Men's Health

Prostate Disease

Prostate Disease | Enlarged Prostate

Benign Prostatic Hyperplasia

What is benign prostatic hyperplasia (BPH)?

BPH (also referred to as benign prostatic hypertrophy) is a condition in which the prostate gland becomes very enlarged and may cause problems associated with urination.

Some of the signs of BPH and prostate cancer are the same, however, having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time, or may develop prostate cancer in the future. Therefore, the National Cancer Institute and the American Cancer Society suggest that all men over 50 have a digital rectal and PSA exams once a year to screen for prostate cancer.

How does BPH occur?

The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a man's life.

The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

BPH rarely causes symptoms before the age of 40.
More than half of men in their sixties have some symptoms of BPH.
As many as 90 percent of men in their seventies and eighties have some symptoms of BPH.

What happens when the prostate enlarges?

As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract even when it contains small amounts of urine, which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind.

Blocking or narrowing of the urethra by the prostate, and partial emptying of the bladder cause many of the problems associated with BPH.

What are the symptoms of BPH?

There are many symptoms that may indicate BPH. Generally, they involve problems with urination. However, symptoms may also indicate other serious conditions that require prompt treatment. It is important to consult with a physician if any of the following symptoms occur:

a hesitant, interrupted, weak stream of urine
urgency to urinate
leaking or dribbling of urine
more frequent urination, especially at night
urine retention -- inability to urinate

These problems can lead to:

urinary tract infections
bladder damage
kidney damage
bladder stones
incontinence

Diagnosing BPH in its earlier stages can lower the risk of developing such complications. Delay can cause permanent bladder -- damage for which BPH treatment may be ineffective.

How is BPH diagnosed?

There are several procedures used by physicians to diagnose BPH, including:

digital rectal examination (DRE) - a test that gives the physician a general idea of the size and condition of the gland. The physician inserts a gloved finger into the rectum to feel the part of the prostate next to it.

rectal ultrasound - a test in which a probe is inserted in the rectum and directs sound waves at the prostate, and the patterns of the sound waves form an image of the prostate gland on a display screen.

urine flow study - a test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.

intravenous pyelogram (IVP) - an x-ray of the urinary tract in which a dye is injected into a vein to make the urine visible on the x-ray and to show any obstruction or blockage in the urinary tract.

cystoscopy - a small tube, called a cystoscope, is inserted through the opening of the urethra in the penis. The tube contains a lens and a light system, which help the physician see the inside of the urethra and bladder to determine the size of the gland, and to identify the location and degree of the obstruction.

Treatment for BPH:

Specific treatment for BPH will be determined by your physician(s) based on:

your overall health and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

BPH symptoms usually require some kind of treatment at some time. However, early treatment, when the gland is just mildly enlarged, may not be necessary because the symptoms of BPH clear up without treatment in some mild cases. Regular checkups are important, however, to watch for developing problems. When BPH poses a danger to the patient's health, or causes a major inconvenience, treatment is usually suggested. Treatments may include:

surgery - to remove only the enlarged tissue that is pressing against the urethra, with the rest of the inside tissue and the outside capsule left intact. Types of surgery may include:

transurethral surgery - no external incision is needed. The surgeon reaches the prostate by inserting an instrument through the urethra.
- transurethral resection of the prostate (TURP) - a resectoscope -- an instrument that is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels -- is inserted through the penis. The surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and flushed out at the end of the operation.
- transurethral incision of the prostate (TUIP) - a procedure that widens the urethra by making some small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
open surgery - surgery that requires an external incision, often done when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.
laser surgery - using laser instruments to vaporize obstructing prostate tissue.

nonsurgical treatments may include:

balloon urethroplasty - a thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra, where the balloon is inflated to widen the urethra and ease the flow of urine.
transurethral microwave thermotherapy (TUMT) - a device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency, urgency, straining, and intermittent flow.
transurethral hyperthermia - an investigative procedure that uses heat to shrink the prostate.
prostatic stents - investigative procedure using stents, inserted through the urethra to the narrowed area, which are allowed to expand, like a spring, and push back the prostatic tissue and widen the urethra.
medical treatment - medications used to shrink or at least stop the growth of the prostate without using surgery.

This page was last updated on: February 1, 2008.

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