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Enlarged Prostate (BPH)

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Related Media: Transurethral Resection of the Prostate (TURP)

Definition

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate. The prostate is a walnut-sized gland located at the neck of the bladder. It surrounds the urethra, a tube that carries urine from the bladder.

An enlarged prostate puts pressure on the urethra. This can make it harder for urine to pass. The urethra may become completely closed off.

Enlarged Prostate
BPH prostate
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Causes

The exact cause of BPH is not known. Natural changes in hormone levels due to age may play a role.

It is not due to cancer.

Risk Factors

BPH is most likely in men aged 50 years or more. Other things that may raise the risk of BPH are:

  • Metabolic syndrome—this is when a person has high blood pressure, high cholesterol, high blood glucose, and are overweight
  • Obesity
  • Lipid disorders—includes problems with overall cholesterol or low good cholesterol

Symptoms

The prostate itself does not cause symptoms. A larger prostate can put pressure on the urethra. It will lead to problems with urine flow such as:

  • Difficulty starting to urinate (pee)
  • Urine stream is weak
  • Dribbling at the end of urination
  • Feeling that the bladder is not completely empty
  • Feel the need to urinate often—this often happens at night
  • Deep discomfort in the lower belly
  • Urge incontinence—strong, sudden urge to urinate

Symptoms often get worse over time.

Diagnosis

The doctor will ask about symptoms and past health. The prostate may need to be checked if BPH is suspected. A gloved finger is inserted into the rectum. The doctor can feel the prostate's size through the rectum.

Urine flow may be checked with:

  • Urine flow study
  • Cystometrogram—checks how the bladder fills and empties
  • Post-void residual volume test—to see if the bladder can empty completely

Images of the prostate and urinary tract may be taken with:

Treatment

BPH does not need treatment if it is not causing symptoms. Most BPH will lead to urinary symptoms at some point. Treatment will be needed to help urinary symptoms. Treatment choices include:

Medicine

Medicines may be given to:

  • Shrink the prostate and help urine flow
  • Relax the muscles around the neck of the bladder and the prostate to improve urine flow
  • Relax the bladder muscles and reduce the urge to urinate often

Some medicines can make BPH symptoms worse. Treatment will include avoiding this type of medicine. Decongestant medicine with pseudoephedrine is one example.

Minimally Invasive Interventions

Some procedures are done through the urethra. They often have shorter recovery times and less tissue damage than open surgeries. One may be done if medicine can no longer manage symptoms. There are different ways to do this such as:

  • Destroying or removing extra prostate tissue with microwaves, lasers, or heated water vapor
  • Implanting small devices to hold the prostate tissue out of the way of the urethra

Surgery

Surgery may be done if other treatments cannot manage symptoms. The goal is to remove excess prostate tissue or widen the path for urine.

Excess prostate tissue may be removed with:

  • Transurethral resection of the prostate—a scope is passed through the urethra to the prostate. Excess prostate tissue can be removed with the scope.
  • Open surgery—an incision is made in lower belly to remove excess prostate tissue.

The urethra may be widened by:

  • Transurethral incision of the prostate—small cuts are made in the neck of the bladder.
  • Prostatic stents—tiny metal coils are inserted into the urethra to make it wider and keep it open.
    • May be good for men who do not want to take medicine or have surgery.
    • Does not seem to be a good long term option.

Prevention

Prostate enlargement is a natural change with age. Problems are more common in those with obesity and cholesterol issues, such as low high-density lipoprotein (HDL). Keeping a healthy weight and a healthy diet may prevent or slow prostate growth.

References

  • American Urological Association (AUA), McVary, K.T., Roehrborn, C.G., et al. Management of benign prostatic hyperplasia (BPH) (Revised 2010, reviewed and validity confirmed 2014).
  • Benign Prostatic Hyperplasia (BPH). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/benign-prostatic-hyperplasia-bph.
  • Chughtai, B,. Forde, J.C., et al. Benign prostatic hyperplasia. Nature Reviews Disease Primers, 2016; 2: 16031.
  • Gacci, M., Corona, G., et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU International, 2015; 115 (1): 24-31.
  • Pearson, R. and Williams, P.M. Common questions about the diagnosis and management of benign prostatic hyperplasia. American Family Physician. 2014; 90 (11): 769-74.
  • Prostate enlargement: Benign prostatic hyperplasia. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement.
  • 11/5/2014 DynaMed Systematic Literature Surveillance http://www.dynamed.com/condition/benign-prostatic-hyperplasia-bph: Friedman, B., Leyendecker, J.R., et al. ACR Appropriateness Criteria lower urinary tract symptoms: suspicion of benign prostatic hyperplasia [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 5 p. Available at: http://www.guideline.gov/content.aspx?id=48292#Section420.
 
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