Overview
Benign prostatic hyperplasia (BPH) is the age-related enlargement of the prostate gland. It is not cancerous but presses on the urinary tract, leading to urinary complaints.
Some degree of BPH is present in 50% of men over age 60 and 90% of men over age 80. It reduces quality of life but can be treated.
Symptoms
Urinary symptoms:
- Frequent urination (especially at night - nocturia)
- Urgent need to urinate
- Difficulty, hesitation in starting urination
- Weak or intermittent urine stream
- Feeling of incomplete emptying
- Dribbling after urination
- Sometimes urinary incontinence
- Inability to hold urine
- Inability to urinate (acute retention - emergency)
Causes
The exact cause is unknown. Age-related hormonal changes (especially testosterone and dihydrotestosterone) are thought to play a role.
Risk Factors
- Age (begins after age 40, becomes prominent after 50)
- Family history
- Diabetes, heart disease
- Obesity
- Sedentary lifestyle
- Ethnicity
Complications
- Acute urinary retention (emergency)
- Frequent urinary tract infections
- Bladder stones
- Bladder damage
- Kidney damage (in advanced cases)
- Hematuria (blood in urine)
When to See a Doctor
- If you have urinary symptoms
- Routine check-up for men over 50
- If frequent urination disturbs your sleep
- If there is blood in the urine
- If you cannot urinate (emergency)
- If accompanied by pain
Diagnosis and Treatment
Diagnosis:
- IPSS scoring
- Digital rectal examination
- PSA test (cancer differential)
- Urinalysis
- Uroflowmetry (urine flow rate)
- Postvoid residual measurement (ultrasound)
- Cystoscopy (when needed)
Treatment:
1. Observation (in mild cases)
2. Medication:
- Alpha blockers: Tamsulosin, doxazosin (relax urine flow)
- 5-alpha reductase inhibitors: Finasteride, dutasteride (reduce prostate size)
- Combination therapy
- Tadalafil (BPH + erectile dysfunction)
3. Minimally invasive procedures:
- Prostate urethral lift (UroLift)
- Water vapor therapy (Rezum)
- Prostate artery embolization
4. Surgery:
- TURP (transurethral resection of the prostate) - gold standard
- Laser surgery (HoLEP, GreenLight)
- Open prostatectomy (in very large prostates)
Prevention
- Maintain a healthy weight
- Exercise regularly
- Eat a vegetable- and fruit-rich diet
- Limit salt, caffeine, alcohol
- Reduce fluid intake before bedtime
- Manage stress
- Annual urology check-up after age 50