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Benign Prostatic Hyperplasia

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Definition

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.

Enlarged Prostate
BPH prostate
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Causes

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

BPH is most likely to occur in men aged 50 years or older. Other factors that may increase your chance of having BPH include:

  • Metabolic syndrome —A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
  • Obesity
  • Lipid disorders
  • Diet high in fats and red meat

Symptoms

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:

  • Difficulty starting to urinate
  • Weak urination stream
  • Dribbling at the end of urination
  • Sensation of incomplete bladder emptying
  • Urge to urinate frequently, especially at night
  • Deep discomfort in the lower abdomen
  • Urge incontinence —strong, sudden urge to urinate

Diagnosis

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:

  • Urine flow study
  • Cystometrogram—a functional study of the way your bladder fills and empties
  • Post-void residual volume test—measures whether you can empty your bladder completely

Images of the prostate and urinary tract may be taken with:

Treatment

Treatment is not needed for mild cases. Most men with BPH eventually request medical intervention to help with urinary symptoms.

Treatments include:

Medication

Medication is often the first line of treatment to help reduce urinary symptoms. Medication options include:

  • 5 alpha-reductase inhibitors—to shrink the prostate, which may decrease some urination problems
  • Alpha-blockers—to relax the muscles around the neck of the bladder and the prostate to improve urine flow
  • Antimuscarinics—to relax the bladder muscles, which helps to reduce the urge to urinate frequently
  • Phosphodiesterase-5 enzyme inhibitor — erectile dysfunction medication that can also improve the symptoms of BPH

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 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:

  • Transurethral microwave thermotherapy (TUMT)—uses microwaves to destroy excess prostate tissue
  • Transurethral needle ablation (TUNA)—uses low levels of radio frequency energy to burn away portions of the prostate
  • Transurethral laser therapy—uses highly focused laser energy to remove prostate tissue

Surgery

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:

  • Transurethral surgical resection of the prostate (TURP) —a scope is inserted through the penis to remove the enlarged portion of the prostate
  • Open surgery—removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area, more invasive

The urethra may be widened by:

  • Transurethral incision of the prostate (TUIP)—small cuts are made in the neck of the bladder to widen the urethra
  • Prostatic stents—tiny metal coils are inserted into urethra to widen it and keep it open
    • Usually used for men who do not want to take medication or have surgery
    • Does not appear to be a good long-term option

Alternative Treatments

Some herbal products have been studied as possible BPH treatments. Herbs that may have some benefit include:

Prevention

Prostate enlargement occurs naturally with age. There are no prevention steps.

Revision Information

  • National Kidney and Urologic Diseases Clearinghouse

    http://kidney.niddk.nih.gov

  • Prostate Cancer Research Institute

    http://prostate-cancer.org

  • Canadian Urological Association

    http://www.cua.org

  • The Prostate Centre at The Princess Margaret

    http://www.prostatecentre.ca

  • Beta-sitosterol. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated July 8, 2014. Accessed September 3, 2014.

  • Fagelman E, Lowe FC. Saw palmetto berry as a treatment for BPH. Rev Urol. 2001 Summer;3(3):134-8.

  • Fried NM. New laser treatment approaches for benign prostatic hyperplasia. Curr Urol Rep. 2007 Jan;8(1):47-52.

  • Greco KA, McVary KT. The role of combination medical therapy in benign prostatic hyperplasia. Int J Impot Res. 2008 Dec;20 Suppl 3:S33-43.

  • Marberger M. Drug insight: 5-alpha-reductase inhibitors for the treatment of benign prostatic hyperplasia. Nat Clin Pract Urol. 2006 Sep;3(9):495-503.

  • Prostate enlargement: Benign prostatic hyperplasia. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement. Updated March 23, 2012. Accessed September 3, 2014.

  • Roehrborn CG, Siami P, Barkin J, et al; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57(1):123-131.

  • Ulbricht C, Basch E, Bent S, et al. Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration. J Soc Integr Oncol. 2006;4(4):170-86.

  • Update on the UAU guideline on the management of benign prostatic hyperplasia. J Urol. 2011 May; 185(5):1793-803.

  • 10/7/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306(12):1344-1351.

  • 10/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm. Updated October 6, 2011. Accessed September 3, 2014.

  • 5/27/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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].