Benign Prostatic Hyperplasia (Enlarged Prostate)

What it is

The prostate is an organ unique to men, encircling the urethra at the base of the bladder like a ring. A healthy prostate is roughly the size of a small strawberry (about 15 to 20 ml), but it tends to enlarge with age, sometimes reaching the size of a kiwi fruit or avocado.

As the enlarged prostate presses on the urethra, the passage for urine narrows. In its earlier stages this tends to over-stimulate the bladder, producing storage symptoms such as frequent urination, nighttime urination, and a feeling of incomplete emptying, alongside voiding symptoms such as a weak or hesitant stream. Left untreated over a long period, this can lead to bladder diverticula, an inability to urinate at all with overflow incontinence, or complications including impaired kidney function, urinary tract infection, and bladder stones.

Symptoms

For men over 50, the following symptoms occurring regularly can suggest benign prostatic hyperplasia.

• Getting up two or more times a night to urinate
• Feeling the need to urinate again within two hours of your last visit
• A urine stream that starts and stops
• Needing to strain to urinate
• A feeling that urine remains after you have finished

Diagnosis

Where this condition is suspected, a treatment plan is generally based on a symptom questionnaire, ultrasound measurement of prostate volume, a flow-rate test, and a blood test (PSA). Suitable treatment can often improve these symptoms considerably, so please come in and talk to us if this is a concern.

Benign prostatic hyperplasia and prostate cancer are both conditions that affect the prostate, but they are distinct diseases. Benign prostatic hyperplasia causes urinary symptoms because the enlarged prostate presses on the urethra. As part of your diagnosis, we also carry out a blood test (PSA) to check for the possibility of prostate cancer.

Treatment

Treatment falls into medication and surgery, and generally begins with medication.

Medication

Where symptoms are relatively mild, medication is the usual starting point. A range of medications is available, and your physician selects one based on prostate size, symptoms, and any medication you already take, sometimes switching or combining medications as your symptoms are reviewed.

The specific medication prescribed is determined by your physician according to your symptoms and constitution. Some medications require caution or are contraindicated in certain situations; please confirm details with us at your consultation.

Surgery

Surgery is considered where medication alone does not sufficiently improve symptoms, or where urinary tract infection, urinary retention, bladder stones, or impaired kidney function are present. Endoscopic surgery is now the standard approach, placing less burden on the body than open surgery. These procedures widen the urethral passage through the prostate using an electric cautery loop, a laser to enucleate the tissue, or vaporisation, depending on the technique; all are covered under Japanese national insurance, and the choice depends on the equipment available and the surgeon's experience.

Our approach

Four surgical options, including robotic and two newer minimally invasive techniques

We offer robotic and minimally invasive surgical options intended to help preserve sexual function and reduce post-operative complications. Taking into account each patient's circumstances (age, lifestyle, other conditions) and prostate size, we offer four surgical approaches in total, including the conventional transurethral resection of the prostate: a robotic procedure (Aquablation), and two minimally invasive procedures (transurethral water vapour therapy, known as WAVE or Rezum, and transurethral prostate lift, known as Urolift).

• Robotic surgery: Aquablation
• Minimally invasive surgery: transurethral water vapour therapy (WAVE / Rezum)
• Minimally invasive surgery: transurethral prostate lift (Urolift)
• Conventional approach: transurethral resection of the prostate (TURP)

No referral letter required

General hospitals typically require a referral letter from your regular doctor; this hospital accepts patients without one. We also hold clinic three days a week, making it easier to fit a visit around your schedule. Please feel free to talk to us, in the same way you might visit a familiar local doctor.

A prompt path to surgery, with safety in mind

We are generally able to arrange surgery within one to two months. A shorter operating time and shorter time under anaesthesia both mean less burden on the body.

The path from consultation to surgery

• First visit: no referral letter is required. We ask about your symptoms, their history, and any medication you are currently taking.
• Examinations: a symptom questionnaire, ultrasound measurement of prostate volume, a flow-rate test, and a blood test (PSA).
• Explaining the treatment plan: based on the results, we discuss whether to begin with medication or move to surgery. Where surgery is considered, we propose an approach based on prostate size, age, and other conditions.
• Scheduling surgery: this can generally be arranged within about one to two months.
• Surgery and hospital stay: depending on the procedure, this ranges from a day case to about four nights, five days.

Comparing the four surgical options

This table summarises information described in the text below. Please ask us at your consultation for details on eligibility and cost in your own case.

Aquablation (robotic surgery)

This technique received Japanese insurance coverage in 2023. Rather than an electric cautery or laser, it uses the force of water to remove the enlarged prostate tissue. An experienced urologist determines the area to be removed using ultrasound, and a robotic system then carries out the resection quickly and precisely under that instruction. As the urinary passage widens, urine flow can be expected to improve, along with a reduction in the bladder over-stimulation behind frequent and nighttime urination. Compared with conventional surgery, operating time and blood loss are both generally lower, and because the ejaculatory ducts can typically be preserved, ejaculatory function that is often affected by conventional surgery may also be preserved.

Advantages

• Uses water, rather than heat, to remove prostate tissue.
• The robotic system removes the enlarged tissue automatically, which tends to mean a shorter resection time with less variation.
• Where the ejaculatory ducts can be preserved by the robot's precision, ejaculatory and erectile function may be maintained after surgery.
• Because a robotic system performs the resection, outcomes depend less on any individual surgeon's technique.
• Operating time, anaesthesia time, and blood loss are generally lower than with conventional surgery, meaning less burden on the body.
• Rates of post-operative incontinence and urethral stricture (narrowing of the urinary passage) are reported to be lower than with conventional surgery.

