10 BPH (benign prostatic hyperplasia) facts

10 BPH (benign prostatic hyperplasia) facts

In this article we will describe 10 facts about BPH (benign prostatic hyperplasia).

Key Points

• Benign prostatic hyperplasia (BPH), also known as prostate enlargement, is a noncancerous condition that causes the prostate gland to enlarge
• It is more than common. It is normal. 20-30% of men aged 50-59, 50-60% of men aged 60-69, and 80-90% of men aged 80-89
• Characterised by enlarged prostate gland, leading to lower urinary tract symptoms (LUTS)
• Diagnosis based on symptoms, digital rectal examination (DRE), and investigations like ultrasound and uroflowmetry
• Treatment options include lifestyle modifications, medications, and surgery.

1. Definition

• Benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement, is a noncancerous condition that causes the prostate gland to enlarge
• As the prostate gland surrounds the urethra, it affects urine flow.
• It is a common condition affecting men, particularly in the fifth decade of life and beyond.

• Small gland BPH: Prostate volume <30g, minimal symptoms
• Large gland BPH: Prostate volume ≥30g, moderate to severe symptoms
• Simple BPH: Symptomatic BPH without complications
• Complicated BPH: BPH with associated complications (e.g. urinary retention, recurrent urinary tract infections, UTIs).

• It is more than common. It is normal
• Prevalence increases with age: 20-30% of men aged 50-59, 50-60% of men aged 60-69, and 80-90% of men aged 80-89
• Estimated 12 million men affected in the UK
• Projected increase in prevalence due to aging population.

3. Risk Factors

• Age: risk increases after 50 years
• Family history: first-degree relatives with BPH
• Ethnicity: higher prevalence in African and Afro-Caribbean men
• Obesity, metabolic syndrome, and diabetes
• Hormonal imbalance (testosterone, dihydrotestosterone).

• Hormonal changes: increased dihydrotestosterone (DHT) levels stimulate prostate growth
• Cellular changes: proliferation of stromal and epithelial cells
• Inflammation and oxidative stress.

• Lower urinary tract symptoms (LUTS)
  • Urinary frequency and urgency
  • Weak urine flow 
  • Straining to urinate, dribbling post urination
  • Feeling of incomplete bladder emptying
  • Nocturia
• Additional symptoms: Painful urination (dysuria), blood in urine or semen

• Medical history and physical examination (DRE)
• Symptom scoring systems (e.g. International Prostate Symptom Score, IPSS).

• Urine dipstick
• Blood tests:
  • U+E (renal function)
  • Prostate-specific antigen (PSA; for prostate cancer); false positive and negative tests occur
• Uroflowmetry: measures urine flow rate and pattern; and post-void residual urine volume  
• Ultrasound (transrectal or transabdominal): assesses prostate size, shape, and bladder wall thickness
• Cystoscopy: also examines urethra and bladder.

• Prostate cancer
• Prostatitis (inflammatory or infectious)
• Bladder cancer
• Overactive bladder
• Neurogenic bladder.

• Lifestyle modifications
  • Fluid management
  • Bladder training
  • Pelvic floor exercises
  • Avoidance of irritants (caffeine, alcohol).
• Medications
  • Alpha-blockers (e.g. tamsulosin)
  • 5-alpha-reductase inhibitors (e.g. finasteride)
  • Phosphodiesterase inhibitors (e.g. tadalafil).
• Surgery
  • Transurethral resection of the prostate (TURP)
  • Open prostatectomy
  • Laser therapy.

Transurethral resection of the prostate (TURP)

• Symptoms persist or worsen
• Difficulty starting or stopping urination
• Painful urination
• Blood in urine (haematuria) or semen
• Recurrent urinary tract infections (UTIs).

• Urinary incontinence
• Urinary retention
• AKI, CKD or AKI on CKD due to obstructive nephropathy (usually with bilateral hydronephrosis)
• Recurrent urinary tract infections
• Bladder stones
• Erectile dysfunction (ED).

• BPH is a chronic condition, but symptoms can be effectively managed
• Early treatment prevents complications
• Regular monitoring essential for disease progression.

10. Prevention

• No known way of reliably preventing
• It may help to: maintain a healthy weight, exercise regularly, have a balanced diet (fruit, vegetables, whole grains), and limit caffeine and alcohol intake.