Enlarged Prostate (BPH / Benign Prostatic Hyperplasia)

Your Enlarged Prostate Care Pathway

An enlarged prostate (BPH) is a common cause of urinary symptoms in men over 50.

The prostate is a small gland located just below the bladder and in front of the rectum. It surrounds the urethra (the tube that carries urine out of the bladder) and helps produce fluid that forms part of semen.

As the prostate enlarges, it can press on the urethra, restricting urine flow and causing bothersome symptoms.

Peter Gilling and Mark Fraundorfer pioneered what is now considered the gold-standard surgical treatment for these symptoms. Holmium Laser Enucleation of the Prostate (HoLEP) is now offered worldwide.

Symptoms

Common symptoms include:

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Weak or slow urine stream

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Difficulty starting urination

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Feeling the bladder is not empty

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Frequent urination (day or night)

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Sudden urgency

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Occasional leakage

These are known as lower urinary tract symptoms (LUTS) and are usually caused by BPH rather than prostate cancer. Specialist assessment is still important.

Diagnosis

Assessment may include:

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Symptom review

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Physical examination (including prostate)

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Urine flow testing

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Ultrasound (bladder and kidneys)

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Symptom questionnaires

These tests help determine severity and guide treatment.

Treatment Options

Treatment depends on symptom severity and impact on daily life.

Lifestyle & Monitoring

Mild symptoms may only require observation and simple adjustments.

Medication

Often first-line treatment. Medicines can:

  • Relax prostate and bladder muscles
  • Improve urine flow
  • Reduce obstruction
  • Sometimes shrink the prostate

Minimally Invasive Surgery

If symptoms persist, procedures may include:

Holmium Laser Enucleation of the Prostate (HoLEP) – A laser removes obstructing prostate tissue to restore urine flow. Benefits are:

  • Effective for small or large prostates
  • Long-lasting results
  • No external incisions
  • Short hospital stay

Bladder Neck Incision (BNI) – Small cuts are made at the bladder neck to improve flow. Often suitable for younger men or smaller prostates.

Recovery

After medication:

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Gradual improvement over weeks

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Ongoing follow-up

After surgery:

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Improved flow soon after

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Short hospital stay

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Return to normal activity within 1–2 weeks

When to See a Specialist

Seek advice if you experience:

  • Increasing difficulty passing urine
  • Frequent night urination
  • Urinary infections
  • Blood in urine
  • Sudden inability to urinate

Early treatment improves quality of life and prevents complications.

Frequent Urination at Night (Nocturia)

Waking multiple times at night to urinate is called nocturia. While common with ageing, it can disrupt sleep and often has treatable causes.

Common Causes

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Enlarged prostate (BPH)

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Bladder overactivity

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Excess urine production overnight

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Sleep disorders

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Medications

When It Suggests BPH

Nocturia often occurs alongside:

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Weak stream

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Difficulty starting urination

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Daytime frequency

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Incomplete emptying

Treatment

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Lifestyle changes

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Medication

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Treatment of underlying BPH (including procedures like HoLEP)

Weak Urine Stream in Men

A weak urine stream is a common symptom in men over 50, often due to prostate enlargement.

Associated Symptoms

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Difficulty starting urination

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Stop-start flow

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Prolonged emptying

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Dribbling

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Frequency

Diagnosis

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Symptom review

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Urine flow testing

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Ultrasound

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Prostate assessment

Treatment

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Medication

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Minimally invasive surgery (HoLEP or BNI) if symptoms persist

Difficulty Starting Urination (Urinary Hesitancy)

Urinary hesitancy is a common early sign of prostate enlargement.

Causes

Most commonly BPH, but may also include:

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Bladder muscle weakness

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Infection

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Medications

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Nerve-related conditions

Associated Symptoms

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Weak stream

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Stop-start urination

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Incomplete emptying

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Frequency and nocturia

When to See a Specialist

Seek advice if symptoms:

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Persist or worsen

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Affect sleep or daily life

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Cause discomfort or pain

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Include blood in urine

Diagnosis

Symptom review and history

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Physical examination

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Urine flow testing

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Ultrasound imaging

Treatment

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Medication – Improves flow by relaxing the prostate and bladder.

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Minimally invasive procedures

    • HoLEP (laser removal of tissue)
    • Bladder Neck Incision

These treatments relieve obstruction and restore urine flow.

Why Choose Urology BOP

Patients benefit from:

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Specialist assessment of sexual dysfunction in men and women

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Comprehensive testing for hormonal, vascular, neurological, and psychological factors

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Personalised treatment plans using medications, minimally invasive devices, hormone therapy, and counselling

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Long-term follow-up to monitor outcomes and maintain sexual health

Specialist Care

Urology Bay of Plenty provides expert diagnosis and treatment for prostate and urinary conditions, including advanced minimally invasive procedures.

If symptoms are affecting your quality of life, a urology consultation can help determine the best treatment.

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