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PROSTATE GLAND ENLARGEMENT | BPH: Everything you need to know

Do you have questions about prostate gland enlargement? BPH can be a confusing and difficult topic to understand, but we're here to help. Check out our comprehensive guide to everything you need to know about BPH, from causes and symptoms to treatment options.

Everything you need to know about PROSTATE GLAND ENLARGEMENT | BPH

Prostate gland enlargement (BPH) is one of the most common conditions affecting middle-aged and older men. The condition occurs when the prostate gland, a small walnut-shaped gland that is part of the male reproductive system, begins to grow larger. The enlarged prostate gland can cause problems with urination, including a weak stream, difficulty starting urination, and the need to urinate more often, especially at night.

BPH is not cancerous and does not increase the risk of developing prostate cancer. However, the symptoms of BPH can be similar to those of prostate cancer, so it is important to see a doctor for an accurate diagnosis.

There are a number of treatment options available for BPH, including medication, surgery, and lifestyle changes. The best treatment for BPH will depend on the severity of the symptoms and the individual’s preferences.


The exact cause of BPH is unknown, but it is thought to be related to hormone changes that occur as men age. The prostate gland is sensitive to the hormone testosterone, which stimulates its growth. As men get older, they produce less testosterone, but the prostate gland does not shrink. This can cause the gland to become enlarged.

Other factors that may contribute to the development of BPH include:

  • A family history of the condition
  • Obesity
  • A diet high in animal fat
  • A sedentary lifestyle


The symptoms of BPH can vary from mild to severe. They may include:

  • A weak stream when urinating
  • A feeling that the bladder is not completely emptied
  • The need to urinate more often, especially at night
  • The need to rush to the bathroom
  • Difficulty starting urination
  • A feeling of urgency when urinating
  • Stopping and starting while urinating
  • Dribbling after urination


BPH is usually diagnosed during a physical exam. The doctor will feel the prostate gland to check for enlargement. A digital rectal exam (DRE) may also be performed. During a DRE, the doctor inserts a gloved, lubricated finger into the rectum and feels the prostate gland for lumps or other abnormalities.

In some cases, further testing may be necessary to rule out other conditions, such as prostate cancer. These tests may include a prostate-specific antigen (PSA) test, which measures the level of PSA in the blood. PSA is a protein produced by the prostate gland. A high level of PSA may be a sign of prostate cancer.

Other tests that may be used to diagnose BPH include:

  • A urinary flow study, which measures the speed and volume of urine flow
  • A post-void residual (PVR) test, which measures the amount of urine remaining in the bladder after urination
  • A cystoscopy, which involves inserting a small camera into the bladder to check for blockages
#prostatehealth #menshealth

In this video, we will be talking about Benign Prostatic Hyperplasia (BPH) or commonly known as Prostate Gland Enlargement, what it can do, what it means for you, and what you can do about it! Be sure to watch until the end to learn all the different options that are currently available today!

Thanks for watching!!

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Rena Malik, MD is a urologist and pelvic surgeon on youtube to educate people about all things urology including erectile dysfunction, how to increase testosterone, problems with sex, premature ejaculation, urinary leakage, or incontinence, overactive bladder, urinary tract infections, prostate issues and more.


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0:00 Intro Card

0:32 What exactly happens with BPH?

1:58 Would you have symptoms if you have an enlarged prostate

2:42 Three ways you can manage with an enlarged prostate

3:55 Medications for BPH

5:53 Saw Palmetto; Herbal Medication

6:41 Surgical Treatment options

10:50 Questions you’ll want to ask your doctor before Surgery

11:28 End Card


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DISCLAIMER: This video is purely educational and does not constitute medical advice. The content of this video is my personal opinion and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of the information contained in this video including but not limited to economic loss, injury, illness, or death.

