For many men, tablets and lifestyle changes control the symptoms of an enlarged prostate well. For others, symptoms continue or get worse. Deciding when to move on to a procedure is a personal choice, but there are some clear signs that it is worth discussing, and a few situations where it becomes important.
When symptoms still affect daily life
Surgery is mainly about quality of life. It may be time to consider it if:
- you still get up several times a night despite treatment
- urgency or frequency limits work, travel or social life
- your flow remains weak and slow
- your symptom score has stayed in the moderate or severe range
Our article on common BPH symptoms explains how the International Prostate Symptom Score measures this.
When medicines cause problems
Some men find the side effects of BPH tablets hard to live with, such as dizziness, tiredness or sexual side effects. Others would simply rather not take medicine for the rest of their lives. Both are reasonable reasons to discuss a procedure.
When the bladder is under strain
In some situations, treatment is recommended to protect the bladder and kidneys:
- Urinary retention: being unable to pass urine, either suddenly or gradually.
- Repeated urine infections: often linked to urine left in the bladder.
- Bladder stones: which can form when the bladder does not empty fully.
- Recurrent bleeding: from enlarged prostate blood vessels.
- Kidney problems: caused by back pressure from the bladder.
NICE guidance on urinary symptoms in men recommends offering surgery in these situations.
Why waiting too long can matter
The bladder is a muscle. When it has to push against a blocked outlet for many years, it can change:
- the wall may thicken and become more sensitive, causing urgency
- small pouches called diverticula can form
- eventually, the muscle may weaken and stop emptying well
If the bladder muscle becomes very weak, removing the blockage may not fully restore normal emptying. This is one reason not to put off assessment for too long when symptoms are significant. It does not mean every man needs surgery early, but it is worth having the bladder checked if symptoms are worsening.
Tests before deciding
Before a procedure, your urologist may recommend:
- a flow test and bladder scan
- a measurement of prostate size by ultrasound or MRI
- a cystoscopy to look inside the urethra and bladder
- urodynamic tests, if it is unclear whether the bladder muscle is working well
Our guide to how BPH is diagnosed explains each test.
The range of options
Surgery for an enlarged prostate now includes a wide range of procedures. Some remove tissue, some reshape the channel and some reduce blood supply to the gland. They differ in recovery time, how long the benefit lasts and their effect on ejaculation. Options include Aquablation therapy, iTind and prostate artery embolisation, as well as established operations such as TURP and laser treatment.
Questions to ask
When discussing a procedure, it may help to ask:
- Which options suit the size and shape of my prostate?
- What recovery time should I expect?
- How might it affect ejaculation and erections?
- How long is the benefit likely to last?
- What would happen if I waited?
The British Association of Urological Surgeons publishes patient information on each procedure.
Making the decision
There is rarely a need to decide quickly unless there is retention or another complication. Many men find it helpful to talk the options over with a partner or family member, and to come back with further questions before making a final choice. Take time to understand the options and how they fit your priorities.
Professor Prokar Dasgupta can assess your symptoms and bladder and talk through the procedures available at The London Clinic. Please contact the clinic to arrange a consultation.