Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate caused by an overgrowth of cells (called hyperplasia) in the prostate.
BPH is a non-cancerous (benign) condition of the prostate. Non-cancerous conditions don’t spread (metastasize) to other parts of the body and are not usually life-threatening. BPH doesn’t increase the risk of prostate cancer and it isn’t considered a health problem unless it causes symptoms.
The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
Less common signs and symptoms include:
- Urinary tract infection
- Inability to urinate
- Blood in the urine
The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.
In some men, symptoms eventually stabilize and might even improve over time.
Causes of Benign Prostatic Hyperplasia
The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.
It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.
Risk factors
Risk factors for prostate gland enlargement include:
- Aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
- Family history. Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.
- Diabetes and heart disease. Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
- Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.
Diagnostics of Benign Prostatic Hyperplasia
If you have symptoms of BPH, your doctor will ask you how bad they are. You may also be asked to complete a questionnaire about your urinary symptoms and bladder habits.
If your doctor thinks you might have BPH, you will be sent for tests to diagnose or rule out BPH as well as other problems, such as a urinary tract infection or prostate cancer. These tests include:
- a physical exam
- a digital rectal exam (DRE)
- urine tests, including urinalysis
- blood tests, including the prostate-specific antigen (PSA) test
If your test results are abnormal or your doctor can’t make a diagnosis, you may have the following:
- a cystoscopy
- a test to check the flow rate of the urine followed by an ultrasound to see how much urine is left behind in the bladder (called flow rate and residual ultrasound)
- imaging tests, such as an x-ray or ultrasound, to check the kidneys, bladder and prostate
- a special test called a urodynamic assessment to see how well the bladder and urethra can hold and release urine
- a biopsy of the prostate done through the rectum using an ultrasound to guide the needle (called a transrectal ultrasound-guided biopsy)
Treatment of Benign Prostatic Hyperplasia
Surgery is used to treat BPH when drug therapy stops working or to treat those who can’t urinate at all. It can also be used to relieve severe symptoms.
Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP) removes prostate tissue through the urethra. It is the surgery most commonly used to treat BPH. While TURP relieves urinary symptoms in most men, urinary problems can come back over time if the prostate starts to grow again. This is why younger men may need to have this surgery more than once.
This surgery is done in an operating room. The doctor passes a resectoscope through the urethra to reach the prostate. A resectoscope is a type of endoscope. It has a thin wire that carries an electric current. The doctor uses the electric current to cut away prostate tissue around the urethra. The doctor then removes this tissue through the resectoscope.
The most common side effects of TURP include:
- bleeding
- infection
- semen flowing into the bladder instead of out the end of the penis (called retrograde ejaculation)
In rare cases, you may develop erectile dysfunction or incontinence after TURP. But this surgery has a lower risk of these side effects than surgery to remove the prostate (called prostatectomy).
Other surgeries and procedures
The following may also be used to relieve urinary symptoms caused by BPH.
Laser prostatectomy uses a laser to destroy prostate tissue. Doctors do this procedure with a laser that is passed through a cystoscope (a lighted magnifying instrument that is used to look at and treat areas inside the urethra and bladder). A laser prostatectomy can be done by holmium laser enucleation or photoselective vaporization (PVP).
Transurethral incision of the prostate (TUIP) uses a special tool on a cystoscope to make small incisions (surgical cuts) in the prostate. TUIP helps relieve pressure on the urethra but it doesn’t remove any tissue. TUIP is mostly used in those with smaller prostates.
Transurethral electrovaporization (TUEVP) uses an electrode attached to a resectoscope. The electrode delivers electricity to heat prostate tissue until it is destroyed.
Prostatic urethral lifts are implants that the doctor places in the prostate to help pull it away from the urethra.
Prostatectomy is surgery to remove the prostate. A prostatectomy is only used in rare cases when other procedures or surgeries can’t be done. It may also be used if the urethra is completely blocked or if the prostate is very large.
