BPH (Enlarged Prostate) — Symptoms, Diagnosis, and Treatment Options in Hyderabad
An enlarged prostate — medically termed benign prostatic hyperplasia (BPH) is so common in older men that it is frequently considered a normal part of ageing rather than a medical condition requiring treatment. By age 60, more than 50% of men have histological evidence of BPH; by age 85, the figure exceeds 90%. But while BPH is common, the lower urinary tract symptoms (LUTS) it produces interrupted sleep, urgency, weak stream, incomplete bladder emptying, and the gradual erosion of daily routine around toilet access are not something men simply have to accept. Effective treatment options exist across a wide spectrum: from medications that can be started by a GP, through to minimally invasive outpatient procedures, laser surgery, and an MRI-guided incision-free option available in India only at KIMS Secunderabad.
What has changed most significantly in BPH treatment in the past decade is the range of surgical options and the ability to match the treatment precisely to the patient. The days when 'prostate surgery' meant a single procedure with a single recovery profile are over. At KIMS, men with BPH are evaluated for three distinct surgical options: TULSA-PRO (MRI-guided, incision-free, same-day discharge — India's only centre), HoLEP (the gold standard for large glands, with the lowest retreatment rate of any BPH surgery), and TURP (the proven 40-year standard for moderate-sized glands, performed at KIMS exclusively with the safer bipolar technique). The recommendation is genuinely individual based on prostate size, anatomy, the patient's priorities, and clinical factors.
This post explains what BPH is, how to recognise its symptoms, how it is diagnosed, and how the treatment decision is made at KIMS — including an honest comparison of all three surgical options.
What is the prostate and why does it enlarge?
The prostate is a walnut-sized gland that sits directly below the bladder and surrounds the urethra the tube through which urine flows from the bladder to exit the body. Its primary function is to produce fluid that forms part of semen. The prostate grows in two phases: rapid growth during puberty under the influence of testosterone, and a slower second phase of growth that begins around age 40 and continues for the rest of a man's life. This second phase of growth driven by dihydrotestosterone (DHT), the active form of testosterone in prostate tissue is Benign Prostatic Hyperplasia (BPH).
As the prostate enlarges, it compresses the urethra that passes through its centre. The bladder compensates by contracting more forcefully to push urine through the narrowed channel at first successfully, but over time leading to detrusor muscle hypertrophy (thickened bladder wall), increased urinary urgency, and eventually in advanced BPH — urinary retention (inability to urinate at all) and the potential for obstructive damage to the kidneys from chronic urinary retention with overflow.
At KIMS Secunderabad, we focus on identifying the exact stage of this enlargement to prevent long-term bladder damage. If you experience a complete inability to urinate, painful bladder swelling, or blood in the urine, please visit KIMS Emergency immediately or call 040 - 44885000.
BPH symptoms — the IPSS score
BPH symptoms are quantified using the International Prostate Symptom Score (IPSS) — a validated questionnaire covering seven urinary symptoms plus a quality-of-life question. The KIMS urology team uses the IPSS at every BPH consultation to grade symptom severity, guide treatment decisions, and track response to treatment objectively.
Incomplete emptying — the sensation that the bladder has not fully emptied after urination.
Frequency — needing to pass urine more than 8 times in a 24-hour period.
Intermittency — the urinary stream starting and stopping several times during a single void.
Urgency — a sudden, compelling need to urinate that is difficult or impossible to defer.
Weak stream — a noticeably reduced force or speed of the urinary stream.
Straining — needing to push or strain to initiate or maintain the flow of urine.
Nocturia — waking up to urinate at night, typically 2 or more times, disrupting sleep.
IPSS Grading — Symptoms are scored as Mild (0–7), Moderate (8–19), or Severe (20–35).
URINARY RETENTION = MEDICAL EMERGENCY
Urinary retention the complete inability to urinate is a medical emergency requiring immediate catheterisation. If you cannot urinate at all and have lower abdominal pain or distension, call KIMS on 040 - 44885000 immediately or proceed directly to the KIMS emergency department. Do not wait for the symptoms to improve on their own.
Diagnosing BPH — what the KIMS assessment includes
A BPH diagnosis at KIMS begins with a clinical assessment but requires objective measurements before any treatment recommendation is made. Our standard assessment ensures we match the right procedure to your specific anatomy and symptoms.
IPSS Questionnaire
Completed by the patient before or at the consultation, this validated tool allows the urologist to grade symptom severity and track treatment response objectively.
