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What Is Benign Prostatic Enlargement?
Benign prostatic enlargement (Benign Prostatic Hyperplasia – BPH) is the non-cancerous growth of the prostate gland that occurs with aging. It begins in the majority of men after the age of 40, and its prevalence increases as age advances.
Because the prostate surrounds the urethra, when it enlarges it compresses the urinary channel and causes various urinary symptoms. BPH is not cancer; however, if left untreated, it can significantly reduce quality of life and may affect the bladder and kidneys.
What Symptoms Can Benign Prostatic Enlargement Cause?
BPH symptoms usually develop gradually and worsen over time.
The most common symptoms are:
Frequent urination
Waking up at night to urinate (nocturia)
Difficulty urinating
Weak and intermittent urine stream
Delay in starting urination
Feeling of incomplete bladder emptying
Sudden urgency to urinate
Urinary incontinence (in advanced stages)
These symptoms are medically referred to as “lower urinary tract symptoms (LUTS).”
Does Benign Prostatic Enlargement Cause Pain?
BPH usually does not cause pain. However, in advanced stages or when urinary retention develops, pain may occur in the following areas:
Lower abdomen (due to bladder fullness)
Groin area
Lower back (if the kidneys are affected)
Around the testicles (referred pain)
Severe pain generally suggests the presence of prostatitis or a urinary tract infection.
What Causes Benign Prostatic Enlargement?
The main cause of BPH is aging and hormonal changes.
Risk factors include:
Being a man over 40
Genetic predisposition
Obesity
Sedentary lifestyle
Diabetes and metabolic syndrome
Changes in the testosterone–estrogen balance
BPH develops as a result of continuous stimulation of prostate cells by male hormones.
Does Benign Prostatic Enlargement Affect Sexual Life?
Yes, both the condition itself and some treatments may affect sexual life.
Effects of the condition:
Erectile dysfunction
Difficulty during ejaculation
Decreased sexual desire
Effects of medications:
Alpha blockers: Retrograde ejaculation
Finasteride: Decreased libido
Effects of surgery:
Erectile function is generally preserved
Ejaculation is often retrograde (dry orgasm)
In other words, BPH does not completely end sexual life, but it may cause certain changes.
Treatment of Benign Prostatic Enlargement
Treatment selection is based on the following factors:
Severity of symptoms
Size of the prostate
Amount of residual urine in the bladder
Patient’s age and expectations
1. Observation (Mild cases)
If symptoms are minimal, monitoring alone may be sufficient.
2. Medical Treatment
The first group of medications relaxes the prostate area. Alpha blockers such as Tamsulosin and Alfuzosin act quickly and improve urine flow.
The second group consists of 5-alpha reductase inhibitors. Finasteride and Dutasteride help reduce prostate volume and are especially preferred in patients with larger prostates.
3. Combination Therapy
(The two medications above can be given together. The goal is to provide short-term symptom relief while achieving long-term prostate shrinkage.) It is the most effective approach in moderate to advanced cases.
Surgical Treatment Methods for Benign Prostatic Enlargement
Surgical treatment is recommended in the following situations:
Persistent symptoms despite medication
Urinary retention requiring catheterization more than twice
Bladder stones
Kidney dysfunction
Recurrent urinary tract infections
Bleeding
A. Minimally Invasive Procedures (New Generation)
The aim here is to use less traumatic methods.
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Rezum (Water Vapor Therapy)
Prostate tissue is reduced using steam.
Advantages:
Does not require general anesthesia
Sexual function is preserved
Disadvantages:
Limited effectiveness
Insufficient for large prostates
2. Urolift (Prostatic Lift System)
Prostate tissue is pulled aside.
Advantages:
Ejaculation is preserved
Fast recovery
Disadvantages:
High chance of recurrence
Not suitable for prostates over 80 grams
B. Surgical Treatment (BPH)
1. Open Prostatectomy:
Removal of the prostate through an incision in the lower abdomen. It is an effective method for large prostates.
