Benigno povečanje prostate

Benign prostatic hyperplasia

Also known as benign prostatic hyperplasia (BPH), it is one of the most common benign urological conditions in older men. It is a non-cancerous increase in the volume of prostate tissue, in which ageing and male sex hormones play an important role. An enlarged prostate can narrow the part of the urethra it surrounds and obstruct the outflow of urine from the bladder, affecting urination and everyday wellbeing. A weaker stream, frequent or night-time urination and a feeling that the bladder has not emptied completely are signs that should not be ignored and are a reason to see a urologist.

A condition that affects older men

Benign prostatic hyperplasia (BPH) is a histological process in which the number of stromal, smooth muscle and epithelial cells increases, mainly in the transition and periurethral zones of the prostate. In the clinical context we speak of benign prostatic enlargement (BPE), which can narrow the prostatic part of the urethra, obstruct the outflow of urine from the bladder and cause lower urinary tract symptoms (LUTS). However, the size of the prostate alone does not tell how severe the symptoms will be. A man with a large prostate may have few or no symptoms, while a man with a smaller prostate may have significant problems.

By far the most important factor in the growth of prostate tissue is age. With increasing age, the interactions between stromal and epithelial cells, growth factors and the hormonal environment of the prostate change (higher levels of the testosterone metabolite DHT). Signs of benign prostatic hyperplasia mainly start to appear after the age of 40, and their frequency gradually increases with age.

Lower urinary tract symptoms (LUTS)

A weaker stream, difficulty starting urination, an interrupted stream, more frequent urination, urinating at night, a sudden urge to urinate and a feeling that the bladder has not emptied completely are the most common symptoms of benign prostatic enlargement. An enlarged prostate can gradually narrow the urethra and make it harder to pass urine. Symptoms usually develop slowly and may worsen over time. In some men they are mild, while in others they significantly affect daily life and sleep. Symptoms are not always caused by the size of the prostate. Bladder function can also change with age, so similar problems can be caused by an overactive or weakened bladder.

If symptoms become bothersome or affect sleep or daily activities, a urological examination is recommended.

Urological examination

During the urological examination we assess the symptoms, the condition of the prostate, bladder function and any residual urine, and rule out other causes. The basic evaluation includes:

medical history with the IPSS questionnaire – we assess the type and severity of symptoms, their impact on quality of life and any other conditions
clinical examination including a digital rectal examination of the prostate – we assess the prostate and any other changes
urine analysis – we rule out infection, haematuria and other causes
prostate-specific antigen (PSA) testing – depending on age, the clinical situation and the risk of prostate cancer
measurement of post-void residual urine (PVR) – we assess how well the bladder empties after urination
uroflowmetry – we objectively assess the speed and pattern of urine flow.
ultrasound of the prostate and urinary tract – we assess the size of the prostate, the bladder, the kidneys and any complications

Treatment of an enlarged prostate

After the diagnostic work-up, the urologist decides on the most appropriate approach together with the patient, based on the severity of symptoms, the size of the prostate, the impact on quality of life, residual urine and any complications. With mild symptoms, treatment is often not needed straight away: the condition is monitored and the patient is advised to adjust daily habits, such as fluid intake, limiting caffeine and alcohol and treating constipation. For bothersome symptoms, first-line treatment is medication (α1-blockers, 5α-reductase inhibitors), combined if necessary. If medication is not enough or complications occur, we use surgical treatment, either minimally invasive procedures (TURP, ThuLEP) or open prostatectomy.

Surgery is needed for recurrent urinary retention, inability to urinate spontaneously, recurrent infections, bladder stones, recurrent macroscopic haematuria due to BPH or damage to the upper urinary tract (hydronephrosis), and when medication is not effective enough.

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist

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dr. Sebastian Jeršinovič, dr. med., FEBU

urology specialist

Specialises in minimally invasive laser endoscopic urology, including laser enucleation of the prostate (ThuFLEP) and laser lithotripsy of kidney stones (URS).

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Frequently asked questions

Do you have questions? Here you will find answers to the most frequently asked questions related to our services and procedures. If you cannot find the answer, please contact us - we are happy to help you.

The urology clinic treats problems with the urinary tract, prostate, bladder, kidneys, and genitals. These include urination disorders, frequent or painful urination, blood in the urine, lower back pain, and other urological problems.

It is recommended to schedule an appointment for an examination if you have persistent or recurring problems with urination, pain in the lower abdomen or lower back, suspicion of an enlarged prostate, suspicion of inflammation, or unusual discharge. We also recommend regular preventive examinations for men over the age of 50.

The doctor will first discuss your problems and medical history, followed by a clinical examination and, if necessary, an ultrasound, laboratory analysis or uroflow test. Everything is done discreetly and with respect for your privacy.

Of course. Women also face urological problems, such as urinary tract infections, incontinence, or urinary tract stones. In our clinic, we treat both male and female patients of all ages.

Yes, all examinations at the urology clinic are self-pay. This allows for shorter waiting times, flexibility in choosing an appointment, and immediate access to top specialists without a referral.