New York Urologic


Enlarged Prostate

About Benign Prostate Hyperplasia

Benign Prostate Hyperplasia, or BPH, is a condition in which the prostate becomes enlarged. The prostate is the gland partially responsible for the production of semen in males. It lies directly beneath the bladder and surrounds the urethra, which empties urine from the bladder. When ejaculation begins, the seminal vesicles, which store semen mixed with sperm, secrete the mixture through the prostate into the urethra. This mixture leaves the body as ejaculate. The prostate is on average the size of a golf ball in young adults and men in their mid 40s, having grown significantly from the size of a pea since childhood. Often, the prostate gets even larger in midlife. By this time, most commonly when men reach their late 40’s and early 50’s, the prostate may have become large enough to cause urine blockage due to its compressing of the urethra. This compression can block or interrupt urine flow, causing contractions of the muscles around the urethra. This makes urinating and completely emptying the bladder increasingly difficult. In some cases, the prostate can become very enlarged (the size of an apple) or extremely enlarged (the size of a grapefruit). However, patients can show symptoms of BHP even with mild to moderately enlarged prostates. It is important to note that an enlarged prostate, or BPH, is NOT the same as prostate cancer, nor does it make one more likely to develop cancer.

BPH Symptoms

At least half of all men develop enlargement of the prostate as they age. Only half of these men, or one quarter of the male population, develop symptoms so noticeable that they seek medical attention. Symptoms may vary greatly among individuals. Generally, patients with BPH present with lower urinary tract symptoms, which are classified into two groups: obstructive symptoms and irritative symptoms:

Obstructive symptoms include:

  • Difficulty initiating urination
  • Interrupted urinary stream (when urine flow comes in fits and starts)
  • Difficulty or inability to fully empty the bladder, and urine dribbling during or after urination

Irritative symptoms include:

  • Increasingly frequent urination
  • Urinary urgency, urinary incontinence (inability to hold urine)
  • Dysuria (painful urination)

Additionally, those with BPH may suffer from Nocturia, which is frequent urination at night.

While the above symptoms often do indicate the presence of BPH, they can also indicate many other urological and medical conditions. Men should always consult a Urologist or medical doctor if they are suffering from any of the above symptoms.

BPH Diagnosis

Your doctor will review your symptoms and obtain facts such as duration of your symptoms and whether your symptoms have been relatively stable or worsening over time. Additionally, your physician may have you complete an American Urological Association (AUA) BPH Symptom Score Index to better gauge the severity of your symptoms. Your doctor will then conduct a physical exam to feel the shape and size of your prostate by performing a rectal examination using a gloved finger. A urine sample may also be analyzed for the presence of infection and or microscopic blood and stone crystals.

Additionally, your doctor may examine your bladder with an ultrasound device called a bladder scan to check how much urine remains in your bladder after urination. Your doctor may also want to perform a transrectal ultrasound, or TRUS, which uses an ultrasound probe through the rectum to more accurately measure the size of the prostate and assess its shape and contours. This procedure is not dangerous or painful, but may be uncomfortable. Your doctor may also want to send a sample of your blood for further analysis, including a check of kidney function and PSA, which is a blood test done usually annually to screen for prostate cancer.

The Urodynamic pressure-flow study is another test that a physician may want to run on a patient suffering from BPH symptoms. During this procedure, in which topical anesthetics are administered, a very narrow catheter is inserted into the bladder through the urethra. This catheter is then connected to a urodynamic computer which measures the strength of contractions in the bladder. This test usually takes about fifteen to twenty minutes and is generally only performed on patients with severe or uncommon symptoms. Your doctor may also perform a cytoscopy or a CT urogram. During the cystoscopy, the physician inserts a very narrow tube with a camera inside, so that he or she can visualize any abnormal anatomy or blockages, as well as other conditions that may be causing the symptoms, such as a bladder stone or bladder tumor. This procedure is usually performed under local anesthesia or occasionally under intravenous sedation. During the CT urogram, a CT scan is taken of the entire urinary tract while dye flows through the system, and a radiologist looks for abnormal blockages. The doctor may also wish to perform a biopsy to ensure that the cause of the symptoms is indeed BPH and not something more severe such as prostate cancer.

BPH Related Conditions

If left untreated, the symptoms of BPH can significantly worsen and lead to some common BPH-related conditions and complications:

  • Acute urinary retention, or AUR: a very painful condition that leaves the patient completely unable to empty his bladder. This can only be treated with a catheter, which is inserted through the penis.
  • Bladder damage: After continued incomplete drainage of the bladder, the wall of the bladder begins to stretch from the stress of holding urine. In some cases, the bladder function has deteriorated so much that patients will retain more than one litter of urine in their bladder without even realizing it! This kind of situation can usually led to even more serious complications, such as persistent urine infections, bladder diverticula, bladder stones, and ultimately, kidney failure.
  • Kidney damage: this may be caused by perpetual bladder and/or kidney infections as well as incomplete drainage of urine. Urine that collects in the kidneys may ultimately lead to hydronephrosis, or a swelling in the kidneys due to collected urine.
  • Bladder stones: Mineral deposits may accumulate and cause irritation, bleeding, infection, and ultimately blockage of urinary flow or urinary retention. In fact, most bladder stones occur in men, and are generally caused by BPH.

It is important to know that up to half of all men in their 60s have symptoms of an enlarged prostate, and this rises up to 90 percent of all men in their 70s. However, only a small percentage of men who suffer from the above symptoms actually talk to their doctors about treatment. Many older men will find the symptoms to be more noticeable, and consequently report them, but any man with irritating symptoms should not hesitate to talk to their doctor.