by Trevor A. Flood, MD FRCPC
October 20, 2022
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland and one of the most common conditions to affect men as they get older.
This is because 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:
At the present time, we do not know exactly what causes BPH. However, current evidence suggests that hormones such as dihydrotestosterone (DHT) and testosterone play a role. In particular, DHT is known to stimulate the growth of the prostate gland and older men have higher levels of DHT.
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. However, the following risk factors are associated with a small increased risk of developing BPH:
The prostate gland is made up of glands that produce fluids used to help nourish and transport sperm that comes from the testicles and a type of connective tissue called the stroma. In BPH there is an increase in both the number of glands and the amount of stroma in the prostate gland. Pathologists describe this change as hyperplasia.
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 are 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 examined under the microscope for features of BPH.
If left untreated, BPH can block the flow of urine from the bladder which results in the inability to fully empty the bladder. As a result, it may become difficult to control urination. This can lead to 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.
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: