Brisbane Urology Clinic

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy is enlargement of the prostate gland. The word "benign" means the cells are not cancerous. "Hyperplasia" means an increased number of cells.

It is common for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

The prostate gland encircles the urethra, so problems with urination can occur if the gland restricts urine flow through the tube. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

  • The bladder wall becomes thicker and irritable
  • The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination
  • Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

  • Urinating more often during the day
  • Need to urinate frequently during the night.
  • Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time.
  • The urine stream is slow to start.
  • Urine dribbling sometime after finishing urination.
  • A sensation that the bladder isn’t fully emptied after urination.
  • Lack of force to the urine flow, which makes aiming more difficult.
  • The sensation of needing to go again a few minutes after urinating.

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may do a physical examination to assess the condition of the prostate.

The tests vary from patient to patient, but the following are the most common.

Urine analysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate. 

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia  or BPH).

PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Intravenous Pyelogram (IVP)

IVP is an x ray of the urinary tract. In this test, a dye is injected into a vein, and the x ray is taken. The dye makes the urine visible on the x ray and shows any obstruction or blockage in the urinary tract.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment

Conservative treatment

If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.

Drug Therapy

Your doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.

Surgery

Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (TransUrethral Resection of the Prostate). A TURP is effective at relieving symptoms quickly. TURP is discussed elsewhere in this website.