2. TUR-P (Transurethral Resection of the Prostate)
The classic gold standard.
Suitable for medium-sized prostates
Excellent long-term results
Risk of bleeding present
3. HoLEP / ThuLEP
A method increasingly used in recent years.
Suitable for prostates between 40 g and 300 g
Less bleeding
Frequently Asked Questions About Benign Prostatic Enlargement
Does BPH turn into cancer?
No. BPH is not cancer and does not turn into cancer.
Does PSA increase?
Yes, PSA levels may increase as the prostate enlarges.
Does it recur after surgery?
Yes, recurrence is possible.
Do herbal treatments work?
They may be supportive in mild cases but are not sufficient alone.
What happens if it is not treated?
Bladder dysfunction, kidney damage, and permanent urinary problems may develop.
Symptoms of Benign Prostatic Enlargement
Symptoms of benign prostatic enlargement usually develop gradually.
The most common complaints include:
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Frequent urination during the day
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Waking up at night to urinate
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Difficulty starting urination
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Weak urine stream
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Intermittent urine flow
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Feeling that there is still urine left after leaving the toilet
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Sudden urgency to urinate
These symptoms are often perceived as a “normal sign of aging,” but in most cases they are actually related to prostate enlargement.
Where Does Benign Prostatic Enlargement Cause Pain?
Benign prostatic enlargement usually does not cause pain. It mainly leads to urinary problems.
However, in advanced stages, the following may occur:
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A feeling of fullness and pressure in the lower abdomen
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Discomfort in the groin area
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Pain in the lower back
Severe pain generally suggests prostatitis (prostate inflammation) or a urinary tract infection.
What Causes Benign Prostatic Enlargement?
The most important cause of benign prostatic enlargement is aging. As men get older, prostate cells continue to grow under the influence of male hormones.
Risk factors include:
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Being over 40 years old
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A family history of prostate disease
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Excess weight
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Sedentary lifestyle
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Diabetes
In short, BPH is considered a natural part of the aging process in men.
Does Benign Prostatic Enlargement Affect Sexuality?
Yes, in some patients sexual life may be affected.
The condition itself may cause erectile dysfunction and decreased sexual desire. The medications used for treatment may lead to retrograde ejaculation (dry orgasm) or reduced libido.
After surgery, erectile function is generally preserved; however, ejaculation is often reduced or becomes retrograde.
It should be clearly stated that benign prostatic enlargement does not end sexual life.
Treatment of Benign Prostatic Enlargement
Treatment is selected according to the patient’s symptoms. Not every patient requires immediate surgery.
1. Observation
If symptoms are mild, monitoring alone may be sufficient.
2. Medical Treatment
The most commonly used medications are:
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Medications that relax urination (alpha blockers)
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Medications that shrink the prostate (finasteride, dutasteride)
In many patients, medications significantly reduce symptoms.
Surgical Treatment Methods for Benign Prostatic Enlargement
If medications are not sufficient, surgical treatment may be considered.
Surgery is recommended in the following cases:
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Inability to urinate
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Frequent urinary tract infections
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Bladder stones
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Impaired kidney function
TUR-P (Transurethral Resection of the Prostate)
The most classic method. The inner part of the prostate is removed through the urinary channel.
HoLEP (Laser Prostate Surgery)
A next-generation laser technique.
Advantages:
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Very minimal bleeding
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Can be performed even in very large prostates
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Permanent solution in a single session
GreenLight Laser
Suitable for patients who use blood thinners.
Rezum – Urolift
Modern methods used in milder cases.
Frequently Asked Questions About Benign Prostatic Enlargement
Does BPH turn into cancer?
No. It does not turn into cancer.
Does PSA increase?
Yes, PSA levels may rise as the prostate enlarges.
Does it recur after surgery?
Recurrence after laser surgery is very rare.
Do herbal products work?
They may be supportive in mild cases but are not sufficient alone.
What happens if it is not treated?
Bladder dysfunction and kidney damage may develop.
