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Benign prostatic hyperplasia - Symptoms

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of benign prostatic hyperplasia (BPH).

Alternative Names

Enlarged prostate; BPH

Symptoms:

Lower urinary tract symptoms (LUTS) are categorized either as voiding (formerly called obstructive) or storage (formerly called irritative) symptoms. BPH is often, but not always, the cause of LUTS, especially the voiding symptoms. Other medical conditions, such as bladder problems, can also cause these symptoms.

Some men with BPH may have few or no symptoms. The size of the prostate does not determine symptom severity. An enlarged prostate may be accompanied by few symptoms, while severe LUTS may be present with normal or even small prostates.

Voiding (Obstructive) Symptoms

Voiding symptoms can be caused by an obstruction in the urinary tract. They are often due to BPH. (Obstruction is the most serious complication of BPH and requires medical attention.) Voiding symptoms include:

  • A hesitation before urine flow starts despite the urgency to urinate
  • Straining when urinating
  • Weak or intermittent urinary stream
  • A sense that the bladder has not emptied completely
  • Dribbling at the end of urination or leakage afterward

Storage (Irritative) Symptoms

Storage symptoms, also referred to as filling symptoms, include:

  • An increased frequency of urination (every few hours), particularly at night
  • An urgent need to urinate and difficulty postponing urination
  • Painful or burning sensation when urinating
Urine flows from the kidney through the ureters into the urinary bladder where it is temporarily stored. As the bladder becomes distended with urine, nerve impulses from the bladder signal the brain that it is full, giving the individual the urge to void. By voluntarily relaxing the sphincter muscle around the urethra, the bladder can be emptied of urine. Urine then flows out through the urethra.
Male urinary system

Serious Symptoms

Urinary retention (inability to void) is a serious symptom of severe BPH that requires immediate medical attention. Urinary retention can be a sign of obstruction in the bladder. Bladder obstruction can cause bladder stones, urinary tract infections, blood in the urine, and incontinence.

Resources

References

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Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20;301(19):1991-6.

Bravi F, Bosetti C, Dal Maso L, Talamini R, Montella M, Negri E, et al. Food groups and risk of benign prostatic hyperplasia. Urology. 2006 Jan;67(1):73-9.

Davidson JH, Chutka DS. Benign prostatic hyperplasia: treat or wait? J Fam Pract. 2008 Jul;57(7):454-63.

Emberton M, Fitzpatrick JM, Garcia-Losa M, Qizilbash N, Djavan B. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials. BJU Int. 2008 Sep;102(8):981-6. Epub 2008 Jun 28.

Fitzpatrick JM. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 88.

Friedman AH. Tamsulosin and the intraoperative floppy iris syndrome. JAMA. 2009 May 20;301(19):2044-5.

Johnson AR, Munoz A, Gottlieb JL, Jarrard DF. High dose zinc increases hospital admissions due to genitourinary complications. J Urol. 2007 Feb;177(2):639-43.

Johnson TM 2nd, Burrows PK, Kusek JW, Nyberg LM, Tenover JL, Lepor H, et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol. 2007 Nov;178(5):2045-50; discussion 2050-1. Epub 2007 Sep 17.

Kirby R and Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007:chap 87.

Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ,et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol. 2009 Mar 20;27(9):1502-16. Epub 2009 Feb 24.

Lourenco T, Armstrong N, N'Dow J, Nabi G, Deverill M, Pickard R, et al. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess. 2008 Nov;12(35):iii, ix-x, 1-146, 169-515.

Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. BMJ. 2008 Jun 30;337:a449. doi: 10.1136/bmj.39575.517674.BE.

Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials. BMJ. 2008 Oct 9;337:a1662. doi: 10.1136/bmj.a1662.

Mattiasson A, Wagrell L, Schelin S, Nordling J, Richthoff J, Magnusson B, et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2007 Jan;69(1):91-6.

Moyad MA, Lowe FC. Educating patients about lifestyle modifications for prostate health. Am J Med. 2008 Aug;121(8 Suppl 2):S34-42.

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Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008 Feb;179(2):616-21; discussion 621. Epub 2007 Dec 21.

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van der Meulen J, Brown CT, Yap T, Cromwell DA, Rixon L, Steed L, et al. Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ. 2007 Jan 6;334(7583):25. Epub 2006 Nov 21.

  • Reviewed last on: 7/8/2009
  • Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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