Prostate adenoma / Top clinic in Germany, Friedrichshafen

Benign prostate enlargement (prostate adenoma)

The benign enlargement of the prostate gland is also called benign prostatic hyperplasia (BPH) or prostate adenoma. It is therefore not a malignant enlargement (prostate cancer).

Benign prostate enlargement can narrow the urethra

The usually about chestnut-sized prostate grows slowly from the age of 30, faster after the age of 50 years. This is probably to be classified as a natural, individually different aging process and not as an illness. The cause is an imbalance of sex hormones (testosterone, estrogen) suspected. However, this increase in size can lead to narrowing of the urethra with different degrees of discomfort. Since in rare cases, prostate cancer may be present, a reliable diagnosis is necessary.

Causes and risk factors: Enlarged prostate is related to testosterone

Despite intensive research, there is still no clarity about the cause of benign prostate enlargement (prostate adenoma). The enlargement of the prostate usually begins in the inner part of the organ, which surrounds the urethra directly. The growth can take different forms and lead to the constriction of the urethra.

At birth, the prostate weighs about two grams and grows during puberty to a weight of about 25 grams. After a period of cessation of growth, a slow, benign increase in size then occurs from about the age of 30 years. The prostate can be five to six times as heavy.

There are several factors that lead to an enlargement. In addition to increasing age, the male hormone testosterone has a decisive influence. Men who do not produce testosterone (for example, after testicular removal = castration), do not develop enlargement of the prostate. Other hormones, metabolic factors and probably also a genetic predisposition influence growth.

Risk factors such as high-fat diet, lack of exercise or alcohol and nicotine consumption are repeatedly mentioned as causes. This is a presumption that there is no valid evidence.

Complications of a benign prostate enlargement

It is important to recognize a benign enlargement of the prostate early, otherwise severe problems may occur.

When the bladder has to deflate against the resistance of the urethra narrowed by the benign prostatic enlargement (prostate adenoma), the muscles in the bladder wall initially become stronger. At this stage, which is also called the irritation stage, the complaints - such as the urinary stream attenuation, the frequent urination and nocturnal urination in the foreground.

Over time, however, the muscles give way and it comes to the Restharnstadium in which the bladder can not be completely emptied. In the remaining urine bacteria can multiply and lead to a bladder infection. In addition, as the bacteria spread, inflammation of the prostate and kidneys may occur.

In the last stage of the disease, the decompensation stage, it comes to the overflow urine bladder, which is often noticeable by a continuous urine dripping. Also, an impoundment of the upper urinary tract can occur, which can lead to renal insufficiency.

In a so-called urinary retention, although there is a strong urinary urgency, the emptying of the bladder is not possible. The urinary retention is an emergency that must be treated by the physician using a bladder catheter inserted either through the urethra or over the abdominal wall.

Symptoms of benign prostate enlargement: Often the stream of urine becomes weak

As the prostate gland increases in size, there may be a progressive constriction of the urethra with urinary symptoms. The severity of symptoms is not always related to the extent of enlargement.

Even if the prostate is only slightly enlarged, it can, for example, by inflammation and swelling and by changes in the connective tissue to pain and disturbances in urination. A strong enlargement can also exist without complaints.

The symptoms of benign prostate enlargement (prostate adenoma) are classified according to their severity in three stages. A so-called urinary retention can occur at any stage. This is the sudden inability to spontaneously release water. A painful dilatation of the bladder is the result. Here a doctor's visit is urgently needed. He can derive the urine by catheter.

Prostate enlargement stage 1 (initial stage):

  • weak stream of urine
  • frequent urination (Pollakisurie)
  • nocturnal urination (nocturia)
  • delayed onset of urination
  • active abdominal press when urinating (the emptying of the bladder is possible only with use of the abdominal muscles)
  • sudden heavy urination, even with involuntary urine leakage
  • Dripping of urine after urination
  • Urinary retention (urinary blockage)

Prostate enlargement stage 2 (advanced stage):

  • Symptoms as in stage 1
  • Residual urine formation (a part of the urine remains in the urinary bladder)
  • possibly urinary tract infections (especially bladder infections)
  • possibly bladder stone formation (associated with pain when urinating)
  • possibly bleeding

Prostate enlargement stage 3 (end stage):

  • Symptoms as in stages 1 and 2
  • Overflow bladder (droplet-like continuous urine discharge in case of overflowing urinary bladder)
  • Urinary blockage kidneys (if the urine can no longer flow away, it will stagnate back into the kidneys)
  • kidney failure
  • The transitions between the stages are fluid. Sometimes it comes in the initial stage to a temporary regression of the complaints.

