Benign prostatic hypertrophy (BPH) is growth of the prostate with normal aging and causes symptoms, because the prostate blocks the flow of urine through the prostate as the urine exits the bladder. The name BPH indicates enlargement of the prostate, but men may suffer symptoms even with smaller prostates as they age. Other terms that describe the same process include: lower urinary tract symptoms (LUTS), bladder outlet obstruction (BOO) and benign prostatic enlargement (BPE).

Diagnosis and Treatment of Benign Prostatic Hypertrophy

As men age and the prostate continues to enlarge, symptoms typically slowly progress, and men can develop retention of urine, bleeding, urinary infections, stones in the bladder and even kidney problems. Evaluation and management of these symptoms begin with an assessment of the urinary symptoms and quality of life. In the past treatment was often based on relieving serious problems, such as kidney failure, inability to urinate (retention), bleeding, recurrent infections and bladder stones. These are still indications for aggressive treatment but are less frequently encountered. In modern practice the level of bother from the symptoms most often drives treatment decision-making.


Medical therapy relies on three different types of medications used alone or in combination. Alpha blockers are medications that relax the prostate and bladder opening so the urine can flow more freely. These are typically well tolerated and offer quick improvement in symptoms. Five alpha reductase inhibitors shrink the prostate and work slowly over a four to six month period. These work best for patients with large prostates. Anticholinergic medications help treat bladder over activity and the frequency and urgency that many patients experience with prostate enlargement. These are often used when symptoms of frequency and urgency do not improve after other medical or surgical management and when PVR is reasonably low.

Recently, the phosphdiesterase inhibiting drugs have been shown to improve symptom scores in men being treated for both erectile dysfunction and BPH. Exactly how these drugs improve LUTS is not currently known; but for patients with both problems, this is a new option for medical management.

Surgical Management

Surgical management relies on opening the urethra where it runs through the prostate. This can be done with a variety of different procedures including:

  • TUIP (transurethral incision of the prostate). Relaxing incisions are made in the prostate using a small scope; typically used for small prostates
  • TUMT (transurethral microwave therapy). Destroys prostate tissue with heat delivered by a catheter
  • Vaporization of the prostate. Using either laser energy or electrical energy to destroy tissue using a small scope under direct vision
  • TURP (transurethral resection of the prostate). Removal of prostatic tissue using electrical energy through a small scope
  • HoLEP (holmium laser enucleation of the prostate). Using a laser to carve out the prostate in larger portions and then remove them from the bladder with a morcellating device
  • Simple prostatectomy. Removing prostate tissue through an incision in the lower abdomen; typically used for very large prostates

The risks, benefits and indications for each of these procedures are slightly different, and your surgeon will discuss which is best for you. Often, surgeon experience with one technique will also help select the procedure with the lowest risk of complication and best outcome.

In general risks for surgery for BPH include bleeding, urinary tract infection, abnormal healing with scar tissue formation in the urethra and bladder opening, erectile dysfunction, retrograde ejaculation (where semen flows backward into the bladder with orgasm) and incontinence (leaking urine without control). Complications are not common and most surgeries work very well to increase the strength of men’s urinary flow and relieve the symptoms of frequency and urgency of urination. Surgery is a very good option for men that do not tolerate medicines because of side effects or men for whom the medicines are not strong enough to relieve the symptoms of the problem.

Benign Prostatic Hyperplasia (BPH)

What is benign prostatic hyperplasia (BPH)?

BPH (also referred to as benign prostatic hypertrophy) is a condition in which the prostate gland becomes very enlarged and may cause problems associated with urination. BPH can raise PSA (prostate-specific antigen) levels two to three times higher than the normal level. An increased PSA level does not indicate cancer, but the higher the PSA level, the higher the chance of having cancer.

Some of the signs of BPH and prostate cancer are the same; however, having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time or may develop prostate cancer in the future. Therefore, the National Cancer Institute and the American Cancer Society recommend that all men over 50 consult their doctors about having a digital rectal and PSA examination once a year to screen for prostate cancer.

How does BPH occur?

The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a man's life.

