Benign prostate hyperplasia (BPH)

Definition

Benign prostatic hyperplasia (BPH) is the gradual increase in size of the prostate in middle-aged and elderly men.

Urinary obstruction

• Benign prostatic hyperplasia (BPH) can lead to obstructive and bothersome lower urinary tract symptoms.
• Prostate gland enlargement can block the flow of urine out of the bladder, which can cause bladder, urinary tract, or kidney problems.

Growth periods

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size during this phase. The second phase of growth begins around age 25 and continues during most of a man’s life and benign prostatic hyperplasia often occurs with the second growth phase.

Mechanism of urinary obstruction

As the prostate enlarges, the gland presses against and pinches the urethra.

Bladder wall thickening

• 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—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.

Nodular hyperplasia of the prostate

Cause

• The cause of benign prostatic hyperplasia is not well understood.
• It occurs mainly in older men.
• Benign prostatic hyperplasia 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.

Estrogen to testosterone ratio

• Throughout their lives, men produce testosterone, and small amounts of estrogen.
• As we age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen compared to testosterone.
• Benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

BPH

Role of DHT

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Even with a drop in blood testosterone levels due to aging, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

Incidence

• 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.

Risk factors

• age 40 years and older
• family history of benign prostatic hyperplasia
• medical conditions such as obesity, heart disease, and type 2 diabetes
• lack of physical exercise
• erectile dysfunction

Signs and symptoms

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
• dribbling at the end of urination
• nocturia or frequent urination during periods of sleep
• urinary retention
• urinary incontinence—the accidental loss of urine
• pain after ejaculation or during urination
• urine that has an unusual color or smell
• Symptoms of benign prostatic hyperplasia most often come from a blocked urethra and a bladder that is overworked from trying to pass urine through the blockage

Benign prostatic hypertrophy world map

Diagnosis

A history and physical exam may help diagnose benign prostatic hyperplasia. 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, and performs a digital rectal exam which is a physical exam of the prostate.

Tests

Tests may include:

• urinalysis
• a prostate-specific antigen (PSA) blood test
• urodynamic tests
• cystoscopy
• transrectal ultrasound
• biopsy

Treatment

Treatment options for benign prostatic hyperplasia may include

• lifestyle changes
• medications
• minimally invasive procedures
• surgery

Men may not need treatment for a mildly enlarged prostate unless their symptoms are bothersome and affecting their quality of life. In these cases, instead of treatment, a urologist may recommend regular checkups. If benign prostatic hyperplasia symptoms become bothersome or present a health risk, a urologist most often recommends treatment.

Complications

The complications of benign prostatic hyperplasia may include:

• acute urinary retention
• chronic, or long lasting, urinary retention
• blood in the urine
• urinary tract infections (UTIs)
• bladder damage
• kidney damage
• bladder stones

Newer treatments

Newer techniques involving lasers in urology have emerged in the last 5-10 years.

VLAP

Starting with the VLAP technique involving the ND:YAG laser with contact on the prostatic tissue.

PVP

• A similar technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged very recently.
• This procedure involves a high powered 80 Watt KTP laser with a 550 micrometre laser fiber inserted into the prostate.
• This fiber has an internal reflection with a 70 degree deflecting angle.
• It is used to vaporize the tissue to the prostatic capsule.

See also

• Prostate cancer
• Urinary retention
• High Island Health - offers a patented prostate massager as an alternative means of treating BPH

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