Benign Prostatic Hyperplasia (BPH): Everything You Need To Know

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Chapters

0:00 Introduction
0:53 Causes of Benign Prostatic Hyperplasia
1:21 Risk factors associated with BPH
1:38 Symptoms of Benign Prostatic Hyperplasia
2:30 Diagnosis of Benign Prostatic Hyperplasia
3:07 Treatment for Benign Prostatic Hyperplasia



Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland.[1] Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.[1] Complications can include urinary tract infections, bladder stones, and chronic kidney problems.[2]

The cause is unclear.[1] Risk factors include a family history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction.[1] Medications like pseudoephedrine, anticholinergics, and calcium channel blockers may worsen symptoms.[2] The underlying mechanism involves the prostate pressing on the urethra and thereby making it difficult to pass urine out of the bladder.[1] Diagnosis is typically based on symptoms and examination after ruling out other possible causes.[2]

Treatment options include lifestyle changes, medications, a number of procedures, and surgery.[1][2] In those with mild symptoms, weight loss, exercise, and decreasing caffeine intake are recommended, although the quality of the evidence for exercise is low.[2][4] In those with more significant symptoms, medications may include alpha blockers such as terazosin or 5α-reductase inhibitors such as finasteride.[1] Surgical removal of part of the prostate may be carried out in those who do not improve with other measures.[2] Some herbal medicines that have been studied, such as saw palmetto, have not been shown to help.[2] Other herbal medicines somewhat effective at improving urine flow include beta-sitosterol[5] from Hypoxis rooperi (African star grass), pygeum (extracted from the bark of Prunus africana),[6] pumpkin seeds (Cucurbita pepo), and stinging nettle (Urtica dioica) root.[7]

About 105 million men are affected globally.[3] BPH typically begins after the age of 40.[1] Half of males age 50 and over are affected.[2] After the age of 80, that figure climbs to as high as about 90% of males affected.[8][9][1] Although prostate specific antigen levels may be elevated in males with BPH, the condition does not increase the risk of prostate cancer.[10]
BPH is the most common cause of lower urinary tract symptoms (LUTS), which are divided into storage, voiding, and symptoms which occur after urination.[11] Storage symptoms include the need to urinate frequently, waking at night to urinate, urgency (compelling need to void that cannot be deferred), involuntary urination, including involuntary urination at night, or urge incontinence (urine leak following a strong sudden need to urinate).[12] Voiding symptoms include urinary hesitancy (a delay between trying to urinate and the flow actually beginning), intermittency (not continuous),[13] involuntary interruption of voiding, weak urinary stream, straining to void, a sensation of incomplete emptying, and uncontrollable leaking after the end of urination.[14][15][16] These symptoms may be accompanied by bladder pain or pain while urinating, called dysuria.[17]

Bladder outlet obstruction (BOO) can be caused by BPH.[18] Symptoms are abdominal pain, a continuous feeling of a full bladder, frequent urination, acute urinary retention (inability to urinate), pain during urination (dysuria), problems starting urination (urinary hesitancy), slow urine flow, starting and stopping (urinary intermittency), and nocturia.[19]

BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in residual urine or urinary stasis, which can lead to an increased risk of urinary tract infection.[20]
Causes
Hormones

Most experts consider androgens (testosterone and related hormones) to play a permissive role in the development of BPH. This means that androgens must be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by evidence suggesting that castrated boys do not develop BPH when they age. In an unusual study of 26 eunuchs from the palace of the Qing dynasty still living in Beijing in 1960, the prostate could not be felt in 81% of the studied eunuchs.[21] The average time since castration was 54 years (range, 41–65 years). On the other hand, some studies suggest that administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms, so the role of testosterone in prostate cancer and BPH is still unclear. Further randomized controlled trials with more participants are needed to quantify any risk of giving exogenous testosterone.[22]