Dr. Pavel Gavrilov

The most common symptoms are:

• Weak or interrupted urine stream
• Difficulty or delay starting to urinate
• Feeling that the bladder is not completely empty
• Needing to urinate often, including at night (nocturia)
• Urgency: sudden urges that are hard to hold
• Dribbling at the end

These symptoms can also be caused by other conditions (infections, bladder problems or, less often, prostate cancer), so a urological assessment is important.

• If you cannot pass urine (urinary retention)
• If there is blood in your urine
• If you have a fever with urinary discomfort
• If you notice lower back pain or a marked decrease in urine output

• Medical history and symptom questionnaire (IPSS)
• Physical examination, including a digital rectal exam
• Urine test and PSA blood test
• Ultrasound to measure the prostate and check how much urine remains in the bladder
• Uroflowmetry: measures the strength of the urine stream

Treatment is tailored to each patient, depending on symptoms, prostate size, age, other health problems and personal preferences (for example, how important it is to preserve ejaculation).

Monitoring and lifestyle changes

If symptoms are mild, regular check-ups and a few changes may be enough: drinking less in the evening, cutting down on coffee and alcohol, and not holding urine for too long.

Medication

Some medicines relax the prostate and make it easier to urinate (alpha-blockers), and others gradually reduce its size (5-alpha-reductase inhibitors). They are often combined.

Minimally invasive techniques

In selected patients, options such as Rezum (water vapour) or UroLift aim to relieve symptoms with a quick recovery while preserving ejaculation.

Surgery

When symptoms do not improve with medication or complications appear, surgery is considered: transurethral resection of the prostate (TURP), GreenLight laser vaporisation or laser enucleation, especially useful for large prostates. All are performed through the urethra, with no skin incisions.

No. They are different conditions, although they can occur at the same time. That is why, besides treating symptoms, PSA is monitored.

Most patients are well controlled with medication. Surgery is considered if symptoms do not improve or complications appear, such as urinary retention, recurrent infections, bladder stones or kidney damage.

In general it does not affect erections. What is common after TURP or laser surgery is retrograde ejaculation (semen goes into the bladder instead of coming out). Some techniques, such as Rezum or UroLift, aim to preserve ejaculation. We will discuss it together in the consultation.

A physical examination, a PSA and urine test, an ultrasound to measure the prostate and the urine left in the bladder and, sometimes, a uroflowmetry (measuring the strength of the stream). They are simple outpatient tests.

It depends on the technique. After TURP or laser surgery the hospital stay is usually 1 to 2 days and the catheter comes out within a few days. Most people return to normal life in 2 to 4 weeks, avoiding heavy effort at first.