Benign prostatic hyperplasia (BPH) is an enlargement of the prostate. The prostate is usually a walnut-sized gland located at the neck of the bladder. It surrounds the urethra, a tube that carries urine from the bladder to the outside of the body.
An enlarged prostate puts pressure on the urethra and can make it difficult for urine to pass. Eventually, the urethra may become completely closed off.
The exact cause of BPH is unknown. It may be related to natural changes in hormone level that occur as men age.
The enlargement is not due to cancer.
Enlarged prostate itself does not cause symptoms. Symptoms develop when the prostate gland puts enough pressure on the urethra to interfere with the flow of urine.
Symptoms usually increase in severity over time and may include:
- Difficulty starting to urinate
- Weak urination stream
- Dribbling at end of urination
- Sensation of incomplete bladder emptying
- Urge to urinate frequently, especially at night
- Deep discomfort in lower abdomen
- Urge incontinence —strong, sudden urge to urinate
Your doctor will ask about your medical history and symptoms. If your doctor suspects BPH, a digital rectal exam may be done. A gloved finger is inserted into the rectum to assess the prostate.
To assess problems with urine flow your doctor may recommend:
- Urine flow study
- Cystometrogram (a functional study of the way your bladder fills and empties)
- Post-void residual volume test—measures whether you can empty your bladder completely
Images of the prostate and urinary tract may be taken with:
Treatment is not needed for mild cases. Most men with BPH eventually request medical intervention to help with urinary symptoms.
Medication is often the first line of treatment to help reduce urinary symptoms. Medication options include:
- 5 alpha-reductase inhibitors—to shrink the prostate, which may decrease some urination problems.
- Alpha-blockers—relax the muscles around the neck of the bladder and the prostate to improve urine flow.
- Antimuscarinics—to relax the bladder muscles, which helps to reduce the urge to urinate frequently.
- Phosphodiesterase-5 enzyme inhibitor — erectile dysfunction medication that can also improve the symptoms of BPH.
Each group of medications has different side effects. Enzyme inhibitors may cause decreased sexual desire and problems with erection. Alpha-blockers may cause decreased blood pressure, dizziness, and stuffy nose. Antimuscarinics can cause dry mouth, constipation, dry eyes, trouble emptying the bladder, and confusion. You and your doctor will work to find the best medication or combination of medications to treat your symptoms with minimal side effects.
Your doctor may also recommend avoiding certain medications. For example, decongestant drugs containing alpha-agonists (eg, pseudoephedrine ) can worsen BPH symptoms.
Minimally Invasive Interventions
Minimally invasive procedures can decrease the size of the prostate by removing small portions of the prostate. These procedures may be used if medications were not able to reduce symptoms but surgery is not yet needed. Procedure options include:
- Transurethral microwave thermotherapy (TUMT)—uses microwaves to destroy excess prostate tissue
- Transurethral needle ablation (TUNA)—uses low levels of radio frequency energy to burn away portions of the prostate
- Transurethral laser therapy—uses highly focused laser energy to remove prostate tissue
Surgery may be recommended if medications and noninvasive procedures are not effective. The goal of surgery is to remove excess prostate tissue or widen the pathway for urine.
Portions of the prostate may be removed with:
- Transurethral surgical resection of the prostate (TURP) —a scope is inserted through the penis to remove the enlarged portion of the prostate
- Open surgery—removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area, much more invasive then TURP or TUIP
The urethra may be widened by:
- Transurethral incision of the prostate (TUIP)—small cuts are made in the neck of the bladder to widen the urethra
Prostatic stents—tiny metal coils that are inserted into urethra to widen it and keep it open
- Usually used for men who do not wish to take medication or have surgery
- Does not appear to be a good long-term option
- Reviewer: Adrienne Carmack, MD
- Review Date: 09/2013 -
- Update Date: 09/30/2013 -