BPH (Enlarged Prostate)
Benign prostatic hyperplasia affects the majority of men as they age. Dr. Radtke offers a full range of treatment options—from medications and office-based procedures to advanced robotic surgery—tailored to the size of your prostate and the severity of your symptoms.
Request a ConsultationWhat Is BPH?
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland. The prostate sits just below the bladder and surrounds the urethra—the tube that carries urine out of the body. As the prostate grows, it can squeeze the urethra and obstruct the flow of urine, leading to bothersome urinary symptoms that affect daily life, sleep, and overall well-being.
BPH is not prostate cancer and does not increase your risk of developing cancer. However, the two conditions can coexist, which is why proper evaluation is important.
How Common Is BPH?
BPH is one of the most common conditions affecting older men. Its prevalence increases steadily with age:
- About 50–60% of men in their 60s have evidence of BPH
- By age 70 and older, 80–90% of men are affected
- Roughly one in four men in their 50s, one in three in their 60s, and one in two men over 80 will experience clinical symptoms requiring evaluation or treatment
Risk factors include advancing age, family history, obesity, type 2 diabetes, and a sedentary lifestyle.
Symptoms (Lower Urinary Tract Symptoms)
BPH causes a group of symptoms known as lower urinary tract symptoms (LUTS). These develop gradually and often worsen over time:
- Frequent urination — needing to urinate more often than usual, especially during the day
- Urgency — a sudden, strong need to urinate that is difficult to delay
- Nocturia — waking up two or more times per night to urinate, disrupting sleep
- Weak or slow urinary stream — reduced force of urine flow
- Hesitancy — difficulty getting the stream started, even when the urge is strong
- Intermittent stream — a stream that stops and starts during urination
- Incomplete emptying — feeling that the bladder has not fully emptied after urinating
- Straining — needing to push or bear down to begin or maintain urination
If left untreated, BPH can lead to complications including urinary tract infections, bladder stones, urinary retention (complete inability to urinate), and in some cases, kidney damage from chronic back-pressure on the kidneys.
How Is BPH Diagnosed?
Dr. Radtke uses a combination of tests to evaluate the severity of your symptoms, measure your prostate size, and rule out other conditions:
- Symptom questionnaire (IPSS/AUA-SI) — a standardized scoring tool that quantifies the severity of your urinary symptoms and helps track improvement after treatment
- Digital rectal exam (DRE) — a brief physical exam that allows the doctor to feel the size, shape, and consistency of the prostate and check for any abnormalities
- PSA blood test — prostate-specific antigen levels help estimate prostate size and rule out prostate cancer. Men with larger prostates tend to have slightly higher PSA levels
- Uroflowmetry — a simple, noninvasive test that measures the speed and volume of your urine stream. A maximum flow rate (Qmax) below 15 mL/s may suggest obstruction
- Post-void residual (PVR) — an ultrasound measurement of urine remaining in the bladder after urination. A high PVR (over 200–300 mL) can indicate that the bladder is not emptying effectively
- Cystoscopy — a thin, flexible camera is inserted through the urethra to directly visualize the prostate and bladder. This is typically performed in the office before planning surgery and helps guide the choice of procedure
Not every patient needs every test. The evaluation is tailored to your symptoms and helps Dr. Radtke recommend the most appropriate treatment.
Medications for BPH
For men with mild to moderate symptoms, medications are usually the first step. They can provide meaningful relief, though they do not cure BPH and symptoms may progress over time.
Alpha Blockers
Medications such as tamsulosin (Flomax), silodosin (Rapaflo), and alfuzosin (Uroxatral) relax the smooth muscle in the prostate and bladder neck, improving urine flow within days to weeks. They do not shrink the prostate. Possible side effects include dizziness, low blood pressure, and abnormal ejaculation.
5-Alpha Reductase Inhibitors
Finasteride (Proscar) and dutasteride (Avodart) block the conversion of testosterone to DHT, a hormone that drives prostate growth. These medications can actually shrink the prostate by 20–30% over 6–12 months, and are most effective for men with larger prostates. Potential side effects include decreased libido, erectile dysfunction, and reduced ejaculate volume.
