Benign Prostatic Hyperplasia

Causes

The exact cause of BPH is unknown. Natural changes in hormone levels due to age may play a role.

It is not due to cancer.

Risk Factors

BPH is most likely to occur in men aged 50 years or older. Other things that may increase the risk of BPH are:

• Metabolic syndrome—combination of high blood pressure, high cholesterol, high blood glucose, and overweight
• Obesity
• Lipid disorders—includes problems with overall cholesterol or low good cholesterol

Symptoms

The prostate itself does not cause symptoms. A larger prostate can put pressure on the urethra. It will lead to problems with urine flow such as:

• Difficulty starting to urinate
• Urine stream is weak
• Dribbling at the end of urination
• Feeling that bladder isn't completely empty
• Feel the need to urinate often, often happens at night
• Deep discomfort in the lower belly
• Urge incontinence—strong, sudden urge to urinate

Symptoms often get worse over time.

Diagnosis

The doctor will ask about symptoms and past health. The prostate may need to be checked if BPH is suspected. A gloved finger is inserted into the rectum. The doctor can feel the size of the prostate through the rectum.

Urine flow may be checked with:

• Urine flow study
• Cystometrogram—checks how the bladder fills and empties
• Post-void residual volume test—to see if the bladder can empty completely

Images of the prostate and urinary tract may be taken with:

• Ultrasound
• Cystoscopy

Treatment

BPH does not need treatment if it is not causing symptoms. Most BPH will lead to urinary symptoms at some point. Treatment will be needed to improve urinary symptoms. Treatment choices include:

Medicine

Medicine is the first line of treatment. Some medication choices include:

• 5 alpha-reductase inhibitors—to shrink the prostate and help flow
• Alpha-blockers—to relax the muscles around the neck of the bladder and the prostate to improve urine flow
• Antimuscarinics—to relax the bladder muscles and reduce the urge to urinate frequently
• Phosphodiesterase-5 enzyme inhibitor—medicine for erectile dysfunction that can also improve BPH symptoms

Some medicine can make make BPH symptoms worse. Treatment will include avoiding this type of medicine. Decongestant medicine with pseudoephedrine is one example.

Minimally Invasive Interventions

Minimally invasive procedures are done through the urethra. They often have shorter recovery times and less tissue damage than open surgeries. It may be done if medicine can no longer manage symptoms. There are different types of procedures such as:

• Transurethral microwave thermotherapy (TUMT)—uses microwaves to destroy extra prostate tissue.
• Transurethral laser therapy—laser energy removes extra prostate tissue.
• Small devices are implanted. They will hold the prostate tissue out of the way of the urethra.
• Transurethral radiofrequency (RF) thermal therapy—heated water vapor destroys extra prostate tissue.

Surgery

Surgery may be done if medicine or procedures above cannot manage symptoms. The goal is to remove excess prostate tissue or widen the path for urine.

Excess prostate may be removed with:

• Transurethral resection of the prostate (TURP)—a scope is passed through the urethra to the prostate. Excess prostate tissue can be removed with the scope.
• Open surgery—an incision is made in lower belly. Excess prostate tissue will then be removed.

The urethra may be widened by:

• Transurethral incision of the prostate (TUIP)—small cuts are made in the neck of the bladder.
• Prostatic stents—tiny metal coils are inserted into urethra. They will make it wider and keep it open.
  • May be for men who do not want to take medicine or have surgery.
  • Does not appear to be a good long-term option.

Alternative Treatments

Some herbs have been studied as possible BPH treatments. Supplements or alternative treatments should be reviewed with a doctor before use. Herbs that may have some benefit include:

• Beta-sitosterol
• Pygeum

Prevention

Prostate enlargement is a natural change with age. Problems are more common in those with obesity and low high-density lipoprotein (HDL) 'good cholesterol'. Keeping a healthy weight and a healthy diet may prevent or slow prostate enlargement.