Benign prostatic hyperplasia (BPH) page

Also known as benign prostatic hypertrophy is a non cancerous enlargement of the prostate gland which is situated near the urinary bladder.

Prostate gland

The prostate is a gland about the size of a walnut that is only present in men. It's located just below the bladder and surrounds the urethra, the tube that carries urine from your urinary bladder through to the penis. One of the main functions of the prostate gland is to produce prostatic fluid, one of the components of semen.

BPH is fairly common; four out of ten men over 65 have evidence of it.

Symptoms

  • Difficulty or hesitancy in starting to pass urine even when the bladder feels full.
  • A frequent or urgent need to pass urine
  • Dribbling of urine after urinating
  • Weak stream of urine which stops and starts. It might take several attempts to empty the bladder.
  • A feeling that the urinary bladder is not completely empty.


The diagnosis of BPH is important because the symptoms can be similar to prostate cancer.

Causes

Although unknown it seems to be strongly associated with old age.

Diagnosis

  • A focussed questioning on the symptoms of BPH
  • Abdominal examination to feel the urinary bladder which could be filled with urine as the enlarged prostate could obstruct the outflow.
  • Ultrasound examination of the bladder for bladder stones and for enlarged prostate.
  • Blood test for PSA (prostate specific antigen) a protein secreted by the prostate and the level is raised in BPH, prostate cancer and prostatitis (inflammation of the prostate).
  • Urodynamic testing is a specialised test to measure the pressure and speed of urine flow.


Treatment

Monitoring- initially the condition is monitored and no treatment is required.
Avoid or limit caffeinated drinks and alcohol.

Medicines

Alpha – blockers
  • Tamsulosin
  • Terazosin


They act by relaxing the muscles in the bladder and surrounding the prostate thus alleviating the symptoms. It does not in fact reduce the size of the prostate.

Side effects

Tiredness, dizziness, light headedness, retrograde ejaculation (during ejaculation the semen passes backwards into the urinary bladder and not forward to the penis).
5 alpha reductase inhibitors
  • Finasteride
  • Dutasteride


These drugs act by blocking production of the hormone dihydrotestosterone which can reduce the size of the prostate to a third. They can delay the need for surgery.

Side effects

  • Reduced sex drive
  • Impotency, difficulty in maintaining erection
  • Gynecomastia, tender or enlarged breast tissue.


Surgery

If the medicines fail to relieve symptoms then surgery is considered. The most common surgical option is transurethral resection of prostate (TURP).

Transurethral resection of prostate (TURP) - usually under general anaesthesia a flexible fibre optic cable is inserted up the urethra and the enlarged prostate is removed.

Transurethral incision of prostate (TUIP) – when the prostatic enlargement is less then incision of the prostate is carried out.

Open prostatectomy – in some cases when the prostate is large then the abdomen is opened up in the area of the urinary bladder and the prostate is removed.

Complications
  • Complications which can arise as result of general anaesthesia
  • Retrograde ejaculation
  • Urinary incontinence


Please consult the online doctor for bespoke, evidence based and confidential medical advice.