Benign prostatic hyperplasia (BPH)? Causes, Symptoms, Diagnosis And Treatment

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Overview

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.

What Is BPH?  (Benign Prostatic Hyperplasia)

The prostate gland is a small, solid gland roughly the size of a walnut, located behind the pubic bone.  It is situated beneath the bladder, surrounding the first part of the urethra.  Approximately 0.5ml of each ejaculate is fluid made by the prostate, containing a number of substances that nourish the sperm and are necessary for fertility.  Two small pouches, the seminal vesicles, sit directly behind the prostate, and provide a further 2ml of ejaculatory fluid via small tubes that run through the prostate into the urethra.

Benign prostatic hyperplasia (BPH) is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH. It’s also referred to as and enlarged prostate gland.

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi. The image below illustrates normal prostate anatomy.

You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.

Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause a weak stream when you pee and cause you to wake up a lot at night to go to the bathroom.

BPH isn’t prostate cancer and doesn’t make you more likely to get it.

It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.

Benign prostatic hyperplasia (BPH)? Causes, Symptoms, Diagnosis And Treatment

Where is the prostate?

In young men the prostate is about the size of a walnut, but it gets bigger with age. The prostate sits underneath the bladder, and surrounds the top part of the urethra. Urine passes through the urethra on its way from the bladder to the penis.

How does the prostate gland change with age?

The male sex hormone testosterone makes the prostate grow in size. As men get older, the prostate grows larger. At puberty, testosterone levels in boys start to increase and the prostate grows to about eight times its size. It continues to grow, doubling in size between the ages of 21 and 50 years, and almost doubles again in size between the ages of 50 and 80 years. The reasons for this ongoing growth are not fully understood.

What is the prostate gland?

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).

Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function.

What causes BPH?

The exact cause of BPH isn’t well understood. It appears to be related to aging. About 50% of men over age 50 have BPH. Up to 90% of men older than 80 have it.

The following factors could increase your risk of BPH:

  • age 40 or older
  • family history of BPH
  • being obese
  • heart and circulatory disease
  • type 2 diabetes
  • lack of exercise
  • erectile dysfunction.

Signs and symptoms

When the prostate enlarges, it may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptoms:

  • Urinary frequency
  • Urinary urgency
  • Nocturia- Needing to get up frequently at night to urinate
  • Hesitancy – Difficulty initiating the urinary stream; interrupted, weak stream
  • Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination
  • Straining – The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully empty the bladder
  • Decreased force of stream – The subjective loss of force of the urinary stream over time
  • Dribbling – The loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream.
  • The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:
  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Inability to completely empty the bladder
  • Less common signs and symptoms include:
  • Urinary tract infection
  • Inability to urinate
  • Blood in the urine

The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.

In some men, symptoms eventually stabilize and might even improve over time.

Other possible causes of urinary symptoms

Conditions that can lead to symptoms similar to those caused by enlarged prostate include:

  • Urinary tract infection
  • Inflammation of the prostate (prostatitis)
  • Narrowing of the urethra (urethral stricture)
  • Scarring in the bladder neck as a result of previous surgery
  • Bladder or kidney stones
  • Problems with nerves that control the bladder
  • Cancer of the prostate or bladder

Risk factors

Risk factors for prostate gland enlargement include:

  • Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
  • Family history.Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.
  • Diabetes and heart disease.Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
  • Obesity increases the risk of BPH, while exercise can lower your risk.

Complications

Complications of an enlarged prostate can include:

  • Sudden inability to urinate (urinary retention).You might need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
  • Urinary tract infections (UTIs).Inability to fully empty the bladder can increase the risk of infection in your urinary tract. If UTIs occur frequently, you might need surgery to remove part of the prostate.
  • Bladder stones.These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
  • Bladder damage.A bladder that hasn’t emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.
  • Kidney damage.Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Having an enlarged prostate is not believed to increase your risk of developing prostate cancer.

Diagnosis

Digital rectal examination

The digital rectal examination (DRE) is an integral part of the evaluation in men with presumed BPH. With the DRE, the examiner can assess prostate size and contour, evaluate for nodules, and detect areas suggestive of malignancy.

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Benign prostatic hyperplasia (BPH)?

Laboratory studies

  • Urinalysis – Examine the urine using dipstick methods and/or via centrifuged sediment evaluation to assess for the presence of blood, leukocytes, bacteria, protein, or glucose
  • Urine culture – This may be useful to exclude infectious causes of irritative voiding and is usually performed if the initial urinalysis findings indicate an abnormality
  • Prostate-specific antigen (PSA) – Although BPH does not cause prostate cancer, men at risk for BPH are also at risk for this disease and should be screened accordingly (although screening for prostate cancer remains controversial)
  • Electrolytes, blood urea nitrogen (BUN), and creatinine – These evaluations are useful screening tools for chronic renal insufficiency in patients who have high postvoid residual (PVR) urine volumes; however, a routine serum creatinine measurement is not indicated in the initial evaluation of men with lower urinary tract symptoms (LUTS) secondary to BPH [1]

Ultrasonography

Ultrasonography (abdominal, renal, transrectal) is useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of renal insufficiency. Generally, it is not indicated for the initial evaluation of uncomplicated LUTS.

