BPH (Benign Prostatic Hyperplasia), Enlarged Prostate

Benign Prostatic Hyperplasia (BPH) Overview

Benign Prostatic Hyperplasia is a condition in which the prostate gland and surrounding tissues enlarge in size. It is a non-cancerous growth commonly seen in aging men as they enter puberty or around age 25. BPH is the most common prostate problem for men over 50, affecting about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80. Some enlargement is expected as males grow older, however, a BPH diagnosis occurs when the prostate expands large enough to cause symptoms to present.

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What is BPH?

The prostate is a male reproductive gland, about the size of a walnut, that produces fluid for semen. The prostate surrounds the urethra, which is the tube that carries urine from the bladder out of the body.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.

Normal Prostate Enlarged Prostate

What are the symptoms of Benign Prostatic Hyperplasia?

BPH is non-cancerous and does not increase the risk of developing prostate cancer, however, it can cause discomfort from urinary issues. Common symptoms of BPH include:

Frequency or urgency to urinate

Difficulty starting urination

Weak urine stream

Urinary incontinence

Dribbling at the end of urination

Incomplete emptying of the bladder

Nocturia (frequent urination at night)

If you suffer from the above symptoms, you are not alone. BPH is one of the leading reasons for men to visit a urologist.

How is BPH diagnosed?

It is important for patients experiencing symptoms of BPH to consult with a urological specialist to determine the most appropriate diagnostic approach. There is a range of tests and scans that are commonly used to diagnose and track BPH including the following:

BPH Symptom Quiz – Used to track and evaluate the severity of symptoms if a patient experiences urinary changes.

Physical Exam – Your doctor will assess the edges and surface of your prostate to estimate the size.

Urine Flow Test – Used to measure the rate of urine flow.

Urinalysis – A urine sample is tested to identify the presence of blood, infection, glucose and protein.

Post-void Residual Volume (PVR) – Used to measure the amount of urine remaining in the bladder after passing urine.

Urodynamic Pressure Flow Study – Measures the pressure in the bladder during urination.

Ultrasounds – A scan used to examine the size and shape of the prostate internally.

Cystoscopy – A scan completed through a scope to examine the urethra and bladder.

MRI & CTO – Detailed scans providing clear imaging of the prostate and surrounding area. It is completed when the recommended treatment is surgery.

How is BPH treated?

There are many treatment options to help manage symptoms or treat BPH. You and your urologist will work together to decide the treatment plan that is best for you and your condition. For patients presenting mild symptoms, treatment may not be necessary as the symptoms can be managed. In other cases where symptoms are more severe or significantly affect the individual’s quality of life, less invasive procedures may be the recommended course of action, and sometimes a combination of treatments works best.

The main types of treatments for BPH include:

Active surveillance – For mild symptoms, your doctor may suggest “watchful waiting,” regular check-ups to evaluate and help manage your condition effectively.
Lifestyle changes – For mild but bothersome symptoms, your doctor may recommend lifestyle changes. Lifestyle changes may involve reducing fluid intake, especially caffeinated and alcoholic beverages, exercising pelvic floor muscles and training your bladder to hold more urine for longer. They may also recommend monitoring or avoiding the use of decongestants, antihistamines, antidepressants and diuretic medications.
Medications – Your doctor may prescribe medications including alpha blockers which are used to relax the muscles in your prostate or medications to slow the growth of your prostate gland by reducing the production of the hormone DHT.
Less invasive treatments – Less invasive options may be recommended as they are less damaging to healthy tissue, have fewer side effects and have a shorter recovery time.
- Prostatic Urethral Lift (UroLift® System Treatment) – An instrument called a UroLift® is inserted through the urethra and up to the prostate where small implants are ejected to separate the enlarged prostate lobes and widen the urethra to improve urination.
- Water Vapor Therapy (Rezūm™ System) – An instrument is inserted into the urethra reaching the prostate where a needle is ejected to emit steam vapor. The water’s thermal energy destroys prostate cells which your body reabsorbs and the prostate shrinks.
Surgical treatment – Surgery may be recommended as a long-term treatment option to remove the benign prostate tissue that is blocking the urethra.
- Transurethral resection of the prostate (TURP) – An instrument (resectoscope) is inserted through your urethra to visualize and remove prostate tissue.
- Transurethral incision of the prostate (TUIP) – Two small incisions are made through the prostate where your urethra and bladder join to expand the urethra and improve urine flow.
- Transurethral electrovaporization – An electrode is used to heat the prostate tissue turning the tissue cells in the enlarged areas of your prostate into steam.
- GreenLight™ laser – A special laser is used to evaporate your enlarged prostate tissue.

What are my next steps?

BPH is a very common condition and is one of the leading reasons for men to visit a urologist. Whether you have just started experiencing symptoms or if you have tried various medications or even surgery, there are various treatment options available to you. It is important that you talk with your doctor so they can help guide you through your next steps in connecting you with a urology specialist. Together, we will determine the best diagnostic plan and proper treatment technique for your specific condition.

Benign Prostatic Hyperplasia (BPH)