Benign prostatic hyperplasia (BPH) is when the prostate and surrounding tissue expands. The prostate goes through two main growth periods as a man ages. The first is early in puberty, when the prostate doubles in size. The second begins around age 25 and continues during most of a man's life. As you age, your prostate may get larger. BPH is when it gets large enough to cause problems.

While the prostate is usually the size of a walnut or golf ball in adult men, it can grow to be as large as an orange. As the gland enlarges, it can squeeze the urethra. The bladder wall becomes thicker. Over time the bladder may weaken and lose the ability to empty fully. Urine then remains in the bladder. These problems cause many of the lower urinary tract symptoms (LUTS) of BPH. If you are not able to pass urine at all (called retention) or if you have renal failure, immediate attention is required. But, other symptoms like weak urine stream or the need to push or strain can many times be monitored.

BPH is benign. This means it is not cancer, nor does it lead to cancer. Urinary symptoms are almost never a sign of cancer. Still, BPH and cancer can happen at the same time. BPH itself may not require any treatment, but if it begins to cause symptoms, treatment may help. It is also of great value to know that BPH is common. About half of all men between ages 51 and 60 have BPH. Up to 90% of men over age 80 have it.

Surgery

Several different types of surgery can remove prostate tissue that blocks your urethra. These include:

• Transurethral resection of the prostate (TURP). Your urologist inserts a special instrument (resectoscope) through your urethra that allows them to see and remove prostate tissue.
• Transurethral incision of the prostate (TUIP). Your urologist makes two small incisions in your prostate and where your urethra and bladder join (bladder neck) to widen your urethra and improve urine flow.
• Transurethral electrovaporization. Your urologist uses an electrode to heat your prostate tissue. This turns the tissue cells in the enlarged areas of your prostate into steam.
• GreenLight™ laser. Your urologist uses a special laser to evaporate your enlarged prostate tissue.

After a surgical procedure, you should be able to resume normal activities within a few days or a week.

Minimally invasive treatments

New BPH treatments are less invasive and damaging to healthy tissue than surgery. In general, most of these treatments are outpatient procedures, which means you can go home the same day as the procedure. They’re also cheaper, have fewer side effects and allow for a faster recovery. However, because these techniques are new, there isn’t much information about their long-term effects or complications.

Examples of minimally invasive treatments include:

• Prostatic urethral lift. This procedure separates your enlarged prostate lobes to make your urethra wider, making it easier to pee. Your urologist inserts a special instrument (UroLift®) into your urethra and up to your prostate. When the UroLift reaches the side wall of your prostate, it ejects small implants that pull your prostate lobes apart and open your urethra. Your urologist may place two to six implants, depending on the size of your prostate.
• Water vapor therapy. Your urologist inserts an instrument into your urethra and moves it to your prostate. Your urologist then ejects a needle into your prostate. The needle emits steam vapor, which turns into water. The water’s thermal energy destroys your prostate cells. Your body reabsorbs the dead cells, and your prostate shrinks. Another name for this procedure is the Rezūm™ System.

The most common side effects of these treatments include peeing more than normal and discomfort or irritation while your prostate heals.

After a minimally invasive procedure, you should be able to return to your normal activities in a few days. You should see improvements in your symptoms within three to six weeks.