Benign Prostatic Hyperthrophy (BPH)

Benign prostatic hypertrophy (BPH) is a non-malignant abnormal growth of the prostate gland that affects almost all men to some extent as they age. As shown below, the prostate is a golf ball-sized gland that surrounds the urethra just below the bladder. The urethra carries urine from the bladder out through the penis. The prostate gland is made up of muscular and glandular tissue. Its main funciton is to produce the seminal fluid that transports sperm.

Front View of Interior of Male Urinary System and Prostate

Source: American Foundation for Urological Disease

Usually symptoms of BPH don't appear until about age 50 or older. Half of all men have BPH by the age of 60, and this increases to 80% by age 80. Fortunately, only 40 to 50 percent of men actually develop significant symptoms related to BPH that require treatment (American Foundation for Urologic Disease, 1999). BPH is usually treated only when the symptoms are severe enough that they are bothersome or when urinary tract is seriously affected

Enlarged Prostate Squeezes Urethra and Bladder Wall Is Thickened

Source: American Foundation for Urological Disease

Symptoms of BPH

Symptoms of BPH include a hesitant or weak stream, straining to urinate, a feeling that the bladder does not empty completely, urge incontinence (an involuntary loss of urine preceded by an uncontrollable sense of urgency), increased frequency of urination (particularly at night),an urgent need to urinate, and pain or irritation when urinating.Any urinary difficulties should be checked by a doctor. A urinary workup in older patients includes a digital rectal exam, urinalysis, and a PSA (prostate specific antigen) test which is also used to detect prostate cancer. If severe prostate symptoms are present an ultrasound may be used to evaluate the size of the prostate and may show whether an obstruction is present.

Treatment of BPH

Treatment of BPH includes watchful waiting, drug therapy, and surgery.

• Watchful waiting: This is the most common treatment for mild symptoms-- it involves monitoring symptoms each year for any changes that significantly affect health or quality of life.
  
  
• Drug Therapy
  
  
  • Alpha blockers (e.g. Cardura, Minipress, Hytrin) relax the smooth muscle of the prostate and bladder which can relieve obstructive symptoms. Improvement should occur within the first month or two.
  • Finasteride (i.e., 5-alpha-reductase inhibitors) can shrink the size of the prostate by about 30%, but it may take 6 months or long to see any improvement. It works best when the prostate is greatly enlarged. Unfortunately only one in three patients show improvement in symptoms even with a reduction in prostate size.
    
    
• Surgery.
  Surgery is usually necessary when BPH causes any of the following problems: an inability to urinate, urine backup is damaging kidneys, frequent urinary infections, bleeding through the urethra, or stones in the bladder.