The prostate sits directly below the bladder and surrounds the first section of the urethra. It produces part of the seminal fluid and so plays a role in reproduction. In young men it's roughly the size of a chestnut; with increasing age it continues to grow in many men. This growth is usually benign and is one of the most common age-related changes in men – benign prostate enlargement is not prostate cancer. Because similar symptoms can also have other causes, a careful urological assessment remains important.
When the growing prostate narrows the urethra
Because the urethra runs straight through the middle of the prostate, growing prostate tissue can obstruct the flow of urine. The bladder then has to work harder to push urine through the narrowed urethra. At first it can often compensate; over time, however, symptoms when urinating, incomplete bladder emptying, or a growing strain on the bladder can develop. This is referred to as benign prostatic syndrome.
Typical symptoms
Benign prostate enlargement can present in different ways:
- a weak or interrupted urine stream
- delayed onset of urination
- needing to strain while urinating
- a feeling of incomplete bladder emptying
- frequent urination during the day or at night
- a sudden, hard-to-suppress urge to urinate
- dribbling after urination
The severity of symptoms doesn't depend on prostate size alone: a large prostate doesn't always cause severe symptoms – and a smaller prostate can also significantly obstruct urine flow.
Our diagnostics
We investigate where your symptoms are coming from, how well the bladder empties, and whether the bladder or kidneys have already been affected. Depending on the situation, this includes:
- a detailed medical discussion
- a standardised symptom questionnaire (IPSS)
- a urine test
- an ultrasound of the kidneys, bladder and prostate
- measuring the post-void residual urine
- measuring the urine flow via uroflowmetry
- PSA testing after individual discussion
- if needed, cystoscopy or further functional testing
Based on this, we assess whether treatment is necessary and which option suits you best.
Not every enlarged prostate needs treatment
For mild, mildly bothersome symptoms, regular check-ups and simple everyday adjustments may be enough at first, for example:
- spreading your fluid intake sensibly across the day
- drinking less in the evening, unless there's a medical reason not to
- reducing alcohol and caffeinated drinks if urgency is increased
- emptying the bladder fully, without rushing
- reviewing medications that can affect urination
Treatment is particularly recommended when symptoms affect quality of life, the bladder is no longer emptying adequately, or complications occur.
Medication
Depending on your symptoms and prostate size, various medications are available. They can:
- relax the bladder outlet and make urination easier
- slow the growth of an enlarged prostate
- treat an overactive bladder and strong urinary urgency
- simultaneously improve any coexisting erectile difficulties
Which treatment is suitable depends on your symptoms, prostate size, any coexisting conditions, and your personal priorities. We discuss the expected effect and possible side effects with you in detail.
When is a procedure worthwhile?
A procedure may be considered when medication doesn't help sufficiently, isn't tolerated, or long-term use isn't desired. Surgical treatment may in particular become necessary for:
- repeated or persistent urinary retention
- recurrent urinary tract infections
- bladder stones
- repeated bleeding from the prostate
- increasing damage to the bladder or kidneys
Several proven and modern techniques are available for treatment.
Rezūm™ – gentle water vapour therapy
During Rezūm treatment, controlled water vapour is delivered into the enlarged prostate tissue via the urethra. The treated tissue gradually shrinks over the following weeks, relieving pressure on the urethra and making urination easier. No external skin incision is required.
Advantages:
- minimally invasive technique
- short treatment time
- treatment of a median lobe is possible
- erection and ejaculation are preserved in most cases
- usually a quick return to everyday activities
The effect isn't immediate but develops over several weeks. Temporarily, burning on urination, increased urgency, or slight traces of blood in the urine can occur; a bladder catheter is often needed for a few days. Rezūm is particularly suitable for men for whom a gentle treatment and preserving ejaculation as far as possible matter. Whether the technique suits the individual shape and size of your prostate is assessed during the preliminary examination.
TURP – the well-established standard technique
In transurethral resection of the prostate (TURP), the obstructing prostate tissue is removed using an endoscopic instrument passed through the urethra. Here too, no external skin incision is required. TURP usually achieves a rapid, marked improvement in urine flow; established for decades, it offers very reliable long-term results.
After the procedure, seminal fluid often flows backwards into the bladder and is later passed with the urine – this is known as retrograde ejaculation. Erection and orgasm generally remain possible, but the visible ejaculate may be absent.
Which technique suits me?
There isn't a single best procedure for every man. When choosing, we consider in particular:
- the nature and severity of your symptoms
- the size and shape of the prostate
- the degree of outflow obstruction and any residual urine present
- coexisting conditions and blood-thinning medication
- how important preserving ejaculation is to you
- the desired strength and speed of effect
- recovery time and long-term effectiveness
Gentler techniques such as Rezūm more often preserve ejaculatory function and allow a quick return to everyday activities. Classic surgical techniques such as TURP often provide stronger, more immediate relief and have a particularly long track record.
Deciding together
We explain your findings and the advantages and disadvantages of the suitable treatment options clearly and openly. We then decide together which therapy makes the most medical sense and best fits your personal needs and expectations. For the surgical techniques we offer, we work closely with Lucerne Cantonal Hospital.