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Video transcription:

Hey guys, rena malek, urologist and pelvic surgeon today, we’re talking about prostate gland enlargement or in other words bph, benign prostatic hyperplasia. And what exactly is that? And why should you even care? Well, bph is essentially a disease that is extremely common in men. In fact, in men, over the age of 60, almost 70 of men have bph and over the age of 70, almost 80 of men suffer from this disease and what exactly happens well in men with bph, the cells in the prostate itself actually multiply and you get more and more cells. And then, when you have all these cells, they actually join together and form nodules in the prostate. And if you remember, the prostate is actually a walnut shaped organ that sits around the pee tube and underneath the bladder and as that grows it can actually block urine from coming out of the bladder and in some men it can actually cause symptoms of bladder outlet obstruction. And what exactly are those symptoms? Well, you can have kind of two categories of symptoms. These can include storage, symptoms or voiding symptoms and there’s fancy ways to say it can be a problem with the bladder or a problem with emptying the bladder. And so when you’re talking about problems with the bladder, you can have symptoms like urgency. Gotta go gotta, go urinary frequency and sometimes even having accents when you can’t make it to the bathroom at night and sometimes waking up at night to urinate or you can have problems with the passageway or the urine getting out of the bladder, and that can be often you’re having to wait for your stream to start you’re having to strain or push to empty. Your bladder you’re having intermittency, which means that the urine stops and starts as you, urinate and really common is having a weak stream where like having just really not a strong force behind your urinary stream. So if you have bph, does it mean that you’re definitely going to have symptoms? No, in fact, some men never have symptoms, while others do have symptoms that will kind of gradually appear over many many years. So you might notice this as early as your late 40s, and these can continue to progress over time. So how do if your urinary symptoms are caused by bph? Well, the short answer is you can’t be a hundred percent sure, while it is the most common cause of urinary symptoms in men, you can also have other causes like overactive bladder, which I’ve made videos about before. Sometimes it can be a sign of prostate cancer or other problems presenting themselves for the first time. But if you’ve gone to your primary care doctor or your urologist and they’ve said this is caused, because you have a large, prostate, there’s kind of three ways you can manage this one is you can just watch and wait and see if your symptoms improve over time. Two is you can actually try what we call conservative management and there’s a few things that you can try to do. A lot of these things are similar to the ones I’ve mentioned in five ways to manage your overactive bladder and avoiding bladder irritants, because those things can also help with symptoms of bph, and these can include watching what you drink, especially before the two hours before bedtime, avoiding bladder irritants like coffee, alcohol and the other ones. I mentioned in my bladder irritants video trying to watch out when you’re, taking cold and allergy medications like antihistamines or decongestants. These can actually worsen your urinary symptoms, and so you may want to avoid taking them unless you absolutely need to. And lastly, you can try to double void. What that means. Is you go to the bathroom urinate try to completely empty your bladder, and if you aren’t able to you, stand up, you sit back down and go again. You don’t want to push or strain, but sometimes just doing that motion can help you get out a little bit more urine. Another thing you can do is medical or surgical therapy, so we talked about watching or waiting. We talked about conservative management, now we’re moving on to medications, there’s a few classes of medications that you can try the first one and the most common one that’s prescribed is called. Is a category called alpha blockers things like tamsilosin or terazosin? These medications act by relaxing the smooth muscle in the area of the prostate to allow urine to pass more readily. However, there are some minor side effects. The most common is dizziness and that can occur in five to fifteen percent of patients and then another one to be wary of is retrograde ejaculation, and what that means is that when you ejaculate, instead of having your ejecta, come out like it normally does you may notice that it actually goes backwards and goes into your bladder. And, lastly, if you are getting cataract surgery for any reason, you want to avoid these medications, because these medications can make getting cataract surgery technically very challenging for the ophthalmologist. So make sure you tell your urologist or primary care doctor if you have cataract surgery planned. The second kind of category of medications is phosphodiesterase 5 inhibitors. These are traditionally used for things like erectile dysfunction, but tadala fill in a low dose of five milligrams daily has been shown to benefit urinary symptoms in this medication. You take five milligrams once a day side. Effects of this are extremely rare and they can include headaches, flushing, some gi discomfort, back pain or muscle aches. The last category of medications are alpha, reductase inhibitors, and these are things like proscar, finasteride or dutasteride. What these do is they actually stop the prostate from growing and can actually shrink the prostate there’s. A couple caveats. One is that these take about six to 12 months to see the full effect of them, so you can’t take them and expect to see symptom relief right away. Another one is that there are some sexual side effects and these can include a decreased libido and a decreased sex drive, and sometimes even signs and symptoms of depression or issues with ejaculation. A lot