| Subject | Contents |
| Definition | BPH is a condition where benign (non-cancerous) nodules enlarge the prostate gland (the gland that produces the liquid in which sperm are expelled from the penis).
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| Alternative Names | BPH; Benign prostatic hypertrophy; Enlarged prostate; Prostate - enlarged |
| Causes, incidence, and risk factors | The actual cause of benign prostatic hyperplasia (BPH) is unknown. However, men who have had their testicles removed do not develop BPH and, after castration, BPH has been observed to regress. In other words, the presence of normally functioning testicles appears to be necessary for the development of BPH. Abnormally growing prostate tissue may use male hormones differently than normal prostate tissue. Although this tissue growth is non-cancerous, as the tumor grows larger it can obstruct the urethra and interfere with the normal flow of urine.
The incidence of BPH increases with advancing age. BPH is so common that it has been said, "All men will have benign prostatic hyperplasia if they live long enough!" A small amount of BPH is present in 80% of men over 40 years old and over 95% of men 80 years old. No risk factors have been identified other than having normally functioning testicles. |
| Symptoms | Less than half of all men with BPH have symptoms of the disease. Symptoms from BPH include:urinary hesitancy (slowed or delayed start of the urinary stream) weak urine stream nocturia (needing to urinate 2 to 3 times or more per night) pain with urinationbloody urine urinary retention ( difficulty urinating ) increased urinary frequency strong and sudden urge to urinate ( urinary urgency ) incontinence |
| Signs and tests | A digital rectal exam (where health care provider inserts a finger into the rectum to feel the size of the prostate gland) may reveal an enlarged, firm prostate. Urine flow rate may be measured. (Men with BPH usually have a rate less than 15 ml per second.) The amount of urine left in bladder after urination may be measured. (This is called post-void residual urine.) Pressure flow studies will measure the pressure in the bladder as you urinate. An IVP (an x-ray study) may be done to confirm the diagnosis or look for blockage.Urinalysis may be done to check for blood or infection. Urine culture may be used to evaluate for infection. Voiding cystourethrogram (another x-ray study) may be performed. A prostate-specific antigen ( PSA ) blood test may be performed in patients over 50 years of age or those at increased risk of prostate cancer.Cystoscopy may be performed to visualize the prostate and bladder if surgery is required. Additionally, you may be asked to complete a self-screening form to evaluate the severity of your symptoms and the impact on your daily life. Your score on the screening tool may be compared to past records to evaluate progression of the disease. |
| Treatment | The choice of an appropriate treatment is based on the severity of your symptoms, the extent to which they affect your lifestyle, and the presence of any other medical conditions. Treatment options include "watchful waiting," various drug therapies, and several surgical methods.
MEDICATIONS Alpha 1-Blockers: Your therapy may involve a trial use of alpha 1-blockers (doxazosin, prazosin, tamsulosin, and terazosin), which are also used to treat high blood pressure . These medications are used to treat BPH because they relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms. Finasteride: This drug lowers prostate hormone levels, thus reducing the size of the prostate. Finasteride has been shown to increase urine flow rate and decrease the symptoms of BPH. It may take up to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive (3.3%) and impotence (2.5 - 3.7%). Other medications: Antibiotics may also be prescribed to treat chronic prostatitis , which commonly accompanies BPH. Some men note symptom relief after a course of antibiotics. SURGERY
Surgery is usually recommended for men with symptoms of incontinence , recurrent blood in the urine , urinary retention, and recurrent urinary tract infections . The choice of a specific surgical procedure is usually based on the severity of symptoms and the size and shape of the prostate gland. Surgical treatment options include transurethral resection of the prostate ( TURP ), transurethral incision of the prostate ( TUIP ), and open prostatectomy . Various studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia , laser therapy, and prostatic stents . TURP: Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis. The primary advantage of this procedure is that it does not involve an incision, thus reducing the risk of infection.
Other surgical approaches include the retropubic (behind the pubic structures) and suprapubic (above the pubic structures) open prostatectomies, which are done through an abdominal incision. The perineal surgical approach (through the region from the scrotum to the anus) is rarely used because the impotence rate after surgery may be as high as 50%.
Among men who have had a TURP, 88% reported an improvement in symptoms lasting from 10 to 15 years. Impotence occurred in 13.6% and one percent of the men reported urinary incontinence after a TURP. TUIP: Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed on an outpatient basis and does not require a hospital stay.
The procedure is done through the penis without an incision. A small incision is made in the prostatic tissue to enlarge the lumen (opening) of the urethra and bladder outlet, thus improving the urine flow rate and reducing the symptoms of BPH. Eighty percent of the men who had this procedure reported some improvement in their symptoms. Possible complications include bleeding , infection, urethral stricture , and impotence. Open Prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus). This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.
Most of the men (98%) who had open prostatectomy surgery reported some improvement in their symptoms. Possible complications include impotence (16 to 32% depending on surgical approach) and urinary incontinence (less than 1%). LIFESTYLE
Self-help measures may prove beneficial if the degree of obstruction is minimal. These include hot baths, urinating upon the earliest urge to do so, sexual activity or ejaculation on a regular basis, and avoiding alcohol or excessive fluid intake (especially at night). Herbalists suggest that saw palmetto berries and extracts may potentially ease prostate symptoms.
You can reduce the frequency of nighttime trips to the bathroom by eliminating fluids a few hours before you go to sleep. Symptoms of urinary incontinence may be improved by spreading out your fluid intake over the course of the day. You should avoid drinking large amounts of fluids at one time and only take sips of fluids with meals.
Men with BPH should avoid taking over-the-counter cold and sinus medications that contain decongestants, because these medications can increase the symptoms of BPH.
"WATCHFUL WAITING"
Less than half of all men with BPH have symptoms of the disease, or their symptoms are minor and do not severely restrict their lives. These patients can simply be monitored over time for an increase in their symptoms. Studies show that of the men who receive no treatment for BPH, 31 - 55% show an improvement, and only 1 - 5% ever develop complications. Men who choose "watchful waiting" should receive yearly exams to monitor progression of the disease.
MONITORING
All men who have BPH should receive a yearly exam to monitor the progression of symptoms. |
| Support Groups | Several national groups provide information on BPH. See support groups - BPH .
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| Expectations (prognosis) | About 70% of all men with BPH are relatively symptom free, and only 30% require some form of treatment. |
| Complications | Men who have had long-standing BPH with a gradual increase in symptoms may develop an acute (sudden) inability to urinate, urinary tract infections, urinary stones, damage to the kidneys, and blood in the urine. Even after surgical treatment, a recurrence of BPH may develop over time.
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| Calling your health care provider | Call for an appointment with the health care provider if symptoms of BPH occur. |
| Prevention | The benign enlargement of the prostate is a normal process of aging. Although the castration of men prior to puberty would most certainly prevent the development of benign prostatic hyperplasia, virtually no one would choose to end their fertility and reduce or eliminate sexual desire and capacity for this reason. |
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