Enlarged prostate (BPH) in Taichung: symptoms, tests and treatment
Getting up several times at night. A weaker stream. Still feeling the need to go after you finish. These are the most typical signs of an enlarged prostate. But having symptoms does not mean you need an operation.
This page shows how to measure your symptoms, which treatment stage your score matches, and when surgery is worth considering.
Medically reviewed by Dr. Chao-An Chen, urologist, at 昭安泌尿科診所 (Morning Urology Clinic), West District, Taichung.
In short
- What it is: with age, the prostate grows and presses on the urethra (the tube that carries urine out). It is a common change with age, not prostate cancer.
- Symptoms: storage symptoms (going often, at night, sudden urges) and voiding symptoms (weak or stop-start stream, a feeling of not emptying).
- Self-assessment: the seven-question IPSS puts a number on how severe your symptoms are.
- Treatment: step by step, by severity: lifestyle changes, medicine, then surgery. For a prostate of about 30–80 mL, this clinic offers two minimally invasive procedures without a hospital stay. Finding BPH does not mean you need an operation.
What is an enlarged prostate?
The prostate sits at the outlet of the bladder and wraps around the urethra. With age, the gland tissue slowly grows and narrows the urethra. This causes urinary symptoms. The medical name is benign prostatic hyperplasia (BPH). The key word is “benign”: BPH and prostate cancer are two different conditions.
It is very common. Autopsy studies found it under the microscope in about 8% of men aged 31 to 40, about 50% at 51 to 60, and more than 80% after 80 (Berry and colleagues, 1984). But tissue changes do not always cause symptoms, and treatment is for the part that causes trouble.
Symptoms: storage and voiding
| Type | Symptoms | What it reflects |
|---|---|---|
| Storage | Going often, getting up at night, sudden urges, not reaching the toilet in time | The bladder becomes sensitive or overactive after long-term resistance at its outlet |
| Voiding | Weaker stream, waiting before urine starts, stop-start flow, pushing with the belly, feeling of not emptying | The urethra is squeezed, so urine meets more resistance |
Getting up at night (nocturia) is often the most troublesome symptom, because it affects sleep. But it does not always come from the prostate. If daytime symptoms are mild and night-time urination stands out, keep a three-day bladder diary first: see night-time urination: causes and how to keep the diary (Chinese).
Large-print pages for an older father: urine getting slower and harder to pass (Chinese) and going often and getting up at night (Chinese).
Measure first: the IPSS self-assessment
The IPSS (International Prostate Symptom Score) is the standard tool for measuring symptom severity. Seven questions cover the past month: needing to urinate again within 2 hours, urgency, how many times you get up at night, a weak stream, stop-start flow, pushing to start, and a feeling of not emptying. Each question has six answers, from “not at all” to “almost always” (for night-time urination, from 0 to 5 times or more). The total is from 0 to 35.
The Traditional Chinese version of this page has an interactive form (the Chinese version used in this clinic) that adds up your score as you answer, with no registration and no data stored. The result is for self-assessment only, not a diagnosis. Score meanings and follow-up: the IPSS self-assessment page (Chinese). Bring a screenshot of your score: the consultation can then start from the questions that trouble you most.
Which treatment stage does your score match?
| Total | Severity | Usual approach |
|---|---|---|
| 0–7 | Mild | Lifestyle changes and watching. Most men need no medicine. |
| 8–19 | Moderate | Medicine first. Surgery is an option if medicine does not work well enough or the side effects are hard to accept. |
| 20–35 | Severe | A full assessment: besides medicine, check for too much urine left in the bladder or damaged bladder function, and discuss minimally invasive surgery. |
The score shows how much symptoms bother you, not their cause. The same score can come from BPH, an overactive bladder, a urinary tract infection, stones, or a nerve-related bladder problem (neurogenic bladder). This is why objective tests are also needed.
Do not wait in these situations
- You cannot pass urine at all, and your lower belly is swollen and painful. This is acute urinary retention and needs a catheter (a drainage tube) at once. During consulting hours, come straight to the clinic. Outside consulting hours, go directly to an emergency department.
- Blood in the urine, with or without pain. It must be checked until a tumour is ruled out.
- Fever with pain in the side or back, when you have a stone or a known blockage of the urinary tract (for example a swollen kidney, or a double-J stent in place). Do not send a message and wait for a reply. Go directly to an emergency department.