Combination Therapy
For men with moderate to severe symptoms and a larger prostate, combining an alpha blocker with a 5-alpha reductase inhibitor provides greater symptom relief and a reduced risk of disease progression compared to either medication alone. This approach is supported by major clinical trials.
When Medications Are Not Enough
While many men do well on medications, some continue to have bothersome symptoms, experience side effects they cannot tolerate, or simply prefer a more definitive solution. A significant number of men are poorly compliant with long-term daily medication. When medications are no longer meeting your needs, it may be time to consider a procedure.
Treatment Options by Prostate Size
Dr. Radtke matches the right procedure to your prostate size, anatomy, and goals. Below are the options from least invasive to most extensive.
Rezūm (Water Vapor Therapy)
Rezūm is an office-based procedure that uses steam (water vapor) to destroy excess prostate tissue. The treatment takes approximately 5–10 minutes, requires only local anesthesia, and allows most men to return to normal activities within a few days. Clinical studies show that 95.6% of Rezūm patients do not need any additional surgical intervention at 5 years. Rezūm is particularly appealing for men who want to preserve sexual function, as it has minimal impact on erections and ejaculation. Best suited for small to medium-sized prostates (30–80 g).
TURP (Transurethral Resection of the Prostate)
TURP has been the gold-standard surgical treatment for BPH for decades, with approximately 150,000 procedures performed each year in the United States. A scope is passed through the urethra, and an electrified wire loop is used to remove obstructing prostate tissue—no skin incisions are needed. TURP provides rapid, significant improvement in urine flow and symptoms. It is best suited for medium-sized prostates (30–80 g). Most men stay in the hospital overnight. Retrograde ejaculation (dry orgasm) is common after TURP but is not harmful. Retreatment rates are approximately 10–15% over 10 years.
HoLEP (Holmium Laser Enucleation of the Prostate)
HoLEP uses a holmium laser to separate and remove the obstructing prostate tissue from the inside, similar to scooping out the flesh of an orange. The tissue is then morcellated (broken into small pieces) and removed through the urethra. HoLEP is effective for medium to large prostates (40–150+ g) and offers excellent long-term durability, with retreatment rates below 2% over 10 years—significantly lower than TURP. Most patients go home the same day or the following morning.
Robotic Simple Prostatectomy
For men with very large prostates (typically greater than 80–100 g), robotic simple prostatectomy offers a minimally invasive approach to removing the obstructing tissue through several small incisions. This transforms what was traditionally a major open operation into a procedure with less blood loss, shorter hospital stays (typically 1–2 days), and faster recovery. The robotic approach provides the surgeon with magnified 3D visualization and precise instrument control. It also allows simultaneous treatment of associated conditions such as bladder stones and bladder diverticula. Risk of urinary incontinence is minimal, and outcomes are excellent. Learn more about robotic simple prostatectomy →
When Is Surgery Recommended?
Most men begin with medications, and many find adequate relief. However, surgery or a procedural intervention is recommended when:
- Medications fail to provide adequate relief or symptoms worsen despite treatment
- Side effects of medications are bothersome or intolerable
- Urinary retention — complete inability to urinate, requiring a catheter
- Recurrent urinary tract infections caused by incomplete bladder emptying
- Bladder stones that develop due to chronic obstruction
- Recurrent blood in the urine (hematuria) from the enlarged prostate
- Kidney damage from prolonged back-pressure on the kidneys (renal insufficiency)
- Patient preference — some men prefer a definitive procedural solution rather than taking daily medication long-term
Research suggests that delaying surgery for years while symptoms worsen may lead to less favorable outcomes, as the bladder can lose its ability to contract effectively over time. If you are not getting adequate relief from medications, a timely evaluation for procedural options is worthwhile.
Dr. Radtke will review your symptoms, test results, and prostate size to recommend the option that best fits your situation. The goal is always to restore comfortable, complete urination and protect your long-term bladder and kidney health.
Discuss Your Options
Schedule a consultation with Dr. Radtke to find the right BPH treatment for you.
Schedule an Appointment
Dr. Radtke sees patients through Prevea Health. You can book an appointment online or call our office directly.
Clinic Information
(920) 458-6664
Monday – Friday: 8:00 AM – 5:00 PM
Saturday – Sunday: Closed