Urology Center of Englewood

Benign Prostatic Hyperplasia (BPH)

Overview

The prostate is a walnut-sized gland that is part of the male reproductive system. It is located just below the bladder and surrounds part of the urethra (the tube that drains urine from the bladder). The prostate produces some of the fluid that makes up semen.

Benign prostatic hyperplasia (BPH) refers to non-cancerous enlargement of the prostate. Enlargement of the prostate is very common as men age, and can eventually lead to obstruction of the urethra and gradual loss of bladder function. This can produce lower urinary tract symptoms (LUTS) such as a weak or interrupted urine stream, urinary urgency and leaking, or more frequent urination, especially at night. Severe BPH can lead to problems such as urinary tract infections, damage to the kidney or bladder, bladder stones, and incontinence (inability to control urination).

Any urinary problems that you experience should be discussed with your physician. If the diagnosis is BPH and the symptoms are bothersome, treatments are available.

How is BPH Diagnosed?

Men may undergo a workup (evaluation) for BPH as a result of symptoms or as a result of routine screening with a digital rectal exam (DRE). During a DRE, a physician inserts a gloved finger into the patient’s rectum. The physician is able to feel part of the prostate and get a sense of its size. A DRE may be performed as part of a man’s routine physical examination, for prostate cancer screening, or in response to urinary or bowel problems.

In addition to a digital rectal exam, several other tests may also be performed to diagnose BPH and to rule out other conditions. These tests may include the following:

Symptom questionnaire: You may be asked to answer questions about the type and severity of symptoms that you are experiencing.

Prostate-specific antigen (PSA) test: PSA is a protein that is produced by the prostate. Men who have prostate cancer frequently have elevated levels of PSA in their blood, but PSA levels can also be elevated as a result of other conditions, including BPH.

Urinalysis: A urine sample may be tested for signs of blood, infection, or other problems.

Other evaluations may include urinary diaries, measurement of urinary flow rate, measurement of the amount of urine that remains in the bladder after urination, and imaging of the prostate with ultrasound.

Management of BPH

Depending on your particular situation and the extent to which you’re bothered by your lower urinary tract symptoms, options to manage BPH include watchful waiting, drug treatment, and a range of surgical options.[1]

Watchful waiting: If you’re not particularly bothered by your symptoms and your physician agrees that it’s appropriate, watchful waiting (the monitoring of your condition without active treatment)—may be an option. Your physician may suggest lifestyle modifications to minimize symptoms, such as management of fluid intake.

Drug treatment: Drugs that may be used alone or in combination to treat symptoms of BPH are alpha blockers and 5-alpha reductase inhibitors. Alpha blockers do not shrink the prostate, but they can relieve symptoms by relaxing muscles around the prostate and bladder. 5-alpha reductase inhibitors reduce exposure of the prostate to an active form of testosterone; this reduces the size of the prostate.

Surgery: Several different surgical approaches are available to manage BPH. Transurethral resection of the prostate (TURP) involves removal of the excess prostate tissue that is blocking the urethra. The procedure is performed using a device that is inserted through the urethra. Transurethral incision of the prostate (TUIP) involves making cuts in the prostate to relieve the constriction of the urethra. Surgery may also be performed with laser technology or other forms of energy.

What About Dietary Supplements?

There is a great deal of interest in whether dietary supplements can help to relieve symptoms of BPH, but thus far there is no clear evidence to support the use of any dietary supplement for this purpose. Saw palmetto has received the most attention, but recent studies have not shown a benefit.[2] Research in this area is ongoing.

References:


[1] Wilt TJ, Dow JN. Benign prostatic hyperplasia. Part 2—Management. BMJ. 2008;336:146-9.

[2] Barry MJ, Meleth S, Lee JY et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306:1344-51.