Why Many Men Ignore Urinary Problems for Too Long

The prostate is a gland about the size of a chestnut that lies below the bladder and surrounds the urethra. It produces part of the seminal fluid and plays an important role in fertility. As men age, the prostate tissue continues to grow slowly in many men. Doctors refer to this as benign prostatic hyperplasia (BPH). This is not cancer, but rather a benign enlargement of the prostate.

The growing tissue exerts increasing pressure on the urethra, preventing urine from flowing freely out of the bladder. 

Symptoms often develop gradually over several years. While they may be barely noticeable at first, they can significantly interfere with daily life over time.

Typical symptoms include:

• frequent urge to urinate
• nocturia
• weak urine stream
• delayed onset of urination
• Straining during urination
• Dribbling
• Feeling of an incompletely emptied bladder
• Sudden, strong urge to urinate

In advanced stages, complete urinary retention may occur—the bladder can no longer be emptied despite a strong urge to urinate. This condition constitutes a urological emergency and must be treated immediately.

The evaluation begins with a detailed discussion of the symptoms. This is followed by a physical examination, during which the prostate is palpated through the rectum. These examinations not only help assess the extent of the prostate enlargement but also rule out other causes of the symptoms—such as bladder stones or prostate cancer.

The following tests are often used as supplements:

• Ultrasound of the prostate and bladder
• Urine flow measurement (uroflowmetry)
• Measurement of residual urine
• Urinalysis
• Blood tests, including PSA levels when clinically indicated 

Surgery is often not necessary for mild to moderate symptoms. However, various medications can significantly improve symptoms. Alpha-blockers relax the muscles around the prostate and the bladder neck, allowing urine to flow more easily and causing symptoms to subside quickly.

5-alpha-reductase inhibitors, on the other hand, interfere with hormone metabolism and can shrink the prostate over the course of several months. In some patients, both classes of medications are used in combination. It is also important to drink enough fluids, limit alcohol and caffeine in the evening, and urinate regularly. 

It is not always possible to adequately control symptoms with medication. If complications arise or quality of life is impaired, surgery is usually recommended.

Surgical treatment may be considered in cases such as:

• recurrent urinary retention
• frequent urinary tract infections
• bladder stones
• kidney damage caused by urinary retention
• repeated bleeding from the prostate
• Persistent severe symptoms despite medication 

The classic standard surgical procedure is transurethral resection of the prostate (TURP). In this procedure, excess prostate tissue is removed through the urethra without the need for an external incision. This procedure has been considered a proven treatment for many years.

In addition, numerous modern, less invasive procedures have become established. These include, among others, laser treatments such as holmium laser enucleation of the prostate (HoLEP) or GreenLight laser therapy. Both allow for precise removal of prostate tissue while reducing the risk of bleeding.

Minimally invasive procedures such as steam therapy (Rezūm) or prostate artery embolization are also available. However, these methods are not suitable for every form of prostate enlargement and must be evaluated on a case-by-case basis. 

Unfortunately, there is no sure way to prevent it, as hormonal changes and aging are the main causes. However, a healthy lifestyle that includes regular exercise, a normal weight, and a balanced diet is known to promote overall health. Regular screenings help detect changes in the prostate at an early stage. 

Benign prostatic hyperplasia is one of the most common conditions among older men and usually develops gradually. Symptoms such as frequent urge to urinate or a weak urine stream should therefore not be accepted as an inevitable sign of aging. Modern medications can often effectively alleviate the symptoms. If conservative measures are no longer sufficient or complications arise, various minimally invasive surgical procedures are available today. Early urological evaluation enables personalized treatment and helps maintain quality of life in the long term.