of you may have heard of something called saw. Palmetto, which is an herbal medication, saw palmetto, is derived from the berries of a plant called ceranoa, repens or a dwarf palm plant, and it’s thought that it works by inhibiting 5-alpha reductase, which inhibits the conversion of testosterone to another compound called dihydrotestosterone, which causes prostate growth, and it also has some anti-inflammatory properties and, looking at this in multiple studies, the our guidelines or the american neurological association does not recommend using it. But I have found that for some patients this does help them and particularly if they can’t tolerate any of the other medications. This is a reasonable option to at least try has very few side effects and is very safe. All right. The last treatment option is surgical and when you’re thinking about surgery there’s a number of different reasons to undergo surgery, one is, if you just don’t want to take medications. Two is, if you’ve taken all the different types of medications, can’t tolerate them or still having bothersome symptoms if you’re having recurrent urinary tract infections and that can occur because you’re not emptying your bladder, frequently enough or well enough, and so that can cause you to get more bladder infections. And similarly, you can also get recurrent bladder stones and, if you’re, getting bladder stones because of an enlarged, prostate, that’s another reason to consider surgery. Lastly, if you’re having bleeding from the bladder from the prostate over and over again, that’s another reason to have surgery and lastly, in some cases in rare cases, when the prostate gets very, very big, it can actually cause your bladder to be unable to empty and that urine can then back up through the ureters or the tubes that empty the kidneys and then back up into the kidneys and can cause a reduction in the function of your kidneys. And this is called bilateral hydronephrosis. And so, if this happens in the presence of having an enlarged prostate, you are pretty much going to sign up for a surgery to help protect your kidneys. And when you decide to have surgery you’re going to discuss with your urologist based on three major things, one is the size of your prostate. Two is the risk of bleeding during surgery and three is your sexual function and how? How concerned you are with things like specifically retrograde ejaculation, which is a side effect of many of the surgeries that we perform for an enlarged prostate. So briefly, when you look at the surgical options, you want to think about. Are you going to do this in the operating room or in an outpatient surgery center? And what does that really mean for you? So I think for a lot of my patients. I talk to them about the differences based on what their preference would be and if they want to and are eligible for a procedure, that’s done in the outpatient surgery center that avoids them from having to have anesthesia and all the pre-operative clearance. That’s required to undergo anesthesia, so it can be kind of a hassle sometimes to have to have a surgery or if they have other reasons like sexual side effects that they’re concerned about, then outpatient surgeries are usually better in those cases, and those options include a prostatic urethral, lift or also known, as urolift, essentially use kind of a suture to help lift the prostate out of the way so that the urination can empty better or water vapor therapy of the prostate also known as resume, and this is essentially a procedure where we actually use water vapor to vaporize the prostate tissue, and both of these surgeries are typically done in the office or in an outpatient, surgical setting with no anesthesia and the nice part about this is that these are really quick surgeries. Both of them usually require a catheter post-operatively, but they do have pretty high success rates with very low reintervention rates. And what does that mean? Well, reintervention means that you have this procedure and then you feel unhappy with the outcome of the procedure. So then, you go on to have another surgery for your prostate, and the rates, at least up to five years are somewhere between two and six percent for both of these surgeries. These are great for smaller size, prostates, specifically less than 80 grams in size. Then you move on to surgeries that are in the operating room, and these are usually for larger prostates. These can include a laser vaporization of the prostate or a transurethral resection of the prostate and lastly, aqua ablation of the prostate, and these basically use different modalities, either laser a cutting loop with some coagulation or water pressure to actually ablate and take out the prostate tissue. All three of these require a catheter afterwards, and some of them will require a stay overnight in the hospital, while others may not, depending on your surgeon’s preference and, lastly, there’s also homi a nucleation of the prostate. This is a surgery, that’s not offered in every urologist office, but it’s very effective and very safe in the right hands, and so, if you have a very large prostate, this is a great operation that also uses a laser, but also instead of just ablating or vaporizing. The tissue actually removes the prostate tissue in in its entirety. So questions that you’ll want to ask your doctor or your surgeon before you have surgery for your prostate number. One is: how long is it going to be before my symptoms get better a lot of the times it will take up to three months for your symptoms to get much much better, even after an ablative surgery. Two is how long am I gonna need? A catheter three is: am I going to spend the night in the hospital? Four is what is my chance of sexual side effects, issues with ejaculation or erectile dysfunction? And, lastly, what’s the chance that I might need surgery again and so ask these questions, make sure you’re fully informed and find a urologist that you feel comfortable with. I hope this helps and if you have questions, please comment them down below, as always remember to take care of yourself because you’re worth it.

