Enlarged Prostate (Benign Prostatic Hyperplasia)


Normal Prostate, Enlarged Prostate

- Benign Prostatic Hyperplasia -

Prostate enlargement and the resulting symptoms are called by many different names and acronyms.  "Benign prostatic hyperplasia" (BPH) is the most commonly used term, as well as the technically most accurate.  Other terms are Benign Prostatic Hypertrophy (also BPH), and Benign Prostatic Enlargement (BPE).  These terms all refer to the gradual, non-cancerous enlargement of the prostate gland as well as the lower urinary tract symptoms that result from increasing bladder outlet obstruction. These symptoms have been referred to in the past as "prostatism." This common problem affects an increasing percentage of men as they age, often beginning in a man's 40s.

There is no causal relationship between BPH and prostate cancer, but both can cause elevation of the PSA blood test and urinary symptoms due to bladder outlet obstruction.

- Symptoms of BPH -

 BPH symptoms arise due to obstruction of the flow of urine out of the bladder. The common early symptoms are slowing of the urinary stream, frequency, urgency, sensation of incomplete bladder emptying, urinary intermittency, and awakening repeatedly at night to urinate (nocturia). As time passes, the bladder struggles increasingly to empty, eventually becoming less able to do so.  Over time the bladder sustains irreversible injury, including replacement of the muscle fibers with connective tissue that cannot contract to empty out the accumulating urine.  With an increasing amount of residual urine left in the bladder after voiding, new problems may arise including formation of bladder stones, urinary tract infections, overflow urinary incontinence, and urinary retention, which is often a painful emergency.  It is common for men with severe BPH to report that their quality of life is severely impacted by the need to be near a bathroom hourly or even more often.  In rare cases, obstruction can lead to that kidney failure may result. 

In brief, the healthy urinary tract is a stream, efficiently carrying byproducts of metabolism out of the body.  Over time, the obstructed bladder loses its ability to empty, resulting in a range of problems from urinary frequency to bladder infections, bladder stones, painful urinary retention, and even kidney injury.

- Evaluation of BPH -

The evaluation of men with urinary symptoms suggestive of benign prostatic hypertrophy (BPH) includes:

  • complete history and physical exam
  • international prostate symptom score (IPSS) questionnaire.  This score can be followed over time during treatment
  • blood draw for PSA level

Additional elements of the BPH evaluation (determined by symptom severity, progression, and response to treatment) and may include:

  • measurement of bladder volume after voiding, usually by ultrasound (post-void residual)
  • urine flow rate determination (uroflow)
  • cystoscopy (look in bladder with skinny, flexible scope to see the type and degree of obstruction caused by the prostate)
  • urodynamics - this "ECG for the bladder" evaluates bladder pressure and function.