Benign prostate enlargement: diagnostics is essential

The probability of developing a benign prostate enlargement (prostate adenoma) increases with age. The malignant change of the prostate, the prostate carcinoma, is overall much rarer than the prostate adenoma and is based on the outer glandular lobes.

Although there is no direct correlation between the benign prostate enlargement and the malignant prostate change (prostate cancer), a clarification must always be made, since both diseases can also occur simultaneously.

The most important goal of the diagnosis is to detect how pronounced an enlargement is, whether an operation is necessary and whether the change is benign or malignant.

The decision for or against an invasive examination depends on the individual case - for example, the condition of the patient plays a role. Invasive is any diagnostic procedure in which the doctor enters the patient's body with an instrument. Non-invasive studies can usually be performed regardless of age.

Diagnostic procedures

If a benign prostate enlargement is suspected, the doctor will first take a medical history. In other words, it asks general questions (for example about taking medication or illnesses) and specific questions (for example about problems with urination or urinary tract infections). The International Prostate Symptom Score (IPSS) contains the most important questions about individual complaints. The evaluation of the questionnaire allows for a classification of the symptomatology in three degrees and can facilitate a balancing of the treatment options.

Since the prostate is easy to palpate through the rectum, the doctor will also perform a rectal exam. Although this examination may be uncomfortable, it allows a straightforward assessment of the prostate.

With a benign prostate enlargement, it is also useful to determine certain laboratory values. A urinalysis provides information about whether a urinary tract infection exists. Renal values ​​and prostate-specific antigen (PSA) are also determined. The exact size of the prostate can be determined by ultrasound examination. The doctor can also see how much urine remains after urination in the urinary bladder and whether bladder stones are present. Other methods of examination that can be used for benign prostate enlargement include urinary stream measurement, urinary bladder reflex, and prostate biopsy.

Diagnosis of benign prostate enlargement: measurement of urinary stream and further examinations

The urologist will order special examinations for a prostate. These include:

  • Urine flow measurement (uroflowmetry)
    In this examination, the urinary jet strength is measured. The patient urinates in a special measuring device. A computer measures the course, the duration of urination and the amount of urine emptied. In this way, the physician can assess urinary stream strength as well as the urinary flow curve and thus obtain indications for a bladder emptying disorder or the success of a therapy.
  • X-ray. In some cases, an X-ray examination with contrast agent may be necessary to visualize the kidneys, ureters and urinary bladder.
    • Bladder reflex (cystoscopy). In some cases a bladder reflex is occasionally necessary. Here, a flexible tube (endoscope) is inserted into the bladder via the urethra stunned with a local anesthetic. Over the hose the doctor can judge the urethra and urinary bladder. Even a large central lobe of the prostate may be noticed.
    • prostate biopsy. If examination results are conspicuous (tactile findings, blood values) and there is a suspicion of malignancy, a tissue sample (biopsy) can be taken from the prostate. Often this is done under ultrasound control by a guided from the rectum transducer. The tissue is then examined histologically and clarifies the prostate change.

Diagnosis of benign prostate enlargement: rectal examination

The prostate is easy to palpate through the rectum. Thus, the size and condition of the prostate can usually be assessed simply and easily with the finger ("digito") via the rectum ("rectal").

This examination is performed by the doctor in every patient with prostate problems. Even if you find this examination unpleasant, it is rarely painful. Embarrassment is superfluous, since digito-rectal diagnostics is absolutely routine for the doctor. In no case must the fear of this examination keep you from visiting a doctor. Because that might mean refraining from effective therapy and promoting complications.

Diagnosis of Benign Prostate Enlargement: Laboratory Examinations

With a benign prostate enlargement (prostate adenoma), the doctor will also determine some laboratory values. A standard test is urinalysis. This can be helpful, for example, to detect a urinary tract infection or other diseases. An enlarged prostate often causes a bacterial infection of the urinary tract due to residual urine formation.

