This blog post is based on insights from Dr. Priyadarshi Ranjan’s educational discussion on Sehatnama. Video Source: Sehatnama Channel Interview – “Prostate Gland Problems, Symptoms & Modern Treatments”
Have you ever stood in front of a urinal, waiting… and waiting… while nothing happens? Or noticed your urine stream isn’t as strong as it used to be? If you’re a man over 40, these might not just be “signs of aging”—they could be early warnings of Benign Prostatic Hyperplasia (BPH), a condition that affects nearly 90% of men over 80.
The good news? Modern medicine has evolved beyond risky surgeries and side-effect-heavy medications. In this guide, we’ll explore PROMIS therapies—revolutionary treatments that fix your urine flow without destroying your quality of life or sexual health, based on insights from Dr. Priyadarshi Ranjan, one of India’s top urologists and among the world’s top 10 robotic kidney transplant surgeons.
What Is the Prostate and Why Does It Matter?
The “Gatekeeper” Gland You Can’t Ignore
The prostate gland—called “gadud” in Hindi and Punjabi—acts like a gate for your urinary bladder. Dr. Ranjan explains it simply: “Just like a gate at your home, this gland surrounds the opening of the urine bladder. In your youth, it serves an important reproductive function by producing nutritional fluid for sperm. But after age 40-45, it starts enlarging.”
For Example: Imagine your bladder’s exit is a wooden door when you’re young—easy to open and close. As you age, that door turns into a heavy steel gate that gets stuck. That’s exactly what happens when BPH develops.
Why Does the Prostate Enlarge?
BPH isn’t caused by poor lifestyle choices or something you did wrong. It’s a universal aging phenomenon linked to testosterone. As Dr. Ranjan notes: “Just as women experience menopause, men experience andropause. This is a natural part of aging—like gray hair. Some get it at 40, others at 60, and a few lucky ones at 80.”
Early Warning Signs: Don’t Ignore These Symptoms
Most men dismiss early BPH symptoms as “just getting old.” Dr. Ranjan emphasizes that awareness is your best defense against serious complications. Here are the symptoms to watch for:
Stage 1: Early Symptoms (Often Ignored)
| Symptom | What It Feels Like | Why Men Miss It |
| Hesitancy | Standing at the toilet for 5-10 seconds before urine starts | Thought to be “normal aging” |
| Straining | Needing to push with abdominal muscles to start urinating | Assumed to be temporary |
| Poor Flow | Weak stream that falls near your feet instead of 2 feet away | Blamed on bladder not being full |
| Intermittency | Stop-start urination taking 4-5 attempts to finish | Considered inconvenient but not serious |
Dr. Ranjan’s Insight: “In my 20+ years of practice, barely 1% of educated patients report hesitancy as a symptom. They think it’s normal. But if you’re waiting 5-6 seconds every time while younger men urinate immediately, that’s not normal—that’s your first warning.”
Stage 2: When You Should Act (The “Red Flag” Symptoms)
If you experience these symptoms more than 50% of the time (6-7 out of 10 bathroom visits), you need medical evaluation:
- Feeling of incomplete emptying: Urine comes out, but your bladder still feels full
- Burning or pain during urination
- Blood in urine (hematuria)
- Frequent UTIs (urinary tract infections)
- Nocturia: Waking up 3-4 times nightly to urinate
- Urgency: Sudden, uncontrollable need to find a bathroom immediately
Stage 3: Emergency Complications (Never Ignore These)
Untreated BPH can lead to life-altering complications:
- Complete urinary retention: Unable to pass urine at all (requires emergency catheterization)
- Bladder stones: Stagnant urine forms calcium deposits
- Kidney damage: Back pressure from straining damages kidney valves
- Hernia: Excessive straining weakens abdominal muscles
- Kidney failure: The most severe outcome in unfortunate cases
For Example: Dr. Ranjan shares a common scenario: “A businessman comes to me after an Income Tax raid or ED notice. The stress triggered acute urinary retention. While the raid was unrelated to his prostate, the stress exposed an underlying condition that needed attention.”
Traditional Treatments: Why Many Men Refuse Them
The Medication Dilemma
Doctors commonly prescribe two drug types:
- Alpha-blockers (e.g., Flomax, Urimax): Relax bladder neck muscles
- 5-alpha reductase inhibitors (e.g., Finasteride, Dutasteride): Shrink prostate bulk
- The Hidden Costs:
- Postural hypotension: Sudden blood pressure drops causing dizziness and falls (especially dangerous at night)
- Sexual dysfunction: 100% risk of retrograde ejaculation (semen flows backward into bladder)
- Fatigue and weakness: Affects 60-70% of users
- Loss of libido: Often permanent even after stopping medication
Dr. Ranjan warns: “In Western practice, 60-70% of educated patients refuse these medications when informed of side effects. Yet in India, they’re prescribed over-the-counter without proper counseling. Self-medication based on ‘Sharma ji’s advice’ is extremely harmful—every man’s prostate anatomy is different.”
The Surgery Problem: TURP and Its Brutal Reality
Transurethral Resection of the Prostate (TURP) and laser variations have been standard for 20+ years, but Dr. Ranjan stopped performing them after thousands of procedures:
Common Surgical Complications:
- Incontinence: Permanent urine leakage requiring diapers
- Retrograde ejaculation: 100% occurrence rate
- Erectile dysfunction: Significant risk
- Urethral strictures: Scar tissue narrowing the urethra
- Bleeding and extended catheterization
“After performing thousands of TURPs, I realized it’s a brutal procedure. When complications hit that 4-5% of patients, their lives are devastated. A 50-year-old socially active man wearing diapers? That’s not a successful outcome.” — Dr. Priyadarshi Ranjan
The PROMIS Revolution: Modern Treatments That Preserve Your Life
Enter PROMIS—Prostate Minimally Invasive Surgical Treatments. These day-care procedures offer relief without the devastating side effects of traditional surgery.
