Enlarged Prostate (BPH): Urinary and Sexual Effects in Men

Benign prostatic hyperplasia (BPH) compresses the urethra, causing lower urinary tract symptoms (LUTS) and sexual dysfunction.

Urinary Interference

• Bladder Outlet Obstruction: Weak stream, hesitancy, straining, intermittency.
• Incomplete Emptying: Post-void residual ↑ → UTI risk, bladder decompensation.
• Storage Symptoms: Frequency, urgency, nocturia, urge incontinence.
• Post-Void Dribbling: Urine trapped in urethra.

Sexual/Reproductive Interference

• Ejaculatory Dysfunction: Retrograde ejaculation (semen into bladder) from bladder neck incompetence or medication side effect (alpha-blockers).
• Erectile Dysfunction (ED): Shared risk factors (age, vascular disease); BPH meds (5-ARIs) may ↓ libido/ED.
• Reduced Semen Volume/Quality: Obstruction of ejaculatory ducts; inflammation alters seminal fluid.

Management

• Lifestyle: limit caffeine/alcohol, timed voiding, pelvic floor exercises.
• Medications: Alpha-blockers (tamsulosin) for symptoms; 5-ARIs (finasteride) shrink prostate.
• Procedures: UroLift, Rezūm, TURP, HoLEP for refractory cases.
• ED treatment: PDE5 inhibitors (tadalafil also approved for BPH).

See a urologist for IPSS scoring, flow rate, residual ultrasound. Treatment tailored to symptom burden and goals.