  • Investigation of renal values ​​useful
    At the blood examination, the doctor checks the kidney values. These give information about the functionality of the kidney. Screening of kidney values ​​is important because about ten percent of patients with enlarged prostate have impaired renal function, which is reflected in the values.
  • To consider PSA value critically
    Furthermore, one can determine the prostate-specific antigen (PSA). An elevated level may indicate a malignant prostate change. But since other causes - for example, the benign prostate enlargement itself or a prostate inflammation - can also lead to a PSA increase, the value must be considered critically. In addition, there are many different methods of determination, which can lead to difficulties in comparing the values.

Diagnosis of benign prostate enlargement: ultrasound examination

With the ultrasound examination (sonography) over the abdominal wall, among other things the following questions can be answered:

  1. How much urine remains in the urinary bladder after urination?
    The measured amount of residual urine is important for the treatment decision. The larger the amount, the sooner a treatment of benign prostate enlargement (prostate adenoma) is necessary.
  2. Are the kidneys intact?
    When enlarging the prostate, there is a risk that it comes to a urinary stasis in the kidneys, because the urine can not drain. The jamming can damage the kidneys.
  3. Are bladder stones or bladder tumors visible?
  4. How big is the prostate?

With the ultrasound examination on the rectum (Transrectal ultrasound = TRUS), the size of the prostate can be determined even more accurately. In addition, this method can more accurately distinguish between benign and malignant prostate change.

Therapy of benign prostate enlargement

Not all men with benign prostate enlargement (prostate adenoma) have problems urinating. On the other hand, even a small magnification can already lead to problems. Therefore, treatment depends on both the symptoms and the results of the examination. In addition, the therapy decision must also include the assessment of the overall situation, ie the state of health and the suffering of the individual.

As a rule, it is possible to wait for mild symptoms, provided that the examinations have no indication of kidney damage or malignancy of the protastata changes. However, regular check-ups are necessary. This ensures that the doctor can detect any changes in good time and, if necessary, initiate therapy.

Herbal remedies are often used to treat symptoms of benign prostate enlargement. Phytosterols - phytosterols with hormonal action - affect the hormonal balance of the prostate. Extracts of stinging nettle, or saw palmetto fruits have a similar effect. Their effectiveness is not proven. Medications such as alpha-1-receptor blockers reduce muscle tone - muscle tension - at the urinary bladder outlet and thus improve the symptoms. Side effects often include headache and nausea. As the only class of compounds, 5-alpha reductase inhibitors can reduce prostate size by inducing conversion of testosterone. This can cause erectile dysfunction and loss of libido. If the drug therapy without effect or the symptoms are very pronounced, surgery may be necessary.

Interactions with other drugs, side effects. Basically, there may be interactions when taking several medicines at the same time. For certain diseases and disorders, some medications may not be taken at all (contraindications). This also applies to natural remedies. Information about the individual products can be found in the instruction leaflet. Follow the dosage instructions for each medication. Herbal remedies for prostate problems can only work optimally if regularly taken in sufficiently high doses.

Therapy of benign prostate enlargement: drugs

For drug therapy of benign prostate enlargement (prostate adenoma) different preparations are available.

Alpha-1-receptor blockers

Synthetic prostate enlargement drugs include the alpha-1 receptor blockers. They reduce muscle tension (tone) at the urinary bladder outlet. This reduces the pressure on the urethra and allows a better urine flow. Alpha-1 receptor blockers are, according to experts, more effective than herbal supplements.

Since these medications can also have an effect on the heart and blood pressure, it must be clarified before prescribing which medications you are taking and which pre-existing conditions exist. Possible side effects include low blood pressure, dizziness and headache.

5-alpha reductase inhibitors

These preparations cause a decrease in the concentration of (dihydro-) testosterone in the prostate. This leads to a reduction of a significantly enlarged prostate. The 5-alpha reductase inhibitors are also used in combination with the alpha-1 receptor blockers. Since the drug interferes with the testosterone balance, other organs and organ functions can be influenced. For example, libido (sexual desire) and potency may decrease during treatment. Serious side effects such as the development of breast cancer are rare. As a rule, drug therapy is only used if the benign enlargement of the prostate (prostate adenoma) has not caused any complications - such as recurrent or recurrent urinary tract infections or so-called urinary symptoms. Which type of drug therapy is right for you, only the doctor can decide based on the findings. Your cooperation is important so that he can correctly assess the severity of the symptoms.

Therapy of benign prostate enlargement: prostate surgery relatively low risk

If the drug therapy does not have the desired effect or the symptoms are very severe, the prostate adenoma must be surgically removed.

