Benign Prostatic Hyperlasia (BPH)

Nearly every man over 45 has some degree of enlargement of the prostate gland, which slowly progresses throughout the aging process.

The prostate gland is the male organ that produces semen, the milky-colored fluid that nourishes and transports sperm during ejaculation. It sits beneath your bladder and surrounds your urethra — the tube that drains urine from your bladder. When it becomes enlarged, the prostate can put pressure on your urethra and cause difficulty urinating.

Most men have a period of prostate growth in their mid- to late 40s. At this time, cells in the central portion reproduce more rapidly, resulting in prostate gland enlargement. As tissues in the area enlarge, they often compress the urethra and partially block urine flow. Benign prostatic hyperplasia (BPH) is the medical term for prostate gland enlargement.

Treatment of prostate gland enlargement depends on your signs and symptoms and may include medications, surgery or non-surgical therapies. Prostate gland enlargement is not related to the development of prostate cancer.

Prostate gland enlargement varies in severity among men and doesn’t always pose a problem. Only about half the men with prostate gland enlargement experience signs and symptoms that become noticeable or bothersome enough for them to seek medical treatment.

Signs & Symptoms of BPH

* Weak urine stream

* Difficulty starting urination no matter how strong the urge

* Dribbling at the end of urination

* Straining while urinating

* Frequent need to urinate

* Increased frequency of urination at night (nocturia)

* Urgent need to urinate

* Not being able to completely empty the bladder

* Blood in the urine (hematuria)

* Urinary tract infection

 

Causes

At birth, the prostate gland is about the size of a pea. It grows slightly during childhood and then at puberty undergoes a rapid growth spurt. By age 25, your prostate is fully developed and is about the size of a walnut.

The exact cause of prostate enlargement is unknown. As with age, changes in the ratio of male hormone (testosterone) and female hormone (estrogen) levels in men stimulate the prostate to grow. Another theory is that with aging, the testosterone hormone is converted to dihydrotestosterone (DHT) which increases the size of the prostate. Theoritically, drugs that inhibit the conversion of testosterone to DHT or decreasing DHT could reduce the symptoms of BPH. While conventional drugs are available, these have high potential for serious side effects such as impotence and dizziness. Recently, these drugs have been associated with increase death rates in patients with hypertension and heart diseases.

 

Diagnosis

The diagnosis is made by eliciting a classic history, by rectal examination that shows an enlarged gland, by finding a normal prostate specific antigen (PSA) and by confirmatory transrectal ultrasound.

 

Complications

Prostate gland enlargement becomes a serious health threat only if it interferes with your ability to empty your bladder. A bladder that’s continuously full can interfere with your sleep, cause recurrent bladder infection or result in kidney damage. Men who have an enlarged prostate are at increased risk of:

Acute urinary retention (AUR).

AUR is a sudden painful inability to urinate. To empty the bladder, a catheter must be inserted into the bladder through the penis. Some men with BPH require surgery to treat AUR.

Urinary tract infections (UTIs).

Some men with BPH end up having surgery to remove part of the prostate to prevent frequent UTIs.

Bladder stones.

These are mineral deposits that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.

Bladder damage.

This occurs when, over a long period of time, the bladder hasn’t emptied completely. The muscular wall of the bladder stretches, weakens and no longer contracts properly. Often, men with BPH-caused bladder damage improve after surgery to remove part of the prostate.

Kidney damage.

This is caused by frequent infections and acute urinary retention. BPH can also cause a condition called hydronephrosis, a swelling (dilation) of the urine-collecting structures in one or both kidneys due to pooled urine that can’t drain out of the kidney.