old coupleBenign prostatic hyperplasia

The prostate is a gland and it’s purpose is to secrete the major component of ejaculatory fluid. Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate.image 

BPH is considered a normal part of the aging process in men and is hormonally dependent on testosterone and dihydrotestosterone (DHT) production. An estimated 50% of men demonstrate histopathologic BPH by age 60 years. This number increases to 90% by age 85 years. About half of such men develop moderate to severe Lowe Urinary Tract Symptoms (LUTS), which could interfere with advancing age. Image 

LUTS As a man ages, the prostate enlarges and begins to press on and narrow the opening of the bladder neck and urethra. This occurs gradually over several years The voiding dysfunction that results from prostate gland enlargement and bladder outlet obstruction (BOO) is termed lower urinary tract obstruction.

Clinical manifestations of LUTS include urinary frequency, urgency, nocturia (awakening at night to urinate), decreased or intermittent force of stream, or a sensation of incomplete emptying

If you have an enlarged prostate, you may experience these symptoms:

  1. A frequent urge to urinate, especially at night
  2. An urgent need to urinate with little warning
  3. Difficulty beginning urination
  4. Pain or burning during urination
  5. Feeling that your bladder never completely empties
  6. Dribbling or leaking urine
  7. A weak urine stream
  8. Intermittent—or on/off—urine flow
  9. Blood in the urineIn assessing your symptoms please use the BPH symptom score known as IPSS (International Prostate Symptom Score) introduced by the American Urological Association. The purpose of the test is to determine how bothersome the enlargement of the prostate is.
    Take your test by opening the image 

Prostate health can affect Quality of LifeMany men affected by an enlarged prostate report lifestyle changes such as avoiding travel, interrupted leisure activities, and embarrassment about using urinals. Frequent nighttime trips to the bathroom can disrupt sleep for both enlarged prostate sufferers and their partners as well. Men with LUTS and BPH also have been found to be at greater risk for Erectile Dysfunction(ED).

How is an enlarged prostate (BPH) diagnosed?

Several tests help identify the problem and suggest the best course of action. Tests vary from patient to patient, but these are the most common:

  • Digital Rectal Exam (DRE)
  • Prostate Specific Antigen (PSA) Blood Test
  • Ultrasound ( prostate volume measurment , Post voiding residual urine assesment)
  • Urine Flow Study  (read more at Urodynamics)
  • Post-void residual urine test to see how much urine is left in your bladder after urination
  • Urinalysis to check for blood or infection
  • Cystoscopy


The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include “watchful waiting,” lifestyle changes, medication, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.


  • Alpha 1-blockers: These medications relax the muscles of the bladder neck and prostate. This allows easier urination. Most people treated with alpha 1-blocker medication find that it helps their symptoms.
  • Finasteride and dutasteride lower levels of hormones produced by the prostate, reduce the size of the prostate gland, increase urine flow rate, and decrease symptoms of BPHPotential side effects related to the use of finasteride and dutasteride include decreased sex drive and impotence.
  • Many herbs have been tried for treating an enlarged prostate. Some studies have shown that it helps with symptoms, but there is evidence that this popular herb is no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed.


The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

  •  Transurethral resection of the Prostate (TURP): This is the most common and most proven surgical treatment for BPH. Transurethral incision of the prostate (TUIP): This procedure is similar to TURP, but is usually performed in men who have a smaller prostate.
  • Simple Prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Other, less-invasive procedures are available. None have been proven to be better than TURP. Patients who receive these less-invasive procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

  • Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
  • Elderly patients
  • Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis and serious lung, kidney, or heart disease
  • Men who are taking blood-thinning drugs