Benign Prostatic Hyperplasia (BPH; prostate gland enlargement) is the non-malignant growth of prostate tissue and is common in older males (>80-90% of those >70 years). The enlargement often leads to a urethral compression and bladder outflow obstruction causing discomfort and impacting on the quality of life. This is not the same as prostate cancer and does not increase the risk of that cancer.
Aetiology:
The exact cause of BPH is not well understood, but it mainly occurs as a natural part of aging. The prostate goes through two main growth periods as a man ages: first one occurs early in puberty, and the second starts around the age of 25 and continues to enlarge.
Risk factors: type 2 diabetes; genetic predisposition; diet (alcohol, heavy caffeine consumption and higher doses of supplemental vitamin C increase risk); obesity.
Clinical features:
Symptoms vary, but most commonly involve:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder
The American Urological Association have developed the ‘BPH Symptom Score Index’ that can be used to rate the above symptoms and their severity. The severity of symptoms can also be assessed by the International Prostate Symptoms Score (I-PSS) that quantifies incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia, as well as the impact of the symptoms using a Likert scale.
If severe, there is an increased risk for urinary tract infections, bladder stones and other chronic kidney problems due to the backflow of urine affecting the kidneys.
Diagnosis involves the physical examination, including digital rectal examination to palpate posterior of the prostate; urinalysis; screen for prostate-specific antigen (PSA); renal ultrasound can also be done to assess.
Differential: prostate cancer; prostatitis; urinary tract infection
Treatment:
Treatment will depend on severity of the symptoms, and may include:
- Observation: if no or minor symptoms, reviewed annually.
- Lifestyle changes such as reducing fluid intake before bedtime; limiting or avoiding alcohol and caffeine; avoiding medications that can exacerbate symptoms (eg decongestants; antihistamines); practicing “double voiding” (urinating, then waiting a few minutes and trying again).
- Medication: Alpha blockers to help relax the bladder neck and muscle fibres where the prostate joins the bladder can improve urine flow; 5-alpha reductase inhibitors can be used to reduce prostate volume.
- Minimally invasive therapies: for example: transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA); or laser therapy that can reduce excess prostate tissue.
- Surgery: if severe, surgical options include a transurethral resection of the prostate (TURP) or a prostatectomy.
Page last updated:
Comments are closed.