer

Surgery is considered when symptoms persist despite medication or side effects are intolerable, and whenever retention, recurrent infection, stones, bleeding or kidney back-pressure has appeared.

Almost all operations today are endoscopic, through the urethra, with no external incision:

HoLEP (holmium laser enucleation). The enlarged tissue is separated from its capsule in one piece and removed. Works at any prostate size, including 150-200 ml glands that would once have required open surgery. Low bleeding risk makes it one of the safest choices for men on blood thinners, and re-growth is very unlikely because the whole adenoma is taken out. Catheter usually comes out within 24-48 hours. The common trade-off is retrograde ejaculation.

Rezum (water vapour therapy). A few seconds of steam injected into the prostate shrink the tissue. Day-case, under local anaesthesia, with a high chance of preserving ejaculation. Suited to small and medium glands; the effect appears over weeks.

TUR-P. The long-established endoscopic method, cutting tissue piece by piece with electrical energy. Generally limited to prostates under 80 ml, with higher bleeding and re-growth rates than laser enucleation.

Robotic or laparoscopic simple prostatectomy. For very large glands where endoscopic enucleation is not suitable.

The right choice depends on prostate size, your age, medications, other conditions and how much weight you place on preserving ejaculation. This is a decision made together, not a ranking.

Planning Treatment from Abroad

Your uroflowmetry, ultrasound (prostate volume and residual urine) and PSA can be reviewed before you travel, so the recommended method and the length of stay are known in advance. HoLEP typically requires 4-5 days in Istanbul; the dedicated guide on that operation covers the stay and recovery day by day.

This article is for general information only and does not replace a medical consultation. Treatment decisions are made after an individual evaluation of your reports and examination.