Enlarged prostate (BPH): symptoms, treatments & procedures explained simply.

What is an enlarged prostate (BPH)?

The prostate is a small gland that sits below the bladder and surrounds the urethra — the tube that carries urine out of the body. From about the age of 40–50, the prostate naturally grows larger in most men. This non-cancerous growth is called benign prostatic hyperplasia (BPH).

As the gland enlarges, it can squeeze the urethra and irritate the bladder, which is why the symptoms are mostly about urination. BPH is extremely common — it affects roughly half of men over 50 and most men by their seventies. It is not cancer, and having BPH does not mean you will develop prostate cancer.

Common symptoms of an enlarged prostate.

• Weak or slow urine stream
• Frequent urination, especially at night (nocturia)
• Sudden, urgent need to pass urine
• Difficulty starting urination, or stopping and starting
• Dribbling at the end of urination
• Feeling that the bladder has not emptied fully

How BPH is diagnosed.

Diagnosis starts with a conversation about your symptoms (often using a simple symptom score) and an examination. Depending on your situation, your urologist may recommend:

• Urine test — to rule out infection or blood in urine
• PSA blood test — screens the prostate and helps assess cancer risk
• Ultrasound — measures prostate size and how much urine remains after passing urine
• Urine flow test (uroflowmetry) — measures the strength of your stream
• Cystoscopy (telescopic examination) — sometimes advised before a procedure, to look inside the urethra and prostate

These tests matter because the size and shape of your prostate largely decide which treatment options will work well for you.

Treatment options for BPH — from medicines to procedures.

There is no single "best" treatment for everyone. The right choice depends on your prostate size, how much the symptoms bother you, your age and health, and your personal priorities — for example, preserving ejaculation. Broadly, the options are:

• Medicines — alpha-blockers (relax the prostate and bladder neck) and 5-alpha-reductase inhibitors (slowly shrink the prostate). Often combined. They control symptoms but need to be taken long term.
• Ejaculation-preserving procedures — iTind and UroLift — modern, minimally invasive options for suitable prostates.
• Laser enucleation — HoLEP / ThuLEP — removes the obstructing tissue with a laser; works for prostates of any size.
• TURP — the long-established operation that removes obstructing tissue with an electric loop.

Dr. Sreeniketh Reddy offers the full range of these options at MEDICOVER Hospitals, Hitec City, and will walk you through which ones genuinely fit your prostate and your priorities.

What is UroLift?

UroLift (the prostatic urethral lift) is a day-care procedure in which tiny permanent implants are placed through a telescope passed through the urethra. The implants work like curtain tie-backs — they hold the enlarged prostate lobes away from the urethra so urine can flow freely.

• No prostate tissue is cut, heated or removed
• Designed to preserve ejaculation and erectile function
• Usually done as a day-care procedure; many men need no catheter or only a short one
• Most men return to normal routine within a few days

What is iTind?

iTind is a temporary implant made of nitinol (a flexible memory metal). It is placed inside the prostatic urethra through a telescope and left in place for about 5 to 7 days. During that time it gently expands and remodels the passage at the bladder neck and prostate. It is then removed completely — nothing permanent is left inside the body.

• No cutting and no permanent implant
• Designed to preserve ejaculation and erectile function
• Quick procedure, usually as day care
• Some temporary urgency or discomfort is common while the device is in place

What is TURP?

TURP (transurethral resection of the prostate) is the long-established operation for BPH, performed for decades and still one of the most effective treatments. Through a telescope passed via the urethra, the surgeon removes the obstructing prostate tissue using a thin electric loop. There are no cuts on the skin.

• Gives strong, durable improvement in urine flow
• Works well for moderate and larger prostates
• Discharge is usually in 2 days, with a catheter for about 2 days
• The most common lasting effect is retrograde ejaculation (see risks below)

What are HoLEP and ThuLEP?

HoLEP (holmium laser enucleation of the prostate) and ThuLEP (thulium laser enucleation) are advanced laser procedures. Instead of shaving tissue away, the laser is used to shell out the entire enlarged portion of the prostate, which is then removed through the bladder.

• Works for prostates of any size, including very large glands
• Very thorough removal — among the most durable results of any BPH procedure
• Less bleeding than traditional surgery; often suitable for men on blood thinners
• Discharge is usually in 2 days, with a catheter for about 2 days

How the procedures differ.

The procedure sections above explain how each one works. In brief: iTind and UroLift are the gentlest options and preserve ejaculation, while HoLEP/ThuLEP and TURP remove more tissue and give stronger, more durable improvement for larger prostates.

Who may be suitable for each option?

• Medicines — mild to moderate symptoms; most men try these first.
• iTind or UroLift — men with small to moderately enlarged prostates who want a quick recovery and wish to preserve ejaculation; also those keen to avoid or stop long-term medicines.
• TURP — moderate to severe symptoms, larger prostates, repeated retention, or when medicines have not helped enough.
• HoLEP / ThuLEP — large or very large prostates, men on blood-thinning medication, or those wanting the most durable one-time result.

Suitability can only be confirmed after measuring your prostate and, where needed, looking inside with a telescope — this is a routine part of the evaluation.

Recovery after BPH treatment.

• iTind / UroLift — day care; most men are back to routine activities within a few days. Temporary frequency or mild discomfort while healing is common.
• HoLEP / ThuLEP — discharge is usually in 2 days, with a catheter for about 2 days; most men resume normal routine in 1–2 weeks.
• TURP — discharge is usually in 2 days, with a catheter for about 2 days; full recovery over about 2–4 weeks.

After any prostate procedure it is normal to see some blood in the urine and feel frequency or burning for a short while. Drinking plenty of water and avoiding heavy lifting for a few weeks helps healing.

Risks and limitations — explained honestly.

• Retrograde ejaculation — common after TURP and laser enucleation. Orgasm feels normal, but semen passes backwards into the bladder instead of out. It does not affect erections or pleasure, but it does affect fertility. iTind and UroLift are specifically designed to avoid this.
• Retreatment — gentler procedures like iTind and UroLift give more moderate relief, and a small proportion of men may need another procedure some years later. TURP and HoLEP/ThuLEP remove more tissue and tend to be more durable.
• Temporary irritation — frequency, urgency or mild burning for days to weeks after any procedure.
• Uncommon risks — bleeding, infection, urethral stricture, or (rarely) leakage of urine. Your urologist will discuss how these apply to you personally.

Prostate care with Dr. Sreeniketh Reddy.

Dr. Sreeniketh Reddy

Consultant Urologist, Andrologist and Robotic Surgeon (M.S, M.Ch Urology; Fellowship in Advanced Laparoscopic, Robotic & Renal Transplant Surgery). His BPH practice covers the full range of options on this page — medicines, iTind, UroLift, TURP and laser procedures (HoLEP/ThuLEP) — at MEDICOVER Hospitals, Hitec City and LUX Hospitals, Gachibowli.

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Frequently asked questions.