Benign hypertrophy of Prostate

Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth of the prostate observed very commonly in aging men. Although on the surface this statement seems straightforward and simple, there are considerable definitional problems associated with the condition that subsequently lead to problems with epidemiologic definitions, calculations of incidence and prevalence rates, and, ultimately, difficulties with formalizing therapeutic algorithms.

BPH, the actual hyperplasia of the prostate gland, develops as a strictly age-related phenomenon in nearly all men, starting at approximately 40 years of age. In fact, the histologic prevalence of BPH, which has been examined in several autopsy studies around the world, is approximately 10% for men in their 30s, 20% for men in their 40s, reaches 50% to 60% for men in their 60s, and is 80% to 90% for men in their 70s and 80s. No doubt, when living long enough, most men will develop some histologic features consistent with BPH.1

Histologic BPH, although identified by the International Classification of Diseases (ICD) code 600, does not necessarily constitute a problem to the patient. In fact, many men with histologic BPH will never see a doctor for this condition, nor do they ever need any treatment for it. The condition becomes a clinical entity if and when it is associated with subjective symptoms, the most common manifestation being lower urinary tract symptoms (LUTS). It must be recognized, however, that not all men with histologic BPH will develop significant LUTS, although other men who do not have histologic BPH will develop LUTS. Such men might have other conditions of the prostate (prostatitis or prostate cancer), other causes for subvesical outlet obstruction (urethral stricture, bladder neck sclerosis), conditions of the bladder (carcinoma in situ, inflammation, stones), or other conditions leading to the rather nonspecific constellation of symptoms commonly labeled as “LUTS” (Figure 1). The LUTS symptom complex can be conveniently divided into obstructive and irritative symptoms. Among the obstructive symptoms are hesitancy, straining, weak flow, prolonged voiding, partial or complete urinary retention, and, ultimately, overflow incontinence. The often more bothersome irritative symptoms consist of frequency, urgency with urge incontinence, nocturia, and painful urination, as well as small voided volumes. The prevalence of LUTS increases steadily with increasing age. Observations to this effect have been obtained from many cross-sectional studies in various countries and racial groups.2 Not all men with obstructive or irritative voiding symptoms will be bothered by these symptoms, and so will not seek medical attention. Considerable efforts have been expended to understand the reasons men do or do not consult a health care provider when experiencing LUTS. In many cases, these symptoms are accepted as a natural occurrence with aging, and men learn to live with them. Also, the threshold for men to seek consultation with a health care provider for LUTS differs greatly within and between racial groups. Ultimately, however, when men are significantly bothered by these symptoms, they will usually consult a health care provider in hopes of remedying the situation.

The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:

Frequent or urgent need to urinate

Increased frequency of urination at night (nocturia)

Difficulty starting urination

Weak urine stream or a stream that stops and starts

Dribbling at the end of urination

Inability to completely empty the bladder

Less common signs and symptoms include:

Urinary tract infection

Inability to urinate

Blood in the urine

The size of your prostate doesn't necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.

In some men, symptoms eventually stabilize and might even improve over time.

Other possible causes of urinary symptoms

Conditions that can lead to symptoms similar to those caused by enlarged prostate include:

Urinary tract infection

Inflammation of the prostate (prostatitis)

Narrowing of the urethra (urethral stricture)

Scarring in the bladder neck as a result of previous surgery

Bladder or kidney stones

Problems with nerves that control the bladder

Cancer of the prostate or bladder

The cause of prostate enlargement is unknown, but it's believed to be linked to hormonal changes as a man gets older. The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.

The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn't entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.

Risk factors for prostate gland enlargement include:

Aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.

Family history. Having a blood relative, such as a father or a brother, with prostate problems means you're more likely to have problems.

Diabetes and heart disease. Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.

Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

Complications of an enlarged prostate can include:

Sudden inability to urinate (urinary retention). You might need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.

Urinary tract infections (UTIs). Inability to fully empty the bladder can increase the risk of infection in your urinary tract. If UTIs occur frequently, you might need surgery to remove part of the prostate.

Bladder stones. These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.

Bladder damage. A bladder that hasn't emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.

Kidney damage. Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don't develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Men with BPH have a larger-than-normal prostate. Some 9 in 10 men will have it by the time they’re in their 80s. Even with those chances, you still might ask: Are there things I can do to prevent it?

The short answer is no. For most men, the prostate gland is just going to grow, and it might lead to benign prostatic hyperplasia, as it’s formally known.

But it still helps to know when you’d want to see your doctor, what makes you more likely to get it, and how you can keep the symptoms at bay.