Benign Prostatic Hyperplasia (BPH)

Understanding the disease is the first step toward effective treatment. BPH is the most common urological condition in men over 50, yet it remains highly undertreated.

Benign Prostatic Hyperplasia (BPH) is a non-cancerous, progressive enlargement of the prostate gland that compresses the urethra and gradually obstructs urinary flow. Although it is not life-threatening, its impact on quality of life is profound.

Prostate anatomy BPH obstruction

The Prostate and Urinary Obstruction

Normal Prostate

20–30 g in a young adult, located below the bladder, surrounding the urethra. It plays a role in seminal fluid production.

Progressive Enlargement

From age 40, male hormones trigger slow, continuous prostate growth. By age 60, 50% of men are affected; by age 85, 90%.

Urethral Compression

As the gland enlarges, it compresses the urethra, reducing urinary flow progressively. This mechanical obstruction generates a range of symptoms.

Obstructive and Irritative Symptoms

BPH produces two complementary categories of signs.

Obstructive Symptoms

  • Weak urinary stream
  • Hesitancy and delayed start
  • Straining to void
  • Prolonged urination time
  • Sensation of incomplete emptying
  • Post-void dribbling
  • Need to push or strain

Irritative Symptoms

  • Urinary urgency (sudden urge to void)
  • Urge incontinence
  • Frequent daytime urination (pollakiuria)
  • Nocturia (up to 4–5 times per night)
  • Incomplete bladder emptying
  • Pain or burning during urination
  • Altered sleep quality

Psychosocial Impact of Untreated BPH

Chronic Sleep Deprivation:

Repeated nocturia disrupts deep sleep, leading to fatigue and reduced cognitive performance.

Social and Professional Withdrawal:

Constant urge-to-void anxiety limits travel, professional activity, and social life.

Relationship Impact:

Fatigue and sexual disorders alter intimate relationships and self-esteem.

Medical Complications:

Untreated BPH can lead to acute urinary retention, recurrent infections, or renal insufficiency.

The Treatment Spectrum

The therapeutic strategy is tailored to symptom severity, patient profile, and individual preferences.

Step 1
Watchful Waiting

For mild symptoms (I-PSS ≤ 7). Lifestyle modification: limit evening fluids, reduce caffeine/alcohol, pelvic floor exercises, regular monitoring.

Step 2
Medical Treatment

Alpha-blockers (relaxes smooth muscle), 5-alpha-reductase inhibitors (reduces prostate volume). Effective short-term but requires ongoing use and has side effects.

Step 3
Rezūm Steam Therapy

Gold standard for moderate symptoms. Water vapor destroys obstructive tissue. 10 minutes, outpatient, no major surgery, preserves sexual function, durable.

Step 4
Surgical Resection (TURP / HoLEP)

Reserved for severe cases or very large prostates (>80 cc). Requires general anesthesia and hospitalization. Risk of retrograde ejaculation and erectile dysfunction.

Assess Your Symptoms Now

The International Prostate Symptom Score (I-PSS) is the international reference scale for evaluating urological symptoms and guiding treatment decisions.

This questionnaire is for informational purposes only and does not replace a medical consultation.

Have Questions About BPH?

Prof. Rabii and his team are available to advise you on the most suitable treatment for your situation.