- Fever and pain when you urinate (possible infection of the urinary tract or prostate). During consulting hours, tell us on LINE first. Outside consulting hours, go directly to an emergency department.
- Repeated urinary tract infections, or you have been told you have bladder stones or abnormal kidney function. See a doctor soon.
A large prostate does not mean severe symptoms
“My prostate is big. Is it serious?” is a common misunderstanding. Size is only weakly linked with symptom severity. Some men have a small gland but clear symptoms; others have a large gland and almost no trouble. Symptoms depend on where the blockage is and how well the bladder copes. This is why the decision to treat is not based only on the ultrasound number.
Tests at the clinic
- Urine flow test and residual urine ultrasound (Chinese): objective numbers for how well you pass urine. A questionnaire cannot give this.
- Urine test: to rule out infection and blood in the urine.
- PSA, with PHI if needed (Chinese): to rule out prostate cancer. If you take a 5-ARI (such as finasteride or dutasteride), total PSA falls to about half after 6 months of treatment, and this varies a lot between men (standard deviation 30%). Set a new PSA baseline after 6 full months, then watch for a confirmed rise. Do not just multiply your result by 2 at home.
- Cystoscopy, if needed: a direct look at the urethra and prostate.
Weaker urination is not always BPH; it may come from the bladder or the nerves. The IPSS score, urine flow rate and urine left in the bladder together show where the problem is. All three can be done on the day of your visit. If your score is not high but you are worried, the objective tests come first, before any talk of medicine.
Book an assessment on LINETreatment steps: lifestyle, medicine, surgery
Step 1: lifestyle changes
Drink less in the 2 hours before bed. Have less caffeine and alcohol. Avoid long sitting and holding urine. Check whether you take medicines that affect urination, such as diuretics (water tablets). For mild symptoms, this may be enough.
Step 2: medicine, and the side effects of each type
- Alpha-1 blockers (for example tamsulosin) relax the smooth muscle of the prostate and bladder neck, and work within a few days. Possible side effects: low blood pressure on standing up, dizziness, and much less or no semen at ejaculation (semen release is blocked; it is not true retrograde ejaculation). This is more common with the more selective medicines. A systematic review found no effect on sex drive or erections. If this matters to you, discuss an adjustment with the doctor (see retrograde ejaculation: which medicines and operations cause it (Chinese)).
- 5-ARIs (5-alpha reductase inhibitors, such as finasteride and dutasteride) shrink the gland and suit larger glands. They work slowly: the effect versus placebo shows only after at least six months, and the gland usually shrinks, and PSA falls by about half, after six to twelve months. They may lower sex drive, cause erection difficulty and reduce semen volume. Taiwan’s Food and Drug Administration (TFDA) warned in 2025 that finasteride tablets may cause low mood, depression and suicidal thoughts. For dutasteride, the evidence is not enough to show a cause, but mood should be watched during treatment. Tell the doctor if your mood changes. After 6 months, a new PSA baseline must be set (Chinese).
- Daily low-dose tadalafil improves both urinary symptoms and erections, and suits men with both. The EAU guidelines (2026) strongly recommend it for moderate to severe urinary symptoms, with or without erection problems. In trials, symptom scores improved, but maximum urine flow did not improve significantly. Together with an alpha blocker: Taiwan’s product information does not recommend this for BPH, while EAU 2026 lists it as an option to consider (weak recommendation, small benefit). The clinic decides by your symptoms and blood pressure. Do not add or stop medicines on your own. With reduced kidney function, the starting dose is adjusted; if it is severe, daily use is not recommended. Common side effects in BPH trials: headache, indigestion, back pain and muscle pain. Never combine it with nitrate medicines (including tablets under the tongue for angina) or nitrite inhalants: see erection medicines and “poppers” (Chinese).
- Combination tablets combine these actions, so you take fewer tablets.
Step 3: surgery
Surgery is discussed only when medicine does not work well, you do not want long-term medicine, or complications have appeared. See the next section.
When should you consider surgery?
If any one of these applies, surgery should be assessed seriously:
- Medicine does not work well, or you cannot accept its side effects (especially changes in ejaculation).
- You have had acute urinary retention.
- Repeated urinary tract infections, or bladder stones.
- Long-term blockage has damaged bladder function or kidney function.
