Benign prostatic hyperplasia (BPH)

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is one of the most common conditions to affect men as they get older.  BPH occurs when the prostate grows and blocks the flow of urine out of the bladder. This growth occurs because of a process called hyperplasia.  Hyperplasia is a word that pathologists use to describe an increased number of cells compared to normal.  BPH is a non-cancerous condition that does not increase your risk of developing prostate cancer.

The prostate

The prostate is a small organ that is found only in males.  The prostate is normally the size and shape of a walnut.  It is located at the bottom of the bladder and sits between the pubic bone (the front part of the hip) and the rectum.  The prostate also wraps around the urethra. The urethra is the tube that conducts urine from the bladder and semen from the ejaculatory ducts to the exterior of the body.

The prostate acts to secrete a fluid that helps nourish and transport sperm that comes from the testicles.  This fluid is made in by a complex network of small structures called glands and is then transported out of the prostate through channels called ducts. The glands and ducts of the prostate are embedded in a type of connective tissue called the stroma.

Who is at risk to get benign prostatic hyperplasia?

Most men who develop BPH have no known risk factors.  BPH is a very common condition and 9 in 10 men will have it if they live for 80 years or more. The following risk factors are associated with a small increased risk for developing BPH:

  • Age – BPH becomes more common as men get older and BPH is rare in men under the age of 40 years.
  • Family history – Men who have family members with BPH may be more likely to develop BPH.
  • Ethnicity – Asian men are less likely to develop BPH compared to black and white men.
How is benign prostatic hyperplasia diagnosed?

The diagnosis of BPH is usually made based on the symptoms that the man is experiencing. Your doctor may perform a digital rectal exam (DRE) to see if your prostate is enlarged.

A tissue sample and microscopic examination of the prostate is not required to make the diagnosis of BPH. However, if you had your prostate removed (either partially or completely) as a treatment for BPH, the tissue will be sent to a pathologist for examination.

When examined under the microscope, a prostate with BPH will show an increased amount of both glands and stroma. The glands and stroma grow in small circular groups called nodules. These nodules are located around the urethra and their growth causes compression of the urethra.  This compression causes the symptoms that men experience in BPH.

What are the symptoms of benign prostatic hyperplasia?

The prostate wraps around the urethra which is the tube that conducts urine from the bladder (and semen from the ejaculatory ducts) out of the body.  The symptoms of BPH develop because the prostate increases in size and this growth compress the urethra.  This compression makes it more difficult for urine to flow through the narrowed urethra.

Compression of the urethra can cause any of the following symptoms:

  • A weak stream of urine.
  • Straining and pushing to start urination.
  • The sensation of incomplete bladder emptying.
  • Dribbling at the end of urination (post-void dribbling).
  • Having to urinate more than 8 times per day (frequency).
  • Sudden and strong need to urinate (urgency).
  • Waking up in the middle of the night to urinate (nocturia).
  • Stopping and starting urination several times.
What are the potential complications of benign prostatic hyperplasia?

Most complications that develop in patients with BPH are related to the inability to fully empty the bladder.  As a result, it may become difficult to control urination.  This can cause wetting the bed at night or not being able to get to the bathroom quickly enough to urinate.  The bladder can also become infected which can lead to a urinary tract infection (UTI).  UTIs can cause pain during urination and result in blood in the urine.  Other complications of BPH include the formation of stones within the bladder and the complete obstruction of urine.

How do we treat benign prostatic hyperplasia?

Although BPH is a non-cancerous condition, the symptoms can cause significant discomfort and serious complications are possible.  It is important to talk to your doctor to see if your symptoms require treatment.

Treatment options for patients with BPH include:

  • Medical therapy.
  • Minimally invasive therapies including high intensity focused ultrasound (HIFU), laser therapy, transurethral balloon dilatation thermotherapy, and transurethral needle ablation of the prostate.
  • Surgical therapy includes transurethral resection of the prostate (TURP) and open (simple prostatectomy).
by Trevor A. Flood, MD FRCPC (updated June 25, 2021)
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