What BPH is, and why symptoms do not always match size
The prostate surrounds the urethra, the tube that carries urine out of the body. When the prostate enlarges, the bladder has to push harder to empty, and over time it may not empty completely. Symptoms do not line up neatly with size: some men with a modest enlargement have significant symptoms, while others with a large prostate barely notice anything.
Signs and symptoms of BPH
- Frequent or urgent need to urinate
- Getting up more often at night (nocturia)
- Trouble starting the stream
- A weak stream, or one that stops and starts
- Dribbling at the end of urination
- Feeling the bladder has not fully emptied
- Urinary tract infections
- Blood in the urine or being unable to urinate (see the warning above)
Other things that can look like BPH
A careful evaluation matters because several conditions cause similar symptoms: a urinary tract infection, an inflamed prostate, narrowing of the urethra, bladder or kidney stones, prostate cancer, and some cold and allergy medicines. Bring a list of everything you take, including over-the-counter products. Decongestants, antihistamines, some diuretics, tranquilizers and antidepressants can worsen urinary symptoms.
Diagnosis usually combines your history and a physical exam, a digital rectal exam to feel the size and shape of the prostate, a urine test, and often a PSA blood test to help rule out prostate cancer. Ultrasound, a urine-flow study or a post-void residual measurement (how much urine is left after you go) may follow.
When to see a doctor
Talk with a doctor about urinary symptoms even if they do not seem very bothersome. Untreated BPH can lead to complications, including urinary retention, bladder infections, bladder stones, blood in the urine and, in more serious cases, kidney damage. Many men never reach that point, and monitoring can be a perfectly reasonable choice. The goal of an evaluation is to make it a deliberate one.
Everyday changes that can help
- Time your fluids. Avoid large drinks in the two to three hours before bed to cut nighttime trips. Do not restrict fluids so much that you become dehydrated.
- Ease bladder irritants. Caffeine and alcohol can increase urgency and frequency.
- Go on a schedule. Regular bathroom visits can keep the bladder from overfilling.
- Stay active. Regular exercise such as walking or swimming, and pelvic floor (Kegel) exercises, may help bladder control.
- Eat well and manage stress. A balanced diet and stress-reduction habits can support overall urinary comfort.
Medicines for an enlarged prostate
Medicines are the foundation of BPH care for many men. Alpha blockers relax the muscle at the bladder neck and prostate so urine flows more easily. 5-alpha reductase inhibitors work more slowly to shrink the gland or slow its growth, and some men take both. Other medicines are sometimes added. All can have side effects, from minor to significant, so the choice depends on your symptoms, prostate size and overall health, with regular follow-up to adjust the plan.
Procedures, matched to prostate size
When medicines are not enough, or are not tolerated, there are procedures. Advanced Urology groups its options by prostate size, which is measured with imaging. The size ranges are examples, not rules: the choice is individual, each option has trade-offs, and your doctor will explain which fit you. No procedure is right for everyone, and the possible risks are listed below each one.
Smaller prostates (typically under about 40 cc)
UroLift
Small implants lift and hold prostate tissue out of the way to relieve the blockage, without cutting, heating or removing tissue.
Benefits: Quick recovery, and no cutting, heating or removal of tissue. Sexual side effects are uncommon but possible, so ask about them.
Risks: Temporary urinary discomfort; rarely bleeding or infection; additional treatment may be needed over time.
Done as an outpatient procedure. A catheter is usually not needed.
Prostate artery embolization (PAE)
Tiny particles are injected into the arteries that supply the prostate to reduce blood flow and size, through a small puncture in the wrist or groin. Results can take weeks to months, and an interventional radiologist performs it.
Benefits: Non-surgical, minimal downtime, and no general anesthesia.
Risks: Mild pain or bruising at the puncture site; rarely, particles reach non-target areas, or urinary retention.
Outpatient. A catheter is usually not needed.
Medium prostates (about 40 to 80 cc)
Aquablation
A robotic, high-velocity water jet removes prostate tissue under ultrasound guidance.
Benefits: Precise, uniform tissue removal and a shorter operating time than traditional surgery.
Risks: Temporary bleeding or urinary retention; rarely, urethral stricture or sexual side effects.
Hospital, with an overnight stay for monitoring. A catheter for a few days.
Transurethral resection of the prostate (TURP)
A heated loop removes prostate tissue through the urethra to improve flow. It is the long-established surgical option.
Benefits: Well studied, with long-term effectiveness.
Risks: Temporary bleeding or urinary discomfort; a risk of erectile dysfunction and urinary incontinence; possible retrograde ejaculation (semen flows back into the bladder).
Outpatient surgery center. A catheter for one to three days.
Larger prostates (over about 80 cc)
Holmium laser enucleation (HoLEP)
A laser separates prostate tissue, which is then removed through the urethra.
Benefits: Effective for very large glands, with long-lasting results and little bleeding.
Risks: Temporary bleeding or urinary retention; retrograde ejaculation.
Hospital, with a one-night stay. A catheter for one to three days.
Robotic simple prostatectomy
Robot-assisted removal of the inner prostate tissue that is causing the blockage.
Benefits: Suitable for very large prostates, with long-term symptom relief.
Risks: Bleeding or infection; temporary urinary incontinence; retrograde ejaculation.
Hospital. A catheter for about a week.
Prostate artery embolization can also be considered for larger glands. Which options are offered by which physician, and where, varies, so ask the Snellville office what is available for you.
Common questions
Does BPH mean I have prostate cancer?
No. BPH is not cancer, but the two can cause similar urinary symptoms and can occur together. That overlap is why an exam and a PSA discussion are part of a good evaluation.
What happens if BPH goes untreated?
Many men live comfortably with mild BPH. If it is left unchecked it can cause urinary retention, infections, bladder stones, blood in the urine and, in severe cases, kidney damage. Seek emergency care if you cannot urinate.
Is prostate treatment the same as prostate cancer treatment?
No. This guide is about benign enlargement. Prostate cancer is a separate diagnosis with its own evaluation, which can include a PSA test and biopsy, and its own treatment choices. If cancer is a concern, say so at your visit.
Will treatment affect sexual function?
It can. Some medicines and procedures carry sexual side effects, such as retrograde ejaculation or erectile dysfunction, and others are designed to preserve sexual function. Ask for the specific risks of each option before choosing.
How do I find a BPH specialist near Snellville or in Gwinnett County?
A urologist treats BPH. Dr. Patel sees patients with enlarged prostate at Advanced Urology’s Snellville office on Janmar Road in Gwinnett County. See the office page for how to schedule.
Advanced Urology resources
- BPH care at Advanced Urology: Advanced Urology’s overview of this condition and its care team.
- UroLift at Advanced Urology
- Aquablation at Advanced Urology
This page is general information and may not apply to your situation. Talk with your doctor about what is right for you.