Benign prostate enlargement causes lower urinary tract symptoms. A big prostate is not always symptomatic or problematic. A large prostate can cause damage to the kidneys, ureter, or bladder with minimal symptoms. Benign
prostate enlargement is age related but not in a linear fashion. Symptoms increase with size, but also not in a linear fashion, and the condition does not always require surgery. Symptom evaluation of BPE must include the
international prostate symptom score

Clinical Examination

Digital rectal examination (DRE) will reveal enlarged prostate, billobular with smooth surfaces (Interpretation of the prostatic specific antigen [PSA] level should be considered in view of the findings of the DRE.)


  • Urine for culture and sensitivity,
  • Ultrasound of the urinary tract, and
  • Prostatic specific antigen (PSA).


This includes:

  • Watchful waiting is for those with mild symptoms without damage to kidneys and ureters.
  • Medical treatment (alpha reductase inhibitors, e.g., finasteride 5mg daily; review treatment after 6 months. Note: May require treatment for several months before benefit is obtained)
  • Surgical treatment if necessary.
    Surgery is reserved for those with complications, like retention that fails trial without a catheter. Note that retention without such a trial does not qualify as an absolute indication for surgery.

International prostate symptom score (IPSS)

Name: ____________________________________ Date___________________________

not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always Your score
Incomplete emptying
Over the past month, how often have you
had a sensation of not emptying your
bladder completely after you finish
0 1 2 3 4 5
Over the past month, how often have you
had to urinate again less than two hours
after you finished urinating?
0 1 2 3 4 5
Over the past month, how often have you
found you stopped and started again
several times when you urinated?
0 1 2 3 4 5
Over the last month, how difficult have
you found it to postpone urination?
0 1 2 3 4 5
Weak stream
Over the past month, how often have you
had a weak urinary stream?
0 1 2 3 4 5
Over the past month, how often have you
had to push or strain to begin urination?
0 1 2 3 4 5
None 1 time 2 times 3 times 4 times 5 times
or more
Over the past month, how many times did
you most typically get up to urinate from
the time you went to bed until the time you
got up in the morning?
0 1 2 3 4 5

Total IPSS score

Quality of life due to urinary symptoms Delighted Pleased Mostly satisfied Mixed –
about equally
satisfied and
Unhappy Terrible
If you were to spend the rest of your life
with your urinary condition the way it is
now, how would you feel about that?
0 1 2 3 4 5 6

Total score: 0–7 Mildly symptomatic; 8–19 moderately symptomatic; 20–35 severely

Other absolute indications for surgery include:

  • Bladder stone
  • Bladder diverticulum
  • Intractable bleeding
  • Raised creatinine
  • Dilated ureters and kidney.
  • Evaluation of the patient
  • Conservative or definitive surgical management.
  • Surgery includes:
    • Transurethral resection of the prostate (TURP)
    • Open prostatectomy