Uroflowmetry
Non-invasive measurement of urinary flow. A Qmax below 10 ml/second consistently indicates significant obstruction compared to the normal 15+ ml/second.
Post-Void Residual
Ultrasound measurement of urine remaining in the bladder after voiding. A residual above 100ml indicates incomplete emptying and bladder struggle.
Prostate Volume
Measured by ultrasound or MRI. Essential for choosing surgery: TURP (best <80cc), HoLEP (any size), or TULSA-PRO (specific dimensions required).
PSA Blood Test
PSA density and age-contextual review to exclude prostate cancer. Helps determine if an MRI or biopsy is needed before BPH intervention.
Kidney function and upper urinary tract assessment
eGFR and renal ultrasound to check for silent bilateral hydronephrosis (kidney swelling) caused by long-standing bladder outlet obstruction.
Treatment options for BPH — the KIMS spectrum
Medical management — alpha-blockers and 5-alpha-reductase inhibitors
Alpha-blockers (tamsulosin, silodosin, alfuzosin) relax the smooth muscle of the prostate and bladder neck, improving urinary flow within 24 to 48 hours of starting. They do not shrink the prostate. 5-alpha-reductase inhibitors (finasteride, dutasteride) block the conversion of testosterone to DHT, slowly shrinking the prostate over 3 to 6 months — reducing it by 20 to 30% in most cases. Combination therapy (alpha-blocker + 5-ARI) is the most effective medical approach for larger glands. Medical management is appropriate for mild to moderate symptoms (IPSS 8 to 19) in men with smaller prostates or who prefer to defer surgery. It requires lifelong medication, and symptoms return when medication is stopped.
TULSA-PRO — India's only MRI-guided, incision-free prostate treatment
TULSA-PRO (Transurethral Ultrasound Ablation) is the most technologically advanced BPH and prostate cancer treatment currently available — and KIMS Secunderabad is the only centre in all of India that offers it. A thin probe is placed through the urethra and guided by real-time MRI. Focused ultrasound energy ablates the prostate tissue precisely under continuous imaging, without any incision, without any radiation, and without general anaesthesia in most cases. The procedure is performed as a day-care treatment — most patients go home the same evening or the following morning. TULSA-PRO's clinical outcomes from the international pivotal trial: 95% reduction in PSA, 93% of men pad-free at 1 year, and — critically — significantly better ejaculation preservation compared to HoLEP and TURP, both of which cause retrograde ejaculation in approximately 75% of men. For men where preserving sexual function is a priority, TULSA-PRO offers outcomes that no other BPH procedure matches.
HoLEP — gold standard for large glands
Holmium Laser Enucleation of the Prostate (HoLEP) is the most effective surgical treatment for BPH by any measurable long-term outcome — including the lowest retreatment rate (under 2% at 5 years, compared to approximately 15% for TURP). HoLEP removes the entire obstructing adenoma from within the prostate capsule using a 100W Holmium laser, then morcellates the tissue into small pieces for removal. There is no size limit — KIMS performs HoLEP on glands of 300cc and above that other centres decline, avoiding the large abdominal incision of open prostatectomy. HoLEP is performed under spinal or general anaesthesia, with catheter removal at 24 hours and hospital stay of 1 to 2 nights. Blood loss is virtually negligible — the Holmium laser achieves haemostasis as it cuts, making HoLEP the safest BPH surgery for patients on blood thinners (anticoagulants). For men prioritising the lowest possible retreatment rate, or for large prostates that exceed the TURP size limit, HoLEP is the recommended procedure at KIMS.
TURP — proven, effective, bipolar technique at KIMS
Transurethral Resection of the Prostate (TURP) remains the most widely performed BPH surgery worldwide — with a 40-year evidence base demonstrating 85 to 90% symptom improvement at 1 year for prostates between 30 and 80cc. At KIMS, TURP is performed exclusively using the bipolar technique with saline irrigation — eliminating TUR syndrome, the principal safety concern of older monopolar TURP that used glycine irrigation. The bipolar system is the international standard endorsed by EAU and AUA guidelines, and it is what KIMS provides for every TURP patient.
