• The prostate gland is a gland surrounding the bladder (the bladder outlet) that produces a fluid that becomes part of the semen.
• Benign prostatic hyperplasia, or BPH, is a noncancerous enlargement of the prostate gland.
• The treatment of benign prostatic hyperplasia is usually reserved for patients with bothersome symptoms that affect the quality of life and may affect sexual function. Medical and surgical approaches are available to treat BPH. Surgical treatment is recommended if there are kidney problems related to BPH, urinary retention that fails to improve, recurrent urinary tract infections, recurrent bladder stones, bloody urine (gross hematuria), or failure to improve with medical therapy.
• BPH is ubiquitous and can cause bothersome lower urinary tract symptoms, including frequent urge to urinate, getting up at night to urinate, difficulty urinating, and dribbling of urine at the end of urination.
The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).
Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function.
Benign prostatic hyperplasia (BPH) is a nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH and benign prostatic enlargement (BPE). It’s also referred to as an enlarged prostate gland. BPH must be differentiated from prostate cancer. Prostate cancer can cause symptoms like BPH but is more commonly associated with an increase in PSA and an abnormal prostate on rectal examination or ultrasound evaluation.
Medical professionals do not have a good understanding of what causes an enlarged prostate.
BPH generally begins in a man’s 30s, evolves slowly, and most commonly only causes symptoms after 50.
In benign prostatic hyperplasia, the prostate gland grows in size. It may compress the urethra, which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. Lower urinary tract symptoms from BPH can be due to one of the factors: (1) dynamic, (2) static, and (3) compensatory. Dynamic factors are related to the muscle’s tone surrounding the prostate and the outlet of the bladder.
In contrast, static factors are related to the enlargement of the prostate tissue. Dynamic and static symptoms are prostate-related symptoms. Compensatory factors result from changes that occur in the bladder as a result of the bladder working harder to push urine past the bladder neck and prostate.
Signs and symptoms of BPH include lower urinary tract symptoms (LUT) of weak urine stream, difficulty starting the urine stream (hesitancy), straining to urinate, inability to empty the bladder, inability to urinate (urinary retention), blood in the urine (hematuria), leakage of urine (urinary incontinence), decreased urine flow (slow urine stream), and post-void dribbling of urine.
BPH may also be related to the development of bladder stones, recurrent urinary tract infections, and backup of urine in the kidneys (hydronephrosis).
A doctor or other health care professional can usually detect an enlarged prostate by rectal examination. A medical professional may perform a rectal exam to ensure that there are no “nodules,” which are hard, irregular areas in the prostate are suspicious for prostate cancer, and assess the size of the prostate. Assessment of prostate size and shape is better evaluated with abdominal or transrectal ultrasound or cystoscopy. A cystoscope is a long, thin telescope-like instrument with a light source and lens allowing one to look at the urethra, the prostate, and the bladder when inserted through the opening at the tip of the penis. Cystoscopy and or ultrasound are recommended before the surgical treatment of BPH.
Other tests that medical professionals may perform include: (1) bladder scanner postvoid residual determination and (2) uroflowmetry (a test in which one void into a special urine collection device that can measure the rate and pattern of urine flow). Lastly, a PSA is often obtained and, if abnormal, may require further evaluation to rule out prostate cancer.
The American Urological Association (AUA) recommends that men with BPH complete the AUA-symptom index (AUA-SI), which assesses the degree to which symptoms bother. It is a useful way to evaluate changes in bothersome symptoms with treatment.
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