Benign prostatic hyperplasia

A Look at Benign Prostatic Hyperplasia (BPH)

Man stood over toilet
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Benign Prostatic Hypertrophy

Medical Specialties:

Family medicine, Internal medicine, Urology

Clinical Definition:

Benign prostatic hyperplasia or BPH is a condition marked by a non-cancerous proliferation of cells, both smooth muscle and epithelial, in the prostate gland's transition zone. Lower urinary tract symptoms accompany the hyperplasia. Diagnosis is made by medical history, physical exam, and tests, including urinalysis.

Treatments include watchful waiting, medication and surgery.

In Our Own Words:

Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate gland, the walnut-sized gland below the bladder that carries urine from the bladder out through the penis. The prostate produces fluid for the semen.

As the prostate enlarges, urinary symptoms occur, including the need to empty the bladder often, difficulty in initiating urination and a feeling that the bladder is not empty even after urinating. Medical history, physical exam and urinalysis contribute to the diagnosis of BPH. Treatment can range from watchful waiting and lifestyle changes to medicines and surgical interventions. If the condition progresses, a man may become unable to empty the bladder and kidney damage or bladder stones can occur.

More Information About BPH

Benign prostatic hyperplasia is a pathological process that can result in a variety of urinary symptoms, which can be broadly classified into obstructive symptoms and irritative symptoms.

Here are the obstructive symptoms:

  • straining
  • weak stream
  • dribbling
  • prolonged voiding
  • hesitancy
  • incomplete emptying

Here are the irritative symptoms:

  • frequency
  • nocturia (waking up at night to urinate)
  • urge incontinence
  • small volumes of voided urine

In addition to prostatic enlargement, these urinary symptoms are also caused by changes in detrusor muscle activity, which occur due to aging.

Proper relaxation of the detrusor muscle allows you to store urine; whereas, proper contraction of this muscle allows you to urinate.

Symptoms of BPH are assessed using a reproducible and validated index (questionnaire) that examines the severity of BPH and the response of BPH to treatment. One such index is the AUA’s Symptom Index (AUASI), published by the American Urological Association. The AUASI comprises 7 questions that focus on urinary symptoms like hesitancy, urgency, weak stream, nocturia and so forth.

Even though BPH isn't cancer, many men with BPH seek medical attention for this condition because it's uncomfortable. Thus, the goal of treatment for BPH often centers on relief of symptoms.

Here are some symptomatic treatments for BPH:

  • Alpha-blockers like Doxazosin (Cardura) and Tamsulosin (Flomax) help relax (sympathetic) bladder tone and improve urination.
  • PDE5 inhibitors like sildenafil (Viagra) can also be used to treat the symptoms of BPH. However, caution should be exercised when dosing these medications because in addition to alpha-blockers, these medications can drop blood pressure to dangerously low levels.
  • Because BPH often coexists with overactive bladder, medications like anticholinergics, which are used to treat overactive bladder, have been studied in the treatment of BPH.
  • Surgeries can also help with BPH, including TURP (transurethral resection of the prostate) and transurethral ultrasound-guided laser-induced prostatectomy (TULIP). During these procedures, a urologist removes your prostate gland.

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