Benign Prostatic Hyperplasia (BPH)

What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a common condition in which the prostate gland enlarges, leading to urinary symptoms. It primarily affects men over 50 as the prostate tends to grow with age. The prostate is a walnut-sized gland located below the bladder and in front of the rectum, surrounding the urethra, which carries urine from the bladder out through the penis. The prostate produces fluid that nourishes and transports sperm during ejaculation.

BPH can cause symptoms such as frequent urination (day and night), a weak urine stream, dribbling, and incontinence. If left untreated, it can lead to urinary tract infections, bladder stones, bladder damage, and kidney damage. While BPH is not cancerous, it can significantly affect quality of life. Early diagnosis and treatment help manage symptoms and prevent complications.

What causes benign prostatic hyperplasia (BPH)?

BPH results from aging and hormonal changes. Key factors include:

  • Age: Most common in men over 50, with increasing prevalence at ages 60 and 80.
  • Hormonal changes: Dihydrotestosterone (DHT) derived from testosterone promotes prostate growth. A higher estrogen-to-testosterone ratio in older men may also contribute.
  • Family history: Genetic factors can influence prostate tissue growth patterns.
  • Obesity: Excess abdominal fat may disrupt hormonal balance.
  • Physical inactivity: Sedentary lifestyle may affect hormones and metabolism.
  • Diet: High-fat, especially animal-fat diets, may increase risk.
  • Diabetes and heart disease: These conditions can impair blood flow and hormone regulation.
  • Prostatic inflammation: Chronic inflammation may alter tissue structure and promote cell growth.

What are the symptoms of benign prostatic hyperplasia (BPH)?

Enlargement of the prostate can compress the urethra, causing:

  • Frequent urination (more than eight times daily)
  • Nocturia (waking at night to urinate)
  • Urgency (sudden strong need to urinate)
  • Hesitancy (difficulty starting the urine stream)
  • Weak or interrupted stream
  • Dribbling or leaking after urination
  • Feeling of incomplete bladder emptying
  • Double voiding (urinating again soon after)
  • Painful urination or post-ejaculation discomfort

Possible complications include urinary tract infections, bladder stones, bladder muscle damage, kidney damage, and acute urinary retention, which may require emergency intervention.

How is benign prostatic hyperplasia (BPH) diagnosed?

Medical History and Physical Exam

  • Symptom assessment: Frequency, urgency, nocturia, stream strength, and impact on daily life.
  • Family and medication history: Genetic factors and drugs that may worsen symptoms.
  • Digital rectal exam (DRE): Palpation of prostate size, shape, and consistency.

Laboratory Tests

  • Urinalysis: Checks for infection, blood, or other causes.
  • PSA test: Measures prostate-specific antigen to rule out cancer.
  • Creatinine: Assesses kidney function.

Imaging and Functional Tests

  • Ultrasound: Measures prostate size and checks for abnormalities.
  • Bladder ultrasound: Evaluates residual urine after voiding.
  • Uroflowmetry: Measures urine flow rate and volume.
  • Post-void residual (PVR) volume: Quantifies urine left in bladder.
  • Cystoscopy: Visual inspection of urethra and bladder with a camera.
  • Biopsy: Rarely, tissue sampling if cancer is suspected.

How is benign prostatic hyperplasia (BPH) treated?

Watchful Waiting

For mild, nonbothersome symptoms, regular monitoring without immediate treatment.

Lifestyle Modifications

  • Fluid management: Reduce intake before bedtime.
  • Dietary changes: Limit caffeine and alcohol to reduce bladder irritation.
  • Bladder training: Scheduled voiding and control techniques.
  • Avoid decongestants and antihistamines that can worsen symptoms.

Medications

  • Alpha-blockers (e.g., tamsulosin, alfuzosin): Relax prostate and bladder neck muscles for quick symptom relief.
  • 5-alpha-reductase inhibitors (e.g., finasteride, dutasteride): Shrink prostate over months by blocking DHT production.
  • Combination therapy: Both classes together for enhanced benefit.
  • Herbal remedies (saw palmetto): Widely used but with inconclusive evidence.

Minimally Invasive Procedures

  • Transurethral microwave thermotherapy (TUMT): Destroys tissue with microwaves.
  • Transurethral needle ablation (TUNA): Uses radiofrequency heat.
  • Prostatic urethral lift (PUL): Implants hold tissue away from urethra.
  • Water vapor therapy (Rezūm): Steam ablation of excess tissue.

Surgical Options

  • Transurethral resection of the prostate (TURP): Removal of prostate tissue via urethra.
  • Transurethral incision of the prostate (TUIP): Small cuts to relieve pressure.
  • Laser surgeries (PVP, HoLEP): Laser ablation or enucleation of tissue.
  • Open or robotic prostatectomy: Removal via abdominal incision for very large glands.

Sources

  • American Urological Association. Management of benign prostatic hyperplasia/lower urinary tract symptoms. Accessed Aug. 6, 2024.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Prostate Enlargement (BPH). Accessed Aug. 6, 2024.
  • National Cancer Institute. Urinary and bladder problems. Accessed Aug. 6, 2024.
  • Merck Manual. Benign prostate hyperplasia (BPH). Accessed Aug. 6, 2024.
  • Urology Care Foundation. Benign prostatic hyperplasia (BPH). Accessed Aug. 6, 2024.