Benign prostatic hyperplasia (BPH) refers to the enlargement of the prostate gland, which can obstruct the urethra and lead to various urinary problems. The condition typically begins gradually after the age of 40, and the number of patients increases sharply in their 60s, affecting approximately 60–70% of men in this age group.
When BPH develops, patients may experience a range of urinary symptoms, such as a weaker urinary stream, increased frequency of urination—often more than eight times per day—and waking up at least once during the night to urinate. These symptoms can significantly disrupt daily life and reduce the quality of life for many middle-aged and older men, making appropriate treatment important.
In the early stages of BPH, medication is often effective in controlling symptoms. However, when symptoms become severe, surgical treatment may be considered. In general, urology specialists may consider surgery when the prostate size reaches approximately 35–40 grams or larger. Nevertheless, there are cases where surgery is recommended even when the prostate measures only around 20–25 grams.
Although BPH is commonly associated with an increase in prostate size, urinary symptoms are not determined by size alone. Various anatomical and functional factors can also contribute to urinary obstruction. The normal prostate size is typically about 15–20 grams, and a slight increase beyond this range does not automatically require surgery. However, if the urinary stream is weak, significant residual urine remains in the bladder, and medication provides little improvement, further evaluation is necessary to identify the underlying cause.
In some cases, structural issues such as bladder neck contracture or protrusion of prostate tissue into the urethra may play a key role in causing urinary symptoms. When these conditions are present, medication alone may not provide sufficient improvement. Therefore, diagnostic tests such as uroflowmetry and cystoscopy are important to determine the exact cause of the obstruction. Uroflowmetry measures the maximum urinary flow rate during urination, with a normal peak flow generally considered to be above 15 mL per second.
If examination results show narrowing of the bladder neck or protrusion of prostate tissue into the urethra or bladder, surgical correction may be necessary. After surgery, urinary flow often improves significantly, with the peak flow rate returning to normal levels and residual urine disappearing in many cases. For this reason, treatment decisions should not be based solely on prostate size but should instead consider both functional and structural abnormalities to provide personalized treatment.
Dr. Ryu Kyung-ho of Goldman Urology Clinic’s Gangnam branch explained that identifying the exact cause of urinary symptoms requires more than just ultrasound examination. He emphasized that cystoscopy should also be performed when necessary because the location and pattern of prostate enlargement differ from patient to patient. Since urinary symptoms can greatly affect the quality of life in middle-aged men, he advised that surgical decisions should be made based on a thorough and systematic evaluation.