The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases:

  • BPH rarely causes symptoms before age 40.

  • More than half of men in their 60s have some symptoms of BPH.

  • As many as 90 percent of men in their 70s and 80s have some symptoms of BPH.

What happens when the prostate enlarges?

As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract--even when it contains only small amounts of urine--which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, and waking up at night to urinate.

Blocking or narrowing of the urethra by the prostate and partial emptying of the bladder cause many of the problems associated with BPH.

What are symptoms of BPH?

The following are the most common symptoms of benign prostatic hyperplasia. However, each individual may experience symptoms differently. Symptoms may include:

  • Leaking or dribbling of urine

  • More frequent urination, especially at night

  • Urgency to urinate

  • Urine retention (inability to urinate)

  • A hesitant, interrupted, weak stream of urine

These problems may lead to one or more of the following:

  • Incontinence

  • Kidney damage

  • Bladder damage

  • Urinary tract infections

  • Bladder stones

  • Inability to pass urine at all

The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is BPH diagnosed?

Diagnosing BPH in its earlier stages can lower the risk of developing complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical examination, diagnostic procedures for BPH may include the following:

  • Digital rectal exam. A procedure in which the doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer.

  • Intravenous pyelogram. A series of X-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.

  • Cystoscopy (also called cystourethroscopy). An examination in which a scope--a flexible tube and viewing device--is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

  • Urine flow study. A test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.

What is the treatment for BPH?

Specific treatment for BPH will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed. In fact, research has shown that, in some mild cases, some of the symptoms of BPH clear up without treatment. This determination can only be made by your doctor after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.

Treatment for BPH may include:

  • Surgery. To remove only the enlarged tissue that is pressing against the urethra, with the rest of the inside tissue and the outside capsule left intact. Types of surgery often include the following:

    • Transurethral surgery. No external incision is needed. The surgeon reaches the prostate by inserting an instrument through the urethra.

      • Transurethral resection of the prostate. A resectoscope--an instrument that is about 12 inches long and 1/2 inch in diameter and contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels--is inserted through the penis. The surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and flushed out at the end of the operation.

      • Transurethral incision of the prostate. A procedure that widens the urethra by making some small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.

    • Laser surgery. Using laser instruments to cut away obstructing prostate tissue.

    • Open surgery. Surgery that requires an external incision; often performed when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

  • Nonsurgical treatments may include:

    • Balloon urethroplasty. A thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra. The balloon is inflated to widen the urethra and ease the flow of urine.

    • Transurethral microwave thermotherapy. A device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.

    • Medications. To shrink or at least stop the growth of the prostate without using surgery, or to make the muscles surrounding the urethra looser so the urine flows more easily.

    • Transurethral hyperthermia. An investigative procedure that uses heat, usually provided by microwaves, to shrink the prostate.

    • Prostatic stents. An investigative procedure using stents inserted through the urethra to the narrowed area that are allowed to expand, like a spring, and push back the prostatic tissue and widen the urethra.

  • Lifestyle management for BPH may include:

    • Dietary factors. Consuming foods and drinks containing soy, drinking green tea, and taking saw palmetto supplements may benefit the prostate, although this is not yet proven. Also, avoiding or decreasing the intake of alcohol, coffee, and other fluids, particularly after dinner, is often helpful. A higher risk for BPH has been found in association with a diet high in zinc, butter, and margarine, while individuals who eat lots of fruits are thought to have a lower risk for BPH.

    • Avoiding medications that worsen symptoms. Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also aggravate symptoms of BPH. Consult your doctor if you are taking any of these medications to discuss changing dosages or switching medications, if possible.

    • Kegel exercises. Repeatedly tightening and releasing the pelvic muscle, also known as Kegel exercises, is helpful in preventing urine leakage. Doctors recommend practicing this exercise while urinating in order to isolate and train the specific muscle. To perform a Kegel, contract the muscle until the flow of urine decreases or stops and then release the muscle. It is recommended that men with BPH repeat five to 15 contractions, holding each for 10 seconds, three to five times a day. Consult your doctor for more information.

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