What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH) is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.
As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention, which is the inability to empty the bladder completely, cause many of the problems associated with BPH.
What is the prostate?
The prostate is a walnut-shaped gland that is part of the male reproductive system. The prostate makes a fluid that goes into the semen and is essential for a man's fertility. The gland surrounds the urethra at the neck of the bladder, which is where the urethra joins the bladder. The bladder and urethra are a part of the lower urinary tract. The prostate has two or more lobes enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.
What is causes benign prostatic hyperplasia?
The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men. BPH does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.
Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because of the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.
Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue growing. Scientists have noted that men who do not produce DHT do not develop BPH.
How common is benign prostatic hyperplasia?
Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.
Who is more likely to develop benign prostatic hyperplasia?
Men with the following factors are more likely to develop benign prostatic hyperplasia:
Age 40 years and older
Family history of benign prostatic hyperplasia
Medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes
Lack of physical exercise
Erectile dysfunction
What are the symptoms of benign prostatic hyperplasia?
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include:
Urinary frequency—urination eight or more times a day
Urinary urgency—the inability to delay urination
Trouble starting a urine stream
A weak or an interrupted urine stream
Symptoms of benign prostatic hyperplasia most often come from
A blocked urethra
A bladder that is overworked from trying to pass urine through the blockage
The size of the prostate does not always determine the severity of the blockage or symptoms. Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.
Dribbling at the end of urination
Nocturia—frequent urination during periods of sleep
Urinary Retention—inability to urinate
Urinary Incontinence—the accidental loss of urine
Pain after ejaculation or during urination
Urine that has an unusual color or smell
Sometimes men may not know they have a blockage until they cannot urinate. This condition, called acute urinary retention, can result from taking over-the-counter cold or allergy medications that contain decongestants, such as pseudoephedrine and oxymetazoline. A potential side effect of these medications may prevent the bladder neck from relaxing and releasing urine. Medications that contain antihistamines, such as diphenhydramine, can weaken the contraction of bladder muscles and cause urinary retention, difficulty urinating, and painful urination. When men have partial urethra blockage, urinary retention also can occur as a result of alcohol consumption, cold temperatures, or a long period of inactivity.
What are the complications of BPH?
The complications of benign prostatic hyperplasia may include
Acute urinary retention
Chronic, or long-lasting, urinary retention
Most men with benign prostatic hyperplasia do not develop these complications. However, kidney damage can be a serious health threat when it occurs.
Blood in the urine
Urinary tract infections (UTIs)
Bladder damage
Kidney damage
Bladder stones
When should I seek medical care?
The complications of benign prostatic hyperplasia may include
Acute urinary retention
Chronic, or long lasting, urinary retention
Most men with benign prostatic hyperplasia do not develop these complications. However, kidney damage in particular can be a serious health threat when it occurs.
Blood in the urine
Urinary tract infections (UTIs)
Bladder damage
Kidney damage
Bladder stones
How is BPH diagnosed?
A health care provider diagnoses benign prostatic hyperplasia based on:
A personal and family medical history
A physical exam
Medical tests
Personal and Family Medical History
Taking a personal and family medical history is one of the first things a health care provider may do to help diagnose benign prostatic hyperplasia. A health care provider may ask the patient what symptoms are present
Physical Exam:
A physical exam may help diagnose benign prostatic hyperplasia. During a physical exam, a health care provider most often:
Examines a patient’s body, which can include checking for
Discharge from the urethra
Enlarged or tender lymph nodes in the groin
A swollen or tender scrotum
Taps on specific areas of the patient’s body
Performs a digital rectal exam
A digital rectal exam (DRE) or rectal exam, is a physical exam of the prostate. To perform the exam, the health care provider asks the man to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to the rectum. The man may feel slight, brief discomfort during the rectal exam. A health care provider most often performs a rectal exam during an office visit, and this does not require anesthesia. The exam helps the health care provider determine if the prostate is enlarged or tender or has any abnormalities that require more testing.
Many health care providers perform a rectal exam as part of a routine physical exam for men age 40 or older, whether or not they have urinary problems.
Medical Tests
A health care provider may refer men to a urologist—a doctor who specializes in urinary problems and the male reproductive system—though the health care provider most often diagnoses benign prostatic hyperplasia on the basis of symptoms and a digital rectal exam. A urologist uses medical tests to help diagnose lower urinary tract problems related to benign prostatic hyperplasia and recommend treatment. Medical tests may include:
Urinalysis
A prostate-specific antigen (PSA) blood test
Urodynamic tests
Cystoscopy
Transrectal ultrasound
Biopsy
Cystoscopy
Cystoscopy is a procedure that uses a tube-like instrument, called a cystoscope, to look inside the urethra and bladder. A urologist inserts the cystoscope through the opening at the tip of the penis and into the lower urinary tract. A urologist performs the cystoscopy during an office visit or in an outpatient center or a hospital. The urologist will give the patient local anesthesia; however, in some cases, the patient may require sedation and regional or general anesthesia. A urologist may use cystoscopy to look for blockage or stones in the urinary tract.
Transrectal ultrasound
Transrectal ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The health care provider can move the transducer to different angles to make it possible to examine different organs. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images; the patient does not require anesthesia. Urologists most often use transrectal ultrasound to examine the prostate. In a transrectal ultrasound, the technician inserts a transducer slightly larger than a pen into the man’s rectum, next to the prostate. The ultrasound image shows the size of the prostate and any abnormalities, such as tumors. Transrectal ultrasound cannot reliably diagnose prostate cancer.
Prostate Biopsy:
A prostate biopsy is a procedure that involves taking a small piece of prostate tissue for examination with a microscope. A urologist performs the biopsy in an outpatient center, doctor's office or hospital. The urologist will give the patient light sedation and local anesthetic; however, in some cases, the patient will require general anesthesia. The urologist uses imaging techniques such as ultrasound, a computerized tomography scan, or magnetic resonance imaging to guide the biopsy needle into the prostate. A pathologist—a doctor who specializes in examining tissues to diagnose diseases—examines the prostate tissue in a lab. The test can show whether prostate cancer is present.
Urodynamic tests
Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. A health care provider performs urodynamic tests during an office visit or in an outpatient center or a hospital. Some urodynamic tests do not require anesthesia; others may require local anesthesia. Most urodynamic tests focus on the bladder’s ability to hold urine and empty steadily and completely and may include the following:
​uroflowmetry, which measures how rapidly the bladder releases urine. A postvoid residual measurement is used to see how much urine remains in the bladder after urination. This test also allows the provider to see if there is reduced urine flow or residual urine in the bladder, which often suggests urine blockage due to benign prostatic hyperplasia
Urinalysis
Urinalysis involves testing a urine sample. The patient collects a urine sample in a special container in a health care provider’s office or a commercial facility. A health care provider tests the sample during an office visit or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color to indicate signs of infection in the urine.
PSA blood test
A health care provider may draw blood for a PSA test during an office visit or in a commercial facility and send the sample to a lab for analysis. Prostate cells create a protein called PSA. Men who have prostate cancer may have a higher amount of PSA in their blood. However, a high PSA level does not necessarily indicate prostate cancer. In fact, benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations often cause high PSA levels. Much remains unknown about how to interpret a PSA blood test, the test’s ability to discriminate between cancer and prostate conditions such as benign prostatic hyperplasia, and the best course of action to take if the PSA level is high.
Benign Prostatic Hyperplasia (BPH)
​Key Points
Treatment
Complications from Treatment