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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 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 levels 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. Other factors that may increase your chance of having BPH include:
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:
You will be asked about your medical history and symptoms. If BPH is suspected, 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:
Your doctor may also recommend avoiding certain medications. For example, decongestant drugs containing alpha-agonists such as pseudoephedrine can worsen BPH symptoms.
Minimally Invasive Interventions
Minimally invasive procedures can be through the urethra. This type of surgery generally has shorter recovery time and less risk of damage to surrounding tissue than open surgeries. These options may be used if medications were not able to reduce symptoms but surgery is not needed. Procedure options include:
Surgery may be advised 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. It is more common in men with obesity and low HDL cholesterol levels. Maintaining a healthy weight and eating a healthful diet may prevent prostate enlargement.
National Institute of Diabetes and Digestive and Kidney Diseases
Prostate Cancer Research Institute
Canadian Urological Association
The Prostate Centre at The Princess Margaret
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10/14/2011 DynaMed Plus Systematic Literature Surveillance
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5/27/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116944/Benign-prostatic-hyperplasia-BPH : Gacci M, Corona G, et al. Metabolic syndrome and benign prostatic enlargement: A systematic review and meta-analysis. BJU Int. 2014 Mar. [Epub ahead of print].
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http://www.dynamed.com/topics/dmp~AN~T116944/Benign-prostatic-hyperplasia-BPH: Friedman B, Leyendecker JR, et al. ACR Appropriateness Criteria lower urinary tract symptoms: suspicion of benign prostatic hyperplasia [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 5 p. Available at:
Last reviewed September 2018 by
EBSCO Medical Review Board
Rimas Lukas, MD
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