Benign Prostatic Hyperplasia
(BPH; Benign Prostatic Hypertrophy; Prostatism; Bladder Outlet Obstruction)
by Rick Alan
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.
Risk Factors TOP
BPH is most likely to occur in men aged 50 years or older.
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:
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:
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:
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:
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:
The urethra may be widened by:
Prostate enlargement occurs naturally with age. There are no prevention steps.
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Prostate Cancer Research Institute
Canadian Urological Association
The Prostate Centre at The Princess Margaret
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Last reviewed September 2013 by Adrienne Carmack, MD
Last Updated: 9/30/2013