My waterworks are making me miserable - how to treat my enlarged prostate

Prostate enlargement is a common problem for men as they age. We give the diagnosis of Benign Prostatic Hyperplasia to men with an enlarged prostate. The cause of BPH is not completely understood but it is a combination of age related enlargement, hormonal imbalance (increased testosterone (T) and dihydrotestosterone (DHT) within the prostate) and increased enzymes and receptors within the prostate that help T and DHT to stimulate prostate growth.

BPH can make men very unhappy with their activities of daily living as it causes slow flow of urination, increased frequency, increased urgency, straining to empty the bladder and getting up at night. Most patients with BPH only suffer mild symptoms however on the extreme end of the scale BPH can cause bladder and kidney failure which has detrimental long term effects

Our job as a Urologist is to get you ‘peeing’ freely, protecting and preserving your kidneys and bladder and maximising your sexual function.

The first step to managing enlarged prostate is lifestyle changes

  • Avoid fluids which aggravate your waterworks (caffeine, alcohol) especially in the evening which stimulates your bladder to work overnight

  • Healthy diet and regular exercise

    • I often tell my patients “Heart healthy is prostate healthy”

  • Bladder re-training

    • Regular timed toilet stops to help retrain your bladder and avoid over-distension

    • Distraction techniques (penile squeezing, breathing exercises, perineal pressure)

    • Practising “hold on” between toilet stops

  • Encourage double voiding - When you have finish urinating push again to ensure complete bladder emptying

  • Avoiding any medications that can worsen symptoms

The second step to managing enlarged prostate is medications

  • Alpha-blockers (eg Tamsulosin) are the first line in treatment 

  • 5 Alpha Reductase Inhibitors (5ARI) (eg. Finasteride or Dutasteride) can help if the prostate volume is >40gms

  • Medications to reduce bladder overactivity

  • Phosphodiesterase Type 5 Inhibitors

    • These medications have been found to improve sexual function and voiding symptoms

  • Combination therapy of any of the above

If lifestyle changes or medications do not lead to considerable improvement then surgery is often recommended

There are many treatments options for BPH. The best choice is dependent upon patient preference, patient medical problems, prostate size and any other secondary pathology present.

I offer the following treatments

  • Urolift

  • TURP

  • Greenlight laser prostatectomy

  • HoLEP

  • Aquablation

  • Robotic Simple Prostatectomy

Enlarged ProstateMatthew Winter