Treatment Comparison: Old vs. New
| Feature | Traditional TURP/Laser | PROMIS (Urolift/Rezum) |
| Hospital Stay | 2-3 days | 4 hours (day-care) |
| Anesthesia | General/Spinal | Local (numbing jelly only) |
| Recovery Time | 4-6 weeks | 2-3 days |
| Sexual Function | High risk of dysfunction | Zero risk |
| Incontinence Risk | 4-10% | Nearly 0% |
| Bleeding | Common | None |
| Catheter Duration | 3-7 days | None or 1 day |
Urolift: The “Clip” That Opens Your Flow
How it works: Tiny implants are placed through a cystoscope to lift and hold enlarged prostate tissue away from the urethra—like tying back curtains to open a window.
Benefits:
- Immediate relief: Patients urinate freely right after the procedure
- No cutting, burning, or removal of prostate tissue
- Preserves sexual function completely
- No erectile dysfunction or ejaculation issues
For Example: A 55-year-old executive can have the procedure at 9 AM, work on his laptop in the recovery room, and attend a dinner meeting that evening—with no one knowing he had treatment.
Rezum: Steam Therapy That Shrinks the Prostate
How it works: Water vapor (steam) is injected into prostate tissue. The body naturally absorbs the treated tissue over 2-3 weeks, shrinking the prostate and opening the urinary channel.
Benefits:
- Natural absorption: Body clears treated tissue gradually
- No implants left behind
- Painless procedure (90% of patients need only local anesthesia)
- Long-term results with minimal follow-up
Who Qualifies for PROMIS?
These treatments work best for:
- Men with moderate BPH symptoms
- Those wanting to preserve sexual function
- Patients unwilling to take daily medications
- Men with prostates up to 80-100cc (size limitations apply)
- Those seeking quick recovery with minimal downtime
Can You Prevent Prostate Enlargement?
The honest answer? No.
As Dr. Ranjan explains: “You cannot prevent BPH any more than you can prevent gray hair. It’s a universal phenomenon linked to male hormones. However, you CAN prevent complications through early awareness.”
Prevention Strategies That Actually Work
While you can’t stop the prostate from growing, you can prevent the severe outcomes:
- Annual check-ups after 40: Simple digital rectal exam and symptom questionnaire
- Don’t ignore early signs: Hesitancy and weak flow are not “just aging”
- Manage stress: High-stress events (surgeries, travel, emotional trauma) can trigger acute symptoms
- Avoid self-medication: Never take prostate medications without proper diagnosis
- Monitor changes: If symptoms occur >50% of the time, see a urologist
Frequently Asked Questions (FAQ)
Q.1. What is the best age to start checking for prostate problems?
Any man over 40 should have an annual prostate evaluation, even without symptoms. Early detection prevents kidney damage and other complications.
Q.2. Is BPH the same as prostate cancer?
No. BPH is benign (non-cancerous) enlargement. However, symptoms can overlap. Dr. Ranjan emphasizes: “BPH and prostate cancer are two different diseases, though they can coexist. Proper diagnosis requires examination, not just symptom assessment.”
Q.3. Will I need a catheter after PROMIS procedures?
Usually not. Unlike TURP which requires catheters for days, most Urolift and Rezum patients go home catheter-free the same day.
Q.4. How long do PROMIS results last?
Clinical studies show 4-5 years of sustained relief, with many patients experiencing permanent improvement. Unlike medications that stop working when you stop taking them, these procedures address the physical obstruction.
Q.5. Can I still have children after Urolift or Rezum?
Yes. Unlike traditional surgeries that cause retrograde ejaculation, PROMIS procedures preserve normal ejaculation and fertility. Sperm quality remains unaffected.
Q.6. Is BPH treatment covered by insurance?
Most insurance plans cover BPH treatments when medically indicated. PROMIS procedures like Urolift and Rezum are increasingly covered as standard-of-care alternatives to surgery.
Conclusion: Take Control of Your Prostate Health Today
Prostate enlargement isn’t a matter of “if” for most men—it’s “when.” But suffering from it is optional. The key takeaways:
- 90% of men over 80 experience BPH symptoms
- Early signs (hesitancy, weak flow, straining) are often dismissed but crucial to recognize
- Traditional medications carry significant sexual and physical side effects that many doctors don’t adequately disclose
- Traditional surgery (TURP) has a high complication rate that can devastate quality of life
- PROMIS therapies (Urolift, Rezum) offer effective relief as day-care procedures with zero sexual dysfunction risk
Dr. Ranjan’s final message is clear: “If you’re over 40 and sexually active, pay attention to urinary symptoms. Don’t accept them as aging. Get evaluated at least once yearly. We can prevent complications, even if we can’t prevent the prostate from growing.”
Are you experiencing any of the early symptoms mentioned above? Have you or a loved one delayed seeking help because you thought it was ‘just getting old’? Share your thoughts in the comments below.
Source & Credit
This blog post is based on insights from Dr. Priyadarshi Ranjan’s educational discussion on Sehatnama.
Video Source: Sehatnama Channel Interview – “Prostate Gland Problems, Symptoms & Modern Treatments”
The original content has been translated, expanded, and repurposed for educational purposes.
