Benign Prostatic Hyperplasia (BPH) With Obstruction: Why It Matters and How We Treat It

Benign prostatic hyperplasia, or BPH, is one of the most common conditions men face as they get older. By age 60, more than half of men will have some symptoms of an enlarged prostate. While many think of BPH as just a nuisance—needing to urinate more often or getting up at night—what many don’t realize is that BPH with obstruction can cause serious, lasting damage if it’s not properly evaluated and treated.

At Atlanta Prostate Center, we believe that BPH deserves careful attention, because untreated obstruction can lead not only to bothersome symptoms, but also to permanent bladder damage and even kidney problems. The good news is that modern evaluation tools and minimally invasive therapies make it possible to diagnose and treat BPH effectively—without major surgery.

Understanding BPH and Obstruction

What Is BPH?

The prostate is a walnut-sized gland that sits just below the bladder and surrounds the urethra, the tube that drains urine. As men age, the prostate commonly grows. This enlargement is called benign prostatic hyperplasia (BPH).

What Happens With Obstruction?

In many men, the enlarged prostate presses on or squeezes the urethra. This creates bladder outlet obstruction (BOO)—essentially a blockage that makes it difficult for the bladder to empty fully.

Symptoms can include:

Weak urine stream
Hesitancy (difficulty starting urination)
Frequent urination, especially at night
Urgency (feeling you must go right away)
A sense that the bladder never fully empties

At first, these symptoms are mainly bothersome. But over time, chronic obstruction can damage the bladder and kidneys.

Why Untreated BPH With Obstruction Is Dangerous

When the bladder has to constantly push against an obstruction, several harmful things happen:

Permanent Bladder Damage
- The bladder wall thickens and becomes less elastic.
- Over time, the bladder loses its ability to contract effectively.
- This can result in chronic urinary retention (urine sitting in the bladder all the time), leading to infections and long-term catheter dependence.
Kidney Damage From Backpressure
- If the bladder cannot empty, pressure builds inside it.
- High bladder pressures can cause urine to reflux back toward the kidneys (vesicoureteral reflux).
- This backpressure can impair kidney function and, if untreated, lead to renal damage or even kidney failure.
Infections and Stones
- Stagnant urine in a partially obstructed bladder increases the risk of urinary tract infections and bladder stone formation.

This is why BPH is not just a quality-of-life issue. Left untreated, obstruction can cause permanent, irreversible harm.

Modern Testing for BPH

The good news is that today we have non-invasive, accurate ways to diagnose obstruction before serious damage occurs.

UroCuff: Simple, Non-Invasive Testing

UroCuff is a quick, office-based test that evaluates bladder pressure and urine flow without needing catheters.
It involves a pressure cuff around the penis (similar to a blood pressure cuff) that gently occludes flow while urinating.
From this, the system calculates whether there is obstruction and how the bladder is functioning.
It’s painless, quick, and highly informative—an excellent first-line test.

Urodynamics (UDS): Gold Standard Testing

In cases where more detail is needed, we use urodynamic studies (UDS).
This test uses very small catheters to measure bladder pressures, capacity, contractility, and the presence of obstruction in detail.
It remains the most accurate test for diagnosing bladder dysfunction and outlet obstruction.

Cystoscopy: Looking at the Anatomy

A cystoscopy is a simple office procedure using a tiny camera to look inside the urethra and bladder.
This allows us to directly evaluate:
- The size and shape of the prostate
- Whether there is a median lobe protruding into the bladder
- The overall condition of the bladder lining
Cystoscopy helps guide treatment choice by showing whether you are a good candidate for minimally invasive therapies like Urolift or PAE.

Modern Treatments for BPH: Minimally Invasive, No Major Surgery

In the past, men with severe BPH often faced major surgery, such as a TURP (transurethral resection of the prostate). While effective, TURP can involve bleeding, hospitalization, and significant side effects.

Today, we can treat BPH effectively with minimally invasive procedures that avoid the risks of traditional surgery.

UroLift: Mechanical Opening of the Channel

UroLift is a simple, minimally invasive procedure done in the office or outpatient setting.
Small permanent implants are placed through a scope into the prostate.
These implants act like curtain tiebacks, gently pulling the enlarged prostate tissue aside and opening the urethral channel.
Key benefits:
- Rapid symptom relief
- No cutting or removing tissue
- Minimal sexual side effects—erectile and ejaculatory function usually preserved
- Usually no catheter required after the procedure

Prostate Artery Embolization (PAE): Shrinking the Prostate From the Inside

PAE is performed by an interventional radiologist through a tiny puncture in the groin or wrist.
Using catheters and imaging, the arteries that feed the prostate are selectively blocked.
This starves the prostate of excess blood supply, causing it to shrink.
Key benefits:
- Minimally invasive, no incisions
- Often performed under light sedation, not general anesthesia
- Safe for men who are not good candidates for surgery
- Improvement in urinary symptoms over several weeks as the prostate shrinks

Both UroLift and PAE are well-tolerated, outpatient solutions that provide long-lasting relief from obstruction without the risks of major surgery.

Why Early Evaluation Is So Important

Because untreated obstruction can lead to permanent bladder damage and kidney injury, men should not ignore urinary symptoms. The earlier we evaluate, the more treatment options you have and the better your outcomes.

At Atlanta Prostate Center, we follow a stepwise, patient-centered approach:

Symptom assessment with simple questionnaires and discussion.
Non-invasive testing (UroCuff) to quickly screen for obstruction.
Further studies (urodynamics, cystoscopy) when needed for detail.
Tailored treatment, starting with the least invasive option that will effectively relieve obstruction and protect bladder/kidney health.

Key Takeaways

BPH with obstruction is not just a nuisance. Untreated, it can cause permanent bladder dysfunction and kidney damage due to backpressure and reflux.
Non-invasive testing like UroCuff makes it easy to evaluate bladder pressure and flow. Urodynamics and cystoscopy provide more detailed insight when needed.
Minimally invasive therapies such as UroLift and PAE allow men to get relief without major surgery, preserving quality of life.
Early diagnosis and treatment are critical to prevent irreversible damage.

Final Word

At Atlanta Prostate Center, we take BPH seriously because we’ve seen the consequences of untreated obstruction. Fortunately, with today’s diagnostic tools and minimally invasive therapies, men no longer need to choose between “living with it” or undergoing major surgery. Whether through UroLift, PAE, or other modern options, we can help restore normal bladder function, protect your kidneys, and dramatically improve your quality of life.

If you’re experiencing urinary symptoms such as weak stream, frequency, or incomplete emptying, don’t wait. The earlier we evaluate, the more options you’ll have—and the better your long-term outcomes will be.

by Dr Dev Mally

Director of Surgical Oncology