TURP vs HoLEP vs TULSA-PRO — how KIMS recommends
| Factor | TURP | HoLEP | TULSA-PRO |
|---|---|---|---|
| Best prostate size | 30–80cc | Any size — especially >80cc | Typically <100cc with specific MRI anatomy |
| Retreatment at 5 years | ~15% | <2% | ~10–15% (emerging data) |
| Ejaculation preservation | ~25% retained | ~25% retained | Significantly better — best of the three |
| Hospital stay | 2–3 nights | 1–2 nights | Same day or next morning |
| Catheter removal | 48–72 hours | 24 hours | Several days |
| Available at KIMS | Yes — bipolar saline | Yes — 100W, no size limit | Yes — India's only centre |
Because KIMS offers all three options, the recommendation is genuinely objective — not influenced by which procedure the centre happens to have available. If you have been told elsewhere that your only option is TURP, or that your prostate is 'too large' for any procedure except open surgery, come to KIMS for a second opinion.
Book a BPH Consultation at KIMS — Discuss All Three OptionsFrequently Asked Questions — BPH
No — BPH (benign prostatic hyperplasia) is a non-cancerous enlargement of the prostate gland and does not cause or predict prostate cancer. However, both BPH and prostate cancer can cause similar urinary symptoms and both cause an elevated PSA. The KIMS urologist evaluates the PSA in the context of the prostate volume (PSA density) and MRI findings to determine whether further investigation for prostate cancer is needed before proceeding with BPH surgery. All resected tissue from TURP and HoLEP procedures at KIMS is sent for histological analysis — in a small percentage of cases, incidental prostate cancer is found in apparently benign BPH tissue.
The normal prostate in a young adult man is approximately 20 to 25cc (roughly walnut-sized). BPH causes the prostate to grow from this baseline — a prostate of 40cc is mildly enlarged, 60 to 80cc is moderately enlarged, and above 100cc is considered a large gland. Prostate size is measured precisely by transrectal ultrasound (TRUS) or prostate MRI at the KIMS consultation. Size alone does not determine symptom severity — some men with very large prostates have mild symptoms, while others with moderately enlarged prostates have severe obstruction if the growth is primarily into the urethra.
Yes — for mild to moderate symptoms (IPSS below 20) in men with smaller prostates, medications effectively control symptoms for many years. Alpha-blockers (tamsulosin) improve flow within 24 to 48 hours; 5-alpha-reductase inhibitors (finasteride, dutasteride) shrink the prostate by 20 to 30% over 6 months. Combination therapy is the most effective medical approach. However, medication requires lifelong use, does not cure BPH, and symptoms return when medication is stopped. For men with large prostates, severe symptoms, urinary retention, or who prefer a definitive solution without daily medication, surgical options are the better long-term choice.
The most common sexual side effect of both TURP and HoLEP is retrograde ejaculation — where semen travels backward into the bladder during orgasm rather than forward. This occurs in approximately 75% of men after either procedure. It is not harmful and does not affect erection or the sensation of orgasm. For men where any change to ejaculation is unacceptable — for example, men who wish to father children or for whom ejaculation sensation is a priority — TULSA-PRO (India's only centre at KIMS) offers significantly better ejaculation preservation than either surgical option. Erectile function is generally not affected by TURP or HoLEP.
TULSA-PRO (Transurethral Ultrasound Ablation) is the only prostate procedure that is MRI-guided, incision-free, performed without general anaesthesia in most cases, and offers same-day or next-morning discharge as standard. A probe is placed through the urethra and focused ultrasound energy ablates the prostate under real-time MRI guidance — no cutting, no laser, no radiation. The pivotal trial showed 95% PSA reduction and 93% of patients pad-free at 1 year, with significantly better ejaculation preservation than surgery. KIMS Secunderabad is India's first and only TULSA-PRO centre.
BPH that is not treated progresses in most men — prostate size increases, symptoms worsen, and the risk of acute urinary retention increases. Beyond the symptom burden, long-standing untreated BPH causes progressive bladder damage — detrusor muscle hypertrophy, reduced bladder capacity, and eventually bladder overactivity that persists even after the obstruction is relieved. In severe cases, chronic urinary retention causes bilateral hydronephrosis (kidney swelling from back-pressure) and progressive CKD. Regular review allows timely intervention before irreversible damage occurs.
KIMS Secunderabad — India's only TULSA-PRO centre (MRI-guided, incision-free, same-day discharge), 100W HoLEP with no prostate size limit (glands up to 300cc and above treated endoscopically), Bipolar TURP with saline irrigation (TUR syndrome eliminated), and a genuine three-option BPH programme where the recommendation is made objectively based on each patient's prostate, symptoms, and priorities. NABH accredited. Aarogyasri, CGHS, EHS empanelled. Call 040 - 44885000 to book a BPH consultation.