Prostate Enlargement – A Specialist's Insight

Prostate enlargement, often referred to as BPH (Benign Prostatic Hyperplasia) , is common affecting over 50% of men aged over 50 and 90% of men over 80. It is a non-cancerous (benign) condition and is not to be confused with Prostate Cancer.

As the prostate tissue grows, gradual obstruction of the urethra can occur leading to a reduction in the flow of urine. As a result, the bladder has to work hard to empty, over time making the wall thickened and less capable of storing urine. This leads to a number of symptoms, one of the most common is getting up at night to urinate.

Enlarged Prostate

What are the common symptoms that can be caused by BPH?

  • Need to urinate frequently
  • Urgency to get to the toilet
  • Need to urinate during sleep hours
  • Slow or weak urinary stream
  • Urinary stream that stops and starts
  • Difficulty initiating the stream
  • A sensation of the bladder not emptying
  • Needing to strain to get the urine to flow

How can urinary tract symptoms effect your quality of life?

  • Lack of sleep
  • Need to restrict or limit fluid intake
  • Embarrassment due to toilet habits
  • Fear of travel/social activities
  • Difficulty with sexual intimacy

How do I know if I have prostate enlargement ?

If you feel like these symptoms sound familiar, you can go online and complete the International Prostate Symptom Score (IPSS), this can be found in many websites including Take this to your GP to have a discussion. Following a history and examination, the GP may feel your symptoms require a consultation with a Urologist.

What are the treatment options?

Treatment starts with simple measures and then can progress to medications, minimally invasive procedures or even surgical procedures.

  • Watchful waiting – Your symptoms are mild and you can put up with them for now.
  • Lifestyle / Behavioural modification – For some reducing fluid intake in the evening will reduce the number of night time episodes, for others eliminating caffeine from the diet will reduce frequency.
  • Bladder training / Pelvic floor Physiotherapy
  • Medications- These are aimed at either relaxing the smooth muscle in the prostate or physically shrinking the prostate over time. If you are started on prostate medications, they can be effective for many years in treating symptoms but need to be taken long term. Like most medications, they have side effects and should only be started after a consultation with a Urologist.
  • Minimally invasive procedures- The REZUM procedure which is a water vapour therapy is now being performed at St Vincent’s Private Hospital. This day-only procedure, performed under anaesthesia, involves injections of steam into the prostate, causing gradual shrinkage of prostate tissue (over 1-3 months) and reduction in symptoms. It carries very little risk of bleeding so that it may be performed on blood thinning medication.
  • Surgical procedures- These remain the gold standard and include the most commonly performed Trans Urethral Resection of Prostate (TURP). The goal of these procedures is to remove prostate tissue internally making an open channel for urinating. This can also be done with laser energy both Greenlight and Holmium. These procedures require 2-3 nights in hospital and full recovery takes 4-6 weeks.

Please note that symptoms of BPH are common among aging men. Have a conversation with your GP and find the right approach to treatment for you.

Dr Richard Savdie

Dr Richard Savdie, Urologist
Level 9, 
Suite 905
St Vincent's Clinic
438 Victoria Street
Darlinghurst NSW 2010
P: (02) 8382 6959
F: (02) 8004 8116