- Repeated blood in the urine that comes from the prostate.
Do not wait until you cannot pass urine at all. A bladder working against high resistance for a long time may lose function for good, and urination may then not return to a good level even after the blockage is removed.
This clinic offers two minimally invasive procedures without a hospital stay. They differ in how they work, recovery and who they suit:
- Rezūm water vapour therapy: the improvement may be larger, but takes weeks to months.
- UroLift prostatic urethral lift: improvement comes sooner, but the objective improvement in urine flow is usually smaller than after surgery that removes tissue (resection).
The doctor explains the differences, and you decide together. See the full comparison of the two procedures.
If you choose one of the two procedures
- Three visits: the assessment and blood test before surgery; the surgery day (you go home the same day); and a return visit to remove the urinary catheter. After Rezūm, there is also a visit at about 3 months to review your medicines.
- Anaesthesia and waiting time: both are done under sedation. After you decide, the wait is usually about one week, depending on the anaesthesiologist’s schedule.
- Tests before surgery: the urine flow test, residual urine ultrasound and PSA are covered by National Health Insurance. If you are not enrolled in Taiwan’s National Health Insurance, the consultation and tests are self-paid.
- Costs: Costs are explained at the consultation. You can also ask about costs on LINE before you come. The cost depends on prostate size and the procedure, and is given in writing after the assessment.
Prostate larger than 80 mL: which operation?
The two procedures at this clinic suit a prostate of about 30–80 mL. Above 80 mL, for men who can pause anticoagulants (blood thinners), the European Association of Urology (EAU) 2026 guidelines list three first choices: open surgery (only when equipment for endoscopic enucleation is not available), holmium laser enucleation (HoLEP) and bipolar enucleation. Thulium laser enucleation, laser vaporisation and traditional resection are alternatives. For high-risk men who cannot stop anticoagulants, the first choice is laser vaporisation.
In endoscopic enucleation, the surgeon works through the urethra, peels the enlarged gland off along its capsule, then breaks it up or cuts it into pieces and removes it. These operations need spinal or general anaesthesia, and most need a hospital stay.
Still start with a clinic visit: prostate volume, urine flow, residual urine and PSA. The doctor explains which operation suits you. If you have an ultrasound or health check report, book on LINE and bring it.
Book an assessment on LINEBefore enucleation surgery, know this
- Most men have no semen coming out at ejaculation (retrograde ejaculation): about 3 in 4 in studies.
- At first: stinging when urinating, going often, urgency, blood in the urine. A few men cannot pass urine after the catheter is removed and need it put back. A few need a blood transfusion.
- Early leaking of urine is not unusual (in studies of large prostates, about 4 in 10 at 6 weeks and about 15% at 3 months). Most men improve. At one year, about 1–6% still leak, depending on the study definition. The larger the prostate, the higher the chance of early leaking.
- When the tissue is broken up, a few men have an injury to the bladder lining (about 1–5% in studies).
- Later treatment may be needed for narrowing of the urethra (about 2–5%), tightening of the bladder neck (about 1–2%) or regrowth of the gland (about 1%). The first two are more common with smaller prostates. After holmium laser enucleation, with about 7 years of follow-up, about 4% needed another operation in total (studies count this differently).
- The removed tissue goes for pathology testing. In about 5% or more, prostate cancer is found by chance. You are told the result. If cancer is found, the doctor assesses its extent and arranges follow-up or treatment under prostate cancer guidelines. Laser vaporisation burns the tissue, so there is no sample to test. If your PSA is high, the doctor checks for prostate cancer before discussing surgery.
Process, risks and who should not have it: holmium laser enucleation (HoLEP): who it suits.
Does BPH affect your sex life?
There is a link, in three layers: BPH itself, the medicines, and surgery.
BPH itself. In studies, about 70 to 80% of men seeking care for urinary symptoms also had some erection problems (including mild), and more often when urinary symptoms were more severe. With diabetes, look at both: high blood sugar makes more urine, so IPSS frequency (question 1) and night-time (question 3) scores may rise for reasons other than the prostate. Diabetes also affects bladder sensation and squeezing, and is a common factor in erection problems. See how erection problems are assessed (Chinese).
Medicines. Effects on ejaculation, sex drive and erections are listed under Step 2.