Findings that require surgery for a benign prostate enlargement, for example, recurrent urinary tract infections or a so-called urinary retention, high residual urine levels, stones in the bladder and a restriction of renal function (renal insufficiency). In these cases, the operation should prevent the health damage from the enlarged prostate continue to increase.

Surgical method depending on the extent of prostate enlargement

The surgical technique most commonly used in prostate enlargement (prostate adenoma) is endoscopic transurethral prostate resection (TURP). When the prostate is greatly enlarged, an open prostatectomy is often necessary. Open prostate surgery is a bit more stressful than endoscopic surgery.

Transurethral prostate resection for young men only partially suitable

The most common prostate surgery is transurethral prostate resection (TURP). In general anesthesia or spinal anesthesia, a tube (resectoscope) equipped with a light source and a working channel is inserted into the urethra. The doctor can remove disturbing prostate tissue with this endoscope. Subsequently, the patient receives a bladder catheter. With this method you can achieve very good surgical results and minimize complications such as erectile dysfunction.

In about one in ten patients with TUR surgery, however, urinary bladder emptying disorders occur. Edema is relatively common in the urinary bladder (retrograde ejaculation), which can be problematic in younger men with a desire to have children. In addition, in some cases it can come in the course of time in some cases, a renewed growth of the prostate, so possibly an operation is necessary again. However, if scarring occurs at the surgical site, it can be removed relatively easily through the urethra.

Transurethral incision (TUIP): Complications rarely occur

At low magnification, a transurethral incision (TUIP) may be sufficient. In this method, the prostate is cut through the urethra directly on the bladder neck. The cuts sever muscles, causing the bladder neck to relax, relieving resistance and facilitating urinary flow from the bladder.

With the transurethral incision very good results can be achieved, complications are rare. Edema in the urinary bladder is also much rarer than in transurethral prostate resection. However, the long-term results are not as good as with the TURP and it often happens that after some time, either again or with another method must be reoperated.

Laser treatment: Greenlight or holmium laser

There are two ways to treat a prostate enlargement by laser: Either the tissue is evaporated or it is removed. For the so-called vaporization, ie the evaporation, usually a Greenlight laser - also called KTP laser (potassium titanyl phosphate laser) - used. Using this laser, the cell fluid is heated so much that the tissue evaporates. In this process, there is hardly any bleeding, since the blood energy is closed by the laser energy at the same time. In order to remove the tissue, usually the so-called holmium laser is used. In this laser method, the excess prostate tissue is released from the prostatic capsule and transferred to the bladder. There it is crushed and then sucked off. The advantage: The tissue is then available to examine it histologically. This is how a prostate carcinoma can be detected early.

Open-surgical adenomectomy

In some cases - if the prostate adenoma is very large - a complete removal may be necessary. The doctor exposes the prostate through a cut in the lower abdomen. Then he strips the excess tissue with his fingers and removes it. In rare cases, the doctor may consider inserting a prosthesis to keep the urethra open (stent). The expansion of the urethra with a balloon catheter is no longer common.

Benign prostate enlargement: early detection and prevention

Many men are affected by disorders of the urine drainage from around the age of fifty. Decreasing urinary stream, dribbling and nocturnal urination are typical for a mostly benign enlargement of the prostate (prostate adenoma). Men over the age of 45 should therefore arrange an appointment for a screening test with their doctor once a year. The statutory health insurance companies bear the costs.

The examination usually consists of a palpation examination through the rectum (rectal examination). Because of the surface and nature of the gland, the doctor may also assess whether it could be prostate cancer. If he suspects this, a tissue sample (biopsy) is taken to secure the diagnosis.

Part of the screening test is usually the determination of prostate-specific antigen (PSA) in a blood sample. It is important that the blood test is carried out before palpation, as the manipulation is the possibility that the value is distorted. If prostate cancer has been suspected during the early detection examination, the findings must be clarified with other methods.

Prostate adenoma

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Medical Staff

MD Claus F. Fieseler

MD Claus F. Fieseler
Head of the Urology and Nephrology Department

MD Eberhard Köhler

MD Eberhard Köhler
Head physician assistant

MD Carsten Sippel

MD Carsten Sippel
Head physician assistant

Prof MD Wilhelm Esser-Bartels

Prof MD Wilhelm Esser-Bartels
Head physician assistant

MD Christina Schmitt

MD Christina Schmitt
Senior physician


Cancer treatment





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