Benign Prostatic Hyperplasia

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia is commonly referred to as BPH. BPH is a common disorder that occurs in the aging male. Over time the prostate continually grows and can become enlarged. An enlarged prostate can affect the flow of urine and the genitourinary organs such as the kidneys, bladder, and urinary tract. The urethra is the tube that transports urine from the bladder to be excreted. The urethra runs through the middle of the prostate and as the prostate enlarges it begins to compress on the urethra eventually causing a blockage of urine flow.

What are the risk factors of Benign Prostatic Hyperplasia?

There are several risk factors associated with BPH. The risk factors that can be modified through lifestyle changes are obesity, diabetes, and heart disease. However, aging and family history of BPH are the other factors that predispose men to BPH. 

What are the symptoms of Benign Prostatic Hyperplasia?

Symptoms of BPH primarily are related to urinary symptoms. Common signs and symptoms include frequency and urgency to urinate, increased urination during the night, difficulty starting urination, and weak steam that starts and stops. Dribbling at the end of urination is another common symptom related to the inability of the bladder to completely empty. 

What are the complications of Benign Prostatic Hyperplasia?

The complications of BPH are caused by the inability of the bladder to completely empty. This can lead to urinary tract infections, bladder stones, and bladder damage. Bladder stones can cause infection, blood in the urine, and block the flow of urine. Bladder damage can occur by its stretching and weakening due to the bladder not completely emptying. This weakening of the muscle wall can make the bladder to contract inappropriately and also making it harder to empty the bladder. Urinary retention often occurs to varying degrees, but in the most severe cases due to the urethra being completely blocked, due to the enlarged prostate, the patient is not able to pass urine at all. This can lead to the need for a urinary catheter and possible kidney damage.

What are the differential diagnoses of Benign Prostatic Hyperplasia?

  • Prostatitis
  • UTI
  • Neurogenic bladder (depending on history)
  • Prostate or bladder cancer
  • Urethral stricture

What is the treatment of Benign Prostatic Hyperplasia?

According to the American Urological Association guidelines for BPH, clinicians should take a thorough medical history and use the American Urological Association symptoms index and urinalysis during the patient’s first visit who has urological complaints related to BPH. Kidney function blood work, digital exam, and a PSA blood test may be conducted. Clinicians may choose to do further workup with a post-void residual exam, uroflowmetry, or pressure-flow studies. To determine the size and shape of the prostate the clinician may choose to order an abdominal or transrectal ultrasound, cystoscopy, or MRI. Surgery is recommended for patients who develop renal insufficiency, urinary retention, recurrent UTIs and bladder stones, and patients who develop gross hematuria related to BPH and who do not wish to try other therapies. Transurethral resection of the prostate (TURP) and prostatectomy are common surgeries performed for BPH depending on the size of the prostate and the symptoms involved.

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