Surgery. After traditional resection (TURP), less semen or none at ejaculation is common. The EAU 2026 guidelines say the urethral lift can be offered to men who care about ejaculation, whose prostate is smaller than 70 mL, with no protruding middle lobe. Water vapour therapy studies follow men with erection and ejaculation questionnaires. Most follow-up is 5 years or less, and results differ between people.
Both can need further treatment (studies count this differently). In multicentre trials against a sham procedure, repeat surgery within 5 years was about 4.4% after water vapour therapy and 13.6% after the urethral lift. A systematic review found that up to about 11% restarted medicine within 5 years after either procedure. The guidelines also note that the urethral lift has a higher re-treatment rate than traditional resection. Details: water vapour therapy or urethral lift.
Urination and erections can be assessed at one visit. Bring your IPSS score and a photo of your medicine bags. The doctor will plan the order of medicine or surgery.
Book a urinary and erection assessment on LINEFrequently asked questions
Can an enlarged prostate turn into cancer?
No. They are different diseases in different parts of the prostate (BPH mostly in the transition zone, cancer mostly in the peripheral zone). But both can exist together, so PSA is still checked.
Do I have to take medicine for life?
Not always. Mild symptoms may need only lifestyle changes. If symptoms are stable on medicine, you can discuss adjusting it. If you do not want long-term medicine, minimally invasive surgery can be discussed.
Can I take saw palmetto, pumpkin seed or lycopene instead of medicine?
Discuss it with the doctor. Their effect is small, results are not consistent, and they cannot replace tests. A 2023 Cochrane review found saw palmetto alone gives almost no improvement. None of Taiwan’s 14 approved health food claims is about the prostate. With blood in the urine or past inability to pass urine, see a doctor first. Do not stop prostate medicine to switch to supplements on your own.
My score is low. Do I need to see a doctor?
If your quality of life is not affected and there are no warning signs, start with lifestyle changes and check your score from time to time. But with blood in the urine, or if you have ever been unable to pass urine, see a doctor whatever the score.
How often should I repeat the score?
About 4 to 12 weeks after starting treatment. The change in score is a more reliable measure than how you feel.
Can I donate blood while taking BPH medicine?
It depends on the medicine. The Taiwan Blood Services Foundation’s deferral notice names two 5-ARIs, because they can harm an unborn baby: wait 6 months after dutasteride (from the last dose) and 1 month after oral finasteride. Two-ingredient tablets containing either (for example with tamsulosin or tadalafil) are not listed separately, so write all ingredient names on the form; for dutasteride with tamsulosin, the product information also says at least 6 months after the last dose. Alpha-1 blockers such as tamsulosin have no entry: write the name on the form and staff decide. Do not stop medicine to donate; ask the doctor first (blood donation after dutasteride (Chinese)). Over 65, you can continue only if you donated within the past 2 years; otherwise you cannot start again. Other rules follow the blood centre.
Related pages
- Rezūm or UroLift: a full comparison
- Urine flow test and residual urine ultrasound (Chinese)
- PSA and the Prostate Health Index (PHI) (Chinese)
- Changes in sex drive or erections after a 5-ARI (Chinese)
- Microscopic blood in the urine and when cystoscopy is needed (Chinese)
- Urinary tract infections in men (Chinese)
Appointments and access
Consultations are conducted in Mandarin, and can also be conducted in English.
Bring a screenshot of your IPSS score. The urine flow test and residual urine ultrasound are done on the day, with no separate test day. The clinic has private consulting rooms and separate patient flow. Evening consultations run until 21:00.
昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.
This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: October 2026 (same as the Traditional Chinese version). English version published: 5 November 2026. Medically reviewed by Dr. Chao-An Chen, urologist.
Sources: EAU Guidelines on Non-neurogenic Male LUTS (2026) / Taiwan FDA-approved product information / Berry 1984 / Seftel 2013 / Rosen 2003 / McVary 2021 / Roehrborn 2017 / Baboudjian 2023 / Taiwan FDA risk communication on finasteride and dutasteride (10 June 2025) / Franco 2023 (Cochrane) / Vahlensieck 2015 / Taiwan FDA, 14 health food claims (3 July 2025).
This page provides general medical information and does not replace an individual diagnosis or treatment plan. Indications, risks, recovery and costs are decided at a consultation with a doctor. Content on medicines and devices follows the product information approved in Taiwan.