Benign Prostatic Hyperplasia (BPH) Treatment

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia is a medical condition characterized by prostate enlargement this results in urinary symptoms such as difficulty passing urine, incomplete bladder emptying, or frequently urinating at night.  This condition only affects men as women do not have prostate glands.  This condition increases in prevalence with age.  Progressive enlargement of the prostate may cause significantly bothersome symptoms and can increase the risk of urinary tract infections.

Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Benign Prostatic Hyperplasia (BPH)?

The prostate is a male organ that rests beneath the bladder – here, it wraps around the urethra.  The urethra is the region of the urinary tract that connects the bladder to the tip of the penis.

Benign prostatic hyperplasia is caused by progressive enlargement of the prostate gland.  It generally affects older men.  Testosterone is converted into dihydrotestosterone (DHT) in tissues such as the prostate and scalp tissue.  This is performed by the enzyme 5-alpha reductase.  DHT acts on prostate tissue to promote its enlargement.  As the prostate enlarges, it becomes more difficult for urine to travel from the bladder out the penis.  The prostate basically constricts the urethra.

When urethral constriction becomes severe enough, patients may retain urine in the bladder and have a higher risk of developing urinary tract infections.  Sometimes patients develop severe urinary retention that results in kidney injury.  This often requires placement of a Foley catheter or emergency placement of a suprapubic catheter to relieve bladder pressure.

How common is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia is an extremely common condition that is frequently evaluated in the primary care clinic.  This disease often requires referral to a urology specialist.

Its prevalence is increasing due to the rise of elderly men in the United States.  It affects about 25% of American men in their 50s, 33% of men in their 60s, and 50% of men age 80 or older.

What are the symptoms and signs of Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia primary causes urinary symptoms.  The most common symptoms include:

  • Urinary frequency
  • Frequent urination at night (nocturia)
  • Urinary hesitancy – trouble passing urine
  • Incomplete bladder emptying
  • Suprapubic or pelvic pain

Your doctor will often evaluate for certain findings on your physical examination such as:

  • Enlarged prostate on rectal examination
  • Abdominal distension or pain on abdominal palpation
  • Genital examination evaluating for urethral strictures or structural abnormalities such as Peyronie disease

How is Benign Prostatic Hyperplasia (BPH) diagnosed?

Benign prostatic hyperplasia is diagnosed based on symptoms and physical examination.  The palpation of an enlarged prostate on rectal examination is the classic feature.

Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and urine analysis.  They may send urine for a bacterial culture as well.

If you are over the age of 50, you doctor may consider checking a serum PSA level.  This blood test is usually elevated in prostate cancer, but can also increase in the setting of prostate infection or inflammation.

How is Benign Prostatic Hyperplasia (BPH) treated?

If you prostate enlargement has gotten severe enough to completely block off the urinary tract, this is a medical emergency.  Acute urinary retention often requires the placement of a Foley catheter to relieve pressure off the urinary tract and bladder.  If a Foley catheter cannot be placed, a suprapubic catheter may need to be inserted by a urologist.

In mild to moderate cases of prostate enlargement, patients often benefit from the use of medications.  The most commonly prescribed drugs for benign prostatic hyperplasia include:

Alpha blockers:

5-alpha reductase inhibitors:

Alpha blockers work by relaxing the smooth muscles around the urinary tract and prostate gland – allowing urine to pass through the prostate and flow more easily.  They may cause dizziness upon standing very early on in treatment, but this typically improves.  It should be used with caution in individuals at risk for falls.

5-alpha reductase inhibitors work by reducing the conversion of testosterone to dihydrotestosterone (DHT).  DHT is responsible for the enlargement of prostate tissue over time – so 5-alpha reductase inhibitors work by reducing DHT and prostate size.  Side effects may include low of sexual desire, impotence, and projects ejaculating.  These are relatively uncommon and improve with drug discontinuation.

If patients do not respond these medications or are not interested in drug therapy, they may be candidates for prostate surgery.  Their urologist will often recommend a minimally invasive procedure called a transurethral resection of the prostate (TURP) - where they remove prostate tissue by entering through the urethra.  They may also recommend a more invasive procedure called radical prostatectomy, which involves complete removal of the prostate gland.

 

Benign Prostatic Hyperplasia (BPH) Patient Summary:

  • Benign prostatic hyperplasia is a very common urologic condition characterized by prostate enlargement.
  • It is typically caused by increasing age and elevated DHT levels in the prostate gland.
  • This condition only affects men as women do not have prostate glands.
  • It affects about 25% of American men in their 50s, 33% of men in their 60s, and 50% of men age 80 or older.
  • The most common symptoms are urinary frequency, urinary urgency, nocturia, incomplete bladder emptying, trouble passing urine, and suprapubic or pelvic pain.
  • Diagnosis usually requires a prostate examination and urine and blood tests.
  • Your doctor will often order a urinalysis and urine culture to evaluate for infection and blood in the urine.
  • They may also check a PSA to screen for prostate cancer.
  • Treatment typically consists of alpha blockers such as: Uroxatral (alfuzosin), Cardura (doxazosin), Flomax (tamsulosin), and Rapaflo (silodosin).
  • They may also recommend 5-alpha reductase inhibitors: Proscar (finasteride) and Avodart (dutasteride).
  • If patients do not respond these medications or are not interested in drug therapy, they may be candidates for prostate surgery. 
  • These procedures include transurethral resection of the prostate (TURP) or radical prostatectomy.

References:

  1. Pearson R, Williams PM. Common questions about the diagnosis and management of benign prostatic hyperplasia. Am Fam Physician. 2014 Dec 1;90(11):769-74.
  2. Sarma AV, Wei JT. Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med. 2012 Jul 19;367(3):248-57.
  3. McVary KT. BPH: epidemiology and comorbidities. Am J Manag Care. 2006 Apr;12(5 Suppl):S122-8.

Popular Benign Prostatic Hyperplasia (BPH) Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.