Overview, Causes, & Risk Factors
Benign prostatic hyperplasia, or BPH for short, is the enlargement of the
prostate gland. It is caused by excess growth of cells in the prostate. This condition is
not the same as prostate cancer.
What is going on in the body?
The prostate is a walnut-sized gland that is part of the male reproductive
system. This gland surrounds the urethra, the tube that carries urine from the bladder
out of the body. The job of the prostate is to squeeze fluid into semen to help with
fertility. The prostate responds to testosterone, the main male hormone. After puberty,
it doubles in size. Around age 25, it grows again and continues to grow slowly
throughout a man's life. This enlargement does not usually cause problems until later in
life. BPH rarely causes symptoms before age 40. But more than half of men in their
60s and up to 90% in their 70s have some symptoms of BPH. In some
men, the enlarged prostate can cause a blockage of the bladder outlet known as
prostatism. Although the actual causes are more complex, it is helpful to think of BPH
as a blockage of urine flow by an enlarging prostate.
What are the causes and risks of the condition?
The cause of BPH is not well understood. Some experts think that factors
related to aging and changing hormone levels may spur the development of BPH.
The primary risk of BPH is that urine flow may be blocked. This can
sometimes cause kidney damage, bladder stones, and urinary tract infections.
Symptoms & Signs
What are the signs and symptoms of the condition?
Symptoms may range from mild to severe, and the most common ones
involve changes or problems with urination, such as:
a feeling that the bladder has not been emptied completely
frequent urination
a hesitant, weak stream
leaking or dribbling, known as incontinence
more frequent urination, especially at night, known as nocturia
an urge to urinate again soon after emptying the bladder the last time
urgency to urinate
Some men have no symptoms at all before suddenly finding themselves
totally unable to urinate. This condition is called acute urinary retention and may be
triggered by over-the-counter cold or allergy medicines that contain decongestants.
Diagnosis & Tests
How is the condition diagnosed?
BPH is commonly diagnosed when its symptoms begin to interfere with
daily life, but the doctor may also find an enlarged prostate during a routine checkup.
The symptoms of BPH can be very much like those caused by prostate cancer and other serious
conditions. So,
further testing may be needed. A doctor can use a gloved finger in the rectum to check
the prostate size and for small, hard lumps that might suggest prostate cancer.
The doctor may also order a prostate-specific antigen,
also known as a PSA, blood test. If this value is abnormal, the doctor may next order a
biopsy sample of the prostate to look for prostate cancer.
Other tests may be done in certain cases. These may include measuring
the rate of urine flow and checking with a catheter or special X-ray test to see how
much urine is left in the bladder after voiding. A pressure-flow study combines
measuring the urine flow and the pressure in the bladder during voiding.
Cystoscopy
is a procedure that uses a tiny telescope to look inside the urethra, prostate, and bladder for
the amount of blockage. Ultrasound, a type of X-ray test, may be used to measure the exact
size of the prostate. This can be important in making choices about therapy. A symptom
questionnaire can help to measure both the symptoms and the response to treatment.
Although some of the symptoms of BPH and prostate cancer are the same, BPH does not
increase the chance of prostate cancer.
Prevention & Expectations
What can be done to prevent the condition?
There are no widely accepted ways to prevent BPH.
What are the long-term effects of the condition?
Long-term effects are generally due to chronic, incomplete emptying of the
bladder and may include:
a bladder that fails to adequately hold urine, called bladder decompensation or decreased capacity
bladder stones,
also called calculi
a type of damage to the kidney, known as hydronephrosis, which can rarely lead
to kidney failure
urinary tract infections
What are the risks to others?
BPH is not contagious.
Treatment & Monitoring
What are the treatments for the condition?
Prostatism is usually treated first with medicines called alpha blockers,
such as doxazosin
or terazosin.
These drugs were first used to treat high blood pressure. Tamsulosin is the first alpha
blocker developed specifically for BPH. These drugs relax the muscle in the prostate
and at the bladder neck, which allows better urine flow.
The FDA has approved a fourth drug, finasteride,
to treat BPH, but its action is different. It works to suppress testosterone, which can shrink
the size of the prostate and improve symptoms. Some studies suggest that
finasteride
can shrink the prostate by about 30%. This may take several months, and
often the improvement is not as dramatic as that seen with alpha blockers. But
finasteride
has been shown to reduce the long-term risk of a complete inability to urinate. And that
can result in less need for surgery.
If medicine does not work, or cannot be taken, surgery is an option. The
most common operation has been transurethral resection of the prostate,
also called TURP. This involves passing a special tiny telescope, called an endoscope, through
the urethra. The endoscope has an electrified loop, which is passed into the area of the
prostate that surrounds the bladder neck. Under anesthesia, the electrified loop is used
to scoop out tissue from the prostate and free the flow of urine. This surgery has a
success rate of about 85%.
Because TURP
is costly, inconvenient, and invasive, there has been great effort to find other ways that
will relieve BPH symptoms. A variety of energy sources have been tried, including
high-intensity sound waves, lasers, heat, and radio waves. Sometimes tubes called
stents are placed in the urethra to hold it open. Some of these procedures require a
small amount of anesthesia, and others require none at all. In general, these procedures
are less risky than TURP but do not work as well. Many of these techniques are still
being perfected.
What are the side effects of the treatments?
Medicines used to treat BPH may all cause side effects, such as
dizziness, low blood pressure, and impotence. Specific side effects depend on the drug
used.
Dangerous complications after TURP are unusual. The most common side
effect of TURP, which occurs in about 4% to 6% of people who have the procedure, is a
need to place a urinary catheter for a short time after the operation. Some bleeding is
normal after surgery, but it should clear up by the time the person goes home from the
hospital. Drinking a lot of water will help flush out the bladder and speed healing. As
with any surgery, there may be some temporary discomfort for a few weeks. This will
decrease as time goes on.
What happens after treatment for the condition?
Those treated with medicines often need treatment for life or until
symptoms get bad enough to require surgery. Most people recover from TURP quickly.
Blood in the urine gradually disappears over the first week or so. Symptoms of bladder
blockage are usually relieved right away. The degree and speed of return to normal bladder
function is often related to the severity of the condition and how long it existed before
treatment began. In some cases, a second TURP or other prostate surgery may be
needed later.
How is the condition monitored?
Those treated with medicines can often monitor their own symptoms at
home. After TURP or prostate surgery, the person is seen from time to time by the
healthcare provider and watched for a return of symptoms. Any new or
worsening symptoms should be reported to the doctor right away.