Benign Prostate Enlargement (BPH)

Benign prostate enlargement (benign prostatic hyperplasia, BPH) is an age-related enlargement of the prostate gland that can obstruct the flow of urine. Typical signs are a weakened urinary stream, urination at night and a feeling of incomplete bladder emptying. For patients on stable medication, a repeat prescription can also be issued in a video consultation after medical assessment.

Medically reviewed by Adi Zoabi, Approbation als Arzt.
Last reviewed on August 31, 2026. Updated as clinical guidelines change.

Overview

Benign prostate enlargement (benign prostatic hyperplasia, BPH) is one of the most common conditions in older men. Around half of men over 60 have an enlarged prostate, many of them with noticeable urinary symptoms. Because the prostate surrounds the urethra directly below the bladder, its growth can obstruct the flow of urine: the stream becomes weaker, urination takes longer, and the bladder does not empty completely. Many men affected get up several times a night, which can considerably impair sleep and quality of life. The condition is benign and usually responds well to treatment. In many patients, symptoms can be kept stable in the long term with medication – above all alpha-1 receptor blockers such as tamsulosin. For men whose treatment is already well established, a repeat prescription can also be issued in a video consultation after medical assessment – discreetly, with no waiting room and no long journey.

Common causes

The exact cause of benign prostate enlargement has not been fully established. What is considered certain is that hormonal changes with age play a central role: as the years pass, the balance of sex hormones shifts, which can stimulate the growth of prostate tissue. Age is therefore the most important risk factor – the condition becomes markedly more common from the age of 50 onwards. In addition, hereditary predisposition, excess weight, lack of exercise and metabolic disorders such as diabetes mellitus are discussed as contributing factors. Lifestyle also influences the symptoms: alcohol, caffeine and large amounts of fluid in the evening can intensify the urge to urinate, as can certain medications. Important to know: benign enlargement is not a precursor of prostate cancer; however, both conditions can exist at the same time independently of each other.

When to see a doctor

As a rule, have newly occurring urinary symptoms assessed by a urologist before starting long-term treatment. See a doctor promptly if your symptoms worsen despite treatment, if you notice blood in your urine, if urinary tract infections keep recurring, or if urination becomes painful. Fever combined with flank pain is also a warning sign and may indicate involvement of the kidneys. Acute urinary retention is an emergency: the bladder is completely full, but despite a strong urge no urine can be passed, usually accompanied by increasing pain in the lower abdomen. In this case call the emergency number 112 or have someone take you to an emergency department without delay. If, on the other hand, you have been stable on your medication for some time, a video consultation is a suitable way to review your progress and obtain a repeat prescription.

Symptoms & Indications

Weakened or interrupted urinary stream Frequent urination at night (nocturia) Delayed start of urination Feeling of incomplete bladder emptying Dribbling of urine after voiding Sudden urge to urinate that is difficult to suppress Frequent trips to the toilet passing only small amounts of urine

Treatment Options

  • Alpha-1 receptor blockers (e.g. tamsulosin) to relax the muscles of the prostate and bladder neck
  • 5-alpha-reductase inhibitors to reduce the size of the prostate in the long term
  • Herbal preparations, for example based on saw palmetto fruit or pumpkin seeds
  • Adjusting drinking habits: less fluid in the evening, reducing alcohol and caffeine
  • Bladder training and voiding on a fixed schedule
  • Regular physical activity and weight reduction if overweight

Important Notes

  • A video consultation does not replace a urological examination. Initial diagnosis and regular check-ups (e.g. digital rectal examination, ultrasound, laboratory tests) must take place in a practice in person.
  • See a doctor promptly if you notice blood in your urine, fever with flank pain, or pain when urinating.
  • Acute urinary retention – the bladder is full but you are unable to pass urine – is an emergency. In this case call the emergency number 112 or go to an emergency department immediately.
  • Urinary symptoms can also have other causes, including prostate cancer. Therefore attend the recommended urological screening and follow-up examinations.
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Medical notice: Not a substitute for an in-person medical examination. The information on this page is intended for general guidance only. In an emergency, please call 112.

Frequently Asked Questions

Can I get my repeat prescription for tamsulosin online?

If a doctor has already established you on an alpha-1 receptor blocker such as tamsulosin and you tolerate the treatment well, a private prescription can be issued in the video consultation after medical assessment. This requires that your symptoms are stable and that no warning signs are present. There is no entitlement to a prescription; the decision always rests with the treating doctor.

How much does the video consultation cost and who covers it?

Billing is a private medical service under the German medical fee schedule (GOÄ). Privately insured patients can usually submit the invoice to their private health insurer; reimbursement depends on the individual plan. Self-paying patients receive a transparent GOÄ invoice. The cost of any medication at the pharmacy is additional.

Does online treatment replace seeing a urologist?

No. The initial diagnosis of prostate enlargement and regular check-ups – such as digital rectal examination, ultrasound and laboratory tests – belong in a urology practice. The video consultation is best suited to follow-up discussions and repeat prescriptions when treatment is stable. We recommend keeping to the check-up intervals your urologist has advised.

Is benign prostate enlargement dangerous?

Benign prostatic hyperplasia is by definition benign and is not cancer. Left untreated, however, it can lead to complications such as urinary tract infections, bladder stones or, in rare cases, kidney damage. Because similar symptoms can also have other causes, regular urological check-ups are important.

How does a video consultation with OpenClinic24 work?

You book an appointment online, complete a structured medical questionnaire in advance and then speak to a doctor by video. After medical assessment, a private prescription can be issued, which you receive digitally and can redeem at any pharmacy. The video connection is end-to-end encrypted.