Considerations

Insurance coverage is limited to relatively large cases, with a prostate volume of 50 ml or more.

Time required

Even where the prostate is as large as an avocado, resection typically takes under ten minutes. Recovery from general anaesthesia takes about one to one and a half hours.

The 20%/10% co-payment figures are approximate reference values calculated from the 30% co-payment amount above. Please confirm the exact amount with us at your consultation.

This is covered under Japan's high-cost medical care programme; please ask us for details.

Transurethral water vapour therapy (WAVE / Rezum)

This technique, using the Rezum device, inserts a specialised needle through the urethra into the prostate and releases water vapour at 103°C into the tissue. The heat causes the treated prostate tissue to die off and be gradually reabsorbed by the body over one to three months. As the prostate volume shrinks, urination generally becomes easier. This received Japanese insurance coverage in 2022.

Advantages

• Uses water vapour rather than an incision.
• A short operating time with minimal blood loss means less burden on the body.
• Can be performed even for patients taking blood-thinning medication.
• Because no tissue is cut or shaved away, post-operative pain tends to be lower.
• Where the ejaculatory ducts can be preserved, ejaculatory and erectile function may be maintained after surgery.
• Post-operative incontinence and urethral stricture are uncommon with this procedure.

Considerations

A urinary catheter is typically needed for five to seven days after the procedure, and it can take around one to three months to feel the full effect.

Time required

The procedure itself takes about five minutes, with recovery from general anaesthesia taking about fifteen to thirty minutes.

The 20%/10% co-payment figures are approximate reference values calculated from the 30% co-payment amount above. Please confirm the exact amount with us at your consultation.

This is covered under Japan's high-cost medical care programme; please ask us for details.

Transurethral prostate lift (Urolift)

This technique uses a dedicated device to place small implants through the urethra into the prostate, holding open the passage narrowed by the enlarged tissue. Because no prostate tissue is cut or burned away, it places relatively little burden on the body, and because the urethra tends to widen soon after the procedure, an early improvement can often be expected. This received Japanese insurance coverage in 2022.

Advantages

• Used in roughly 300,000 procedures worldwide to date.
• A short operating time with minimal blood loss means less burden on the body.
• Because no heat is used, the urinary catheter can typically be removed the day after surgery.
• A return to ordinary activity within about two weeks can often be expected, supporting an earlier return to daily life.
• Can be performed even for patients taking blood-thinning medication.
• Because no tissue is cut or shaved away, post-operative pain tends to be lower.
• Where the ejaculatory ducts can be preserved, ejaculatory and erectile function may be maintained after surgery.
• Post-operative incontinence and urethral stricture are uncommon with this procedure.

Considerations

• Less effective for a larger prostate, above about 80 ml.
• Depending on the shape of the prostate, this procedure may not be suitable for everyone.

Time required

The procedure itself takes about fifteen minutes, with recovery from general anaesthesia taking about thirty to sixty minutes.

The 20%/10% co-payment figures are approximate reference values calculated from the 30% co-payment amount above. Please confirm the exact amount with us at your consultation.

This is covered under Japan's high-cost medical care programme; please ask us for details.

Transurethral resection of the prostate (TURP)

This conventional approach removes the enlarged prostate tissue with an electric cautery loop, inserted endoscopically through the urethra. It has long been the standard surgical approach and has a substantial track record. We may select this approach depending on prostate size and each patient's circumstances. Operating time, length of hospital stay, and cost vary with prostate size and the patient's condition, and are explained in detail at your consultation.

Surgeon

This procedure is performed by 加藤 大貴 (Head of Urology; PhD). He is a board-certified Urologist and instructor of the Japanese Urological Association, a certified specialist of the Japanese Continence Society, a certified specialist of the Japanese Society of Pediatric Urology, and a certified cancer specialist of the Japan Board of Cancer Therapy.

Go to the Urology / Female Urology page

Q&A

What does the prostate do?

It produces part of the fluid in semen. Prostatic fluid nourishes sperm at ejaculation and supports their motility.

What is a typical, healthy urination frequency and volume?

Around five to seven times during the day and none overnight, with each urination around 200 to 400 ml, though this varies with age.

When is a good time to see a urologist?

If you find yourself getting up twice or more overnight, or if frequent urination is getting in the way of work, golf, a bus trip, going to the cinema, or another part of daily life, or you find yourself avoiding such things because of it, that is a reasonable time to come in.

At what age does this condition appear, and is it hereditary?

Generally from age 50 onward. A hereditary influence has been reported; men whose father or brother has had an enlarged prostate are reported to be more likely to develop it themselves.

Does an enlarged prostate get worse over time?

It can. Among patients with this condition, the prostate is reported to grow by roughly 1.6 to 2.6% a year on average, with research suggesting a larger prostate tends to grow faster. That said, some men's prostates do not enlarge significantly even as they age; not every man develops this condition, and the degree varies from person to person.

How many people in Japan have this condition?

Among men with urinary symptoms attributed to prostate enlargement, this is reported in roughly 6% of men in their sixties, 12% in their seventies, and around 25% from their eighties onward. Around 30,000 people undergo surgery for this condition in Japan each year.

After surgery, can medication be stopped?

Many patients are able to stop their prostate medication after surgery.

I take blood-thinning medication. Can I still have surgery?

Transurethral water vapour therapy (WAVE / Rezum) and transurethral prostate lift (Urolift) can both be performed even for patients taking blood-thinning medication.

Can I discuss surgery without a referral letter?

General hospitals typically require a referral letter from your regular doctor; this hospital accepts patients without one, and holds clinic three days a week.

Speak with us about surgery for an enlarged prostate