What users commented:

What if, my first pee in the morning reflects the symptoms you describe
as being prostate related? The remainder of the day I have no symptoms?
I don’t get up to pee during the night. Every pee after the first is
good, so good I may be called on to put our forest fires! During the
day, I go hrs. between peeing urges, I drink 54 oz. + -, every day.
Some times, maybe once or twice a week I have lower back pain, and hip
socket pain. I drink a hard cider drink once a week, sometimes twice a
week. I use olive , avocado, and coconut oil, and real butter only.
using a Urispec GP+A test trip, my Pee has a neg. to low glucose,
neg. protein, and ascorbic acid is at a + level. I am a white male, 60
yrs. old, I weigh 175 pounds, and 5ft.8 inches tall. I have some belly
fat, These are my only signs of prostate problems. A week ago, I
seriously began starting my transition to a keto diet. My concerns are
the urination issue first thing in the mornings, and the rest of the
day is normal, and would you discuss this in a video? Do other men have
these same symptoms/issues?

Well,the doctors are certainly prettier in today’s world.keep on smiling and helping people.

Ive had prostate problems for years im 65 2 years ago i had turp now i have retrograde ejaculation and still my bladder never empties seldom have a good stream and it comes out split ive tried all of the natural products saw palmetto plant sterols nettle and such and to no avail also after turp erections rarely come and also pereni is usually irritated living with bph is not fun and leaves me feeling like less of a man i guess thats the way it will b also i gave up beer tho i rarely drank anyway and i gave up coffee 2 prostate irritants so such is my life

merci de Dr. Rena Malik et ensuite elle est belle, jusqu’ici , je ensemble avec a elle et autre donteurs

newly married man was hospitalised in Uttar Pradesh’s Prayagraj after he overdosed on Viagra, a drug used to treat erectile dysfunction. Though the doctors have treated him, the man now has a problem that will last him a lifetime.

The man, who was married a few months back, began taking Viagra on the advice of his friends. However, he began consuming more than the recommended quantity, leading to an overdose and subsequent hospitalisation.

He further amped his doses on the recommendations of his friends and went on to consume as much as 200 mg of the drug daily, nearly four times the prescribed amount.

The man ended up with an erection which did not subside even after 20 days. Upset and frustrated with the series of events, his wife left him and returned to her maternal home.

After much cajoling by the man’s family, she returned, but left soon after admitting her husband to a hospital.

Doctors at the hospital successfully performed penile prosthesis surgery on the man. However, now the man has a problem that will last him a life time.

Happened here in India 3 days back.Interesting.Can this be true?

As a man, I’m absolutely terrified of this. It’s a rather hopeless situation. There’s simply no decent treatment, so it’s guaranteed to destroy my life.

Very informative

Dr. Malik, as always fantastic presentation and very helpful advice!!

This is the 2nd video I’ve heard you say to urinate SITTING DOWN but each time you say it so casually that it could be misconstrued. Can you please answer, once and for all, if the MEN SHOULD SIT TO URINATE when double voiding? Also, going forward, you might want to say something like
“obviously men usually stand when urinating but for this method, men should be SITTING
“. Needs to be clearer. Thanks

can a 26 year old suffer from BPH ?

Dr. Malik, I have urolift clips that were installed in 2017 and my prostate is getting larger. Would I be a candidate for the PAE procedure?



May I humbly ask u 2notcherrybloodpegeonrubyred ur lips . It knocks me flatout . Dont mind me :)

Hey Dr Malik! How are you? I absolutely LOVE your helpful informative videos. Please keep up the great work. You’re very professional intelligent knowledgeable helpful & experienced. I’m almost 64 and I’ve had problems with BPH for almost 10 years now. I’ve been experiencing urinary incontinence as well as fecal incontinence. Can BPH affect the rect as well if it’s large enough to press against it? Please let me know Rena. I really appreciate it very much. Take care and keep the wonderful videos coming.

Any suggestions on a reputable brand of saw palmetto? Thank you.


Hi Dr. Malik, I’m only 55 and have had enlarged prostate for about 2 years. Not severe enough to consider Euro-lift so my Dr wants to go in & cut the prostate. I’m concerned what the risk is regarding my erection & or ability to climax. Look forward to your response. Thank you & keep the videos coming.


Just watched Dr Ken Berry MD on YouTube who says hyper insulin is a cause of BPH 80% of the time. What do you think?

Thanks .. I had surgery to hollow out the tissue 25 years ago. Now it’s grown back. Will try the dairy and pumpkin seed oil and see how it goes.

Thank you