What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate that makes it harder to fully empty your bladder. This may mean getting up several times a night or having a weak urine stream. This common condition affects many people over 50 who are assigned male at birth. It happens when the prostate gland, which helps make fluid for semen, grows larger than normal. Because the prostate surrounds the tube that carries urine out of the body, growth of the gland can squeeze that tube and make it hard to empty your bladder. BPH is benign, meaning it’s not cancer, and it doesn’t increase your risk of developing prostate cancer.
BPH is typically treated by urologists and interventional radiologists. At Penn Medicine, our interventional radiology and urology specialists work together to recommend the least invasive and most effective treatment option for you. Many people are treated without surgery, but when procedures are needed, our experts offer advanced minimally invasive, robotic, and microsurgical techniques. We were the first in the region to offer prostate artery embolization, an innovative, nonsurgical approach that shrinks the prostate and relieves symptoms. These options support smaller incisions, faster recovery, and strong outcomes.
Urinary changes that may signal an enlarged prostate
While many people with an enlarged prostate have no symptoms at all, others find that the condition interferes with their sleep and daily activities. You might notice that your bathroom habits have changed over time.
Common symptoms include:
- A weak or slow urine stream
- Trouble starting urination
- Feeling like your bladder doesn’t fully empty
- Dribbling or leaking at the end of your stream
- Needing to urinate two or more times during the night
- A sudden, strong urge to go right away
What causes prostate enlargement?
The exact reason the prostate begins to grow isn’t fully known. It’s believed that shifts in hormone levels, like testosterone and estrogen, play a role. BPH is also closely linked to getting older. Most people assigned male at birth will have some prostate growth if they live long enough. It rarely causes issues before age 40, but most people over age 80 have some level of enlargement.
Certain health conditions can also play a part. You may be more likely to experience symptoms if you have a family history of BPH or live with conditions like obesity, diabetes, or heart disease. Sometimes, even common medications like decongestants can make your symptoms feel worse.
Diagnostic tests for benign prostatic hyperplasia
Diagnosis starts with a conversation about your symptoms and how they affect your life. Your provider may perform a physical exam, including a digital rectal exam to feel the size and shape of the gland. Urine and blood tests check for infection, kidney problems, or other causes of urinary issues. These tests can also measure your urine flow rate. A quick image scan can see if any urine stays in the bladder after you go.
Treatment options for BPH
Many people manage BPH with lifestyle changes or medications. These may include adjusting fluid intake, limiting caffeine, or taking medicines that relax the prostate or shrink it over time. Your care team will talk with you about your symptoms, daily routine, and preferences to help choose a treatment approach that fits your life.
The Urolift® System is a minimally invasive, outpatient treatment for BPH. It doesn’t remove or destroy prostate tissue. Instead, small permanent implants lift enlarged prostate tissue away from the urethra, allowing urine to flow more easily.
Because the procedure is done through the urethra, there are no incisions. Urolift also has a low risk of side effects, and many people notice symptom relief soon after treatment.
Prostate artery embolization (PAE) is a minimally invasive, nonsurgical treatment for BPH. During this outpatient procedure, doctors use imaging guidance to block blood flow to specific areas of the prostate. This causes the gland to shrink over time, easing urinary symptoms.
PAE often leads to a faster, less painful recovery than surgery and carries a lower risk of sexual or urinary side effects for many patients.
GreenLight™ Laser Therapy uses laser energy to remove excess prostate tissue through the urethra. The laser seals blood vessels as it works, which helps limit bleeding.
This minimally invasive procedure doesn’t require incisions or an overnight hospital stay. It’s usually done in an operating room using spinal anesthesia or general anesthesia. Most people notice improvement in symptoms soon after treatment.
Aquablation® uses a heat-free waterjet to remove excess prostate tissue with a high level of precision. This advanced BPH treatment combines robotic technology with real-time ultrasound imaging to guide the procedure.
Urologists perform Aquablation in an operating room under general anesthesia. The waterjet tool is inserted through the urethra, so no incisions are needed. Most people stay in the hospital overnight and go home the next day, often without a catheter.
Real-time imaging allows your surgeon to carefully map which tissue to remove while avoiding areas that affect sexual and urinary function. This precision lowers the risk of side effects like erectile dysfunction or urinary incontinence and provides strong relief from BPH symptoms. Penn Medicine is one of the few health systems in the area to offer this advanced therapy.
Transurethral resection of the prostate (TURP) is a surgical procedure that removes excess prostate tissue to improve urine flow. During the procedure, surgeons insert a thin instrument called a resectoscope through the urethra to reach the prostate. An electrical loop then trims away the extra tissue.
TURP is performed in an operating room using general or spinal anesthesia and has long been the standard surgical treatment for BPH.
A prostatectomy is used for severe cases of BPH when other treatments haven’t provided relief. This surgery removes part or all of the prostate gland to relieve blockage and improve urinary function.
Because this is a more involved procedure, recovery time is longer than with minimally invasive treatments. Your care team will explain what to expect before and after surgery and help you understand whether this option is right for you.
For severe prostate enlargement, Penn Medicine offers minimally invasive urologic surgery care, including robotic prostatectomy. Using robotic technology, surgeons can remove excess prostrate tissue through small incisions with greater precision. Compared with traditional open surgery, robotic prostatectomy often leads to less pain, shorter hospital stays, and faster recovery, while still providing effective symptom relief.