Endoscopy of the lower urinary tract

Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. In addition, endoscopy may be indicated in patients with a history of sexually transmitted disease (eg, gonococcal urethritis), prolonged catheterization, or trauma.

IPSS/AUA-SI

The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. Questions on the AUA-SI for BPH concern the following:

  • Incomplete emptying
  • Frequency
  • Intermittency
  • Urgency
  • Weak stream
  • Straining
  • Nocturia

Other tests

  • Flow rate – Useful in the initial assessment and to help determine the patient’s response to treatment
  • PVR urine volume – Used to gauge the severity of bladder decompensation; it can be obtained invasively with a catheter or noninvasively with a transabdominal ultrasonic scanner
  • Pressure-flow studies – Findings may prove useful for evaluating for BOO
  • Urodynamic studies – To help distinguish poor bladder contraction ability (detrusor underactivity) from BOO
  • Cytologic examination of the urine – May be considered in patients with predominantly irritative voiding symptoms.

Treatment

A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:

  • The size of your prostate
  • Your age
  • Your overall health
  • The amount of discomfort or bother you are experiencing

If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.

Medication

Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:

  • Alpha blockers.These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
  • 5-alpha reductase inhibitors.These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
  • Combination drug therapy.Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
  • Tadalafil (Cialis).Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.

Minimally invasive or surgical therapy

Minimally invasive or surgical therapy might be recommended if:

  • Your symptoms are moderate to severe
  • Medication hasn’t relieved your symptoms
  • You have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems
  • You prefer definitive treatment

Minimally invasive or surgical therapy might not be an option if you have:

  • An untreated urinary tract infection
  • Urethral stricture disease
  • A history of prostate radiation therapy or urinary tract surgery
  • A neurological disorder, such as Parkinson’s disease or multiple sclerosis

Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:

  • Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation)
  • Temporary difficulty with urination
  • Urinary tract infection
  • Bleeding
  • Erectile dysfunction
  • Very rarely, loss of bladder control (incontinence)

There are several types of minimally invasive or surgical therapies.

Transurethral resection of the prostate (TURP)

A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.

Transurethral incision of the prostate (TUIP)

A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.

Transurethral microwave thermotherapy (TUMT)

Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.

Transurethral needle ablation (TUNA)

In this outpatient procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow.

This procedure might be a good choice if you bleed easily or have certain other health problems. However, like TUMT, TUNA might only provide partial relief and results might take some time.

Laser therapy

A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.

The options for laser therapy include:

  • Ablative procedures.These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point.
  • Enucleative procedures.Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.

Prostate lift

In this experimental transurethral procedure, special tags are used to compress the sides of the prostate to increase the flow of urine. Long-term data on the effectiveness of this procedure aren’t available.

Embolization

In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren’t available.

Open or robot-assisted prostatectomy

The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.

Follow-up care

Your follow-up care will depend on the specific technique used to treat your enlarged prostate.

Your doctor might recommend limiting heavy lifting and excessive exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. If you have open or robot-assisted prostatectomy, you might need to restrict activity for six weeks.

 

Treatment at Mayo Clinic

Mayo Clinic specialists have training in a wide range of state-of-the-art technology to treat enlarged prostates. You have access to the latest noninvasive laser treatments, including HoLEP and PVP lasers. Your Mayo Clinic specialist will explain the range of treatments available and help you choose the best approach based on your symptoms.

BPH natural treatment

Natural treatment can include specific actions or lifestyle changes that you can make to help relieve your symptoms of BPH. These include:

  • urinating as soon as you feel the urge
  • going to the bathroom to urinate, even when you don’t feel the urge
  • avoiding over-the-counter decongestants or antihistamine medications, which can make it harder for the bladder to empty
  • avoiding alcohol and caffeine, especially in the hours after dinner
  • reducing your stress level, as nervousness can increase the frequency of urination
  • exercising regularly, as a lack of exercise can aggravate your symptoms
  • learning and practicing Kegel exercises to strengthen your pelvic muscles
  • keeping warm, since being cold can make symptoms worse

Management

Pharmacologic treatment

Agents used in the treatment of BPH include the following:

  • Alpha-adrenergic receptor blockers
  • 5-alpha reductase inhibitors
  • Phosphodiesterase-5 enzyme inhibitors
  • Anticholinergic agents

Surgery

  • Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH
  • Open prostatectomy – Reserved for patients with very large prostates (>75 g), patients with concomitant bladder stones or bladder diverticula, and patients who cannot be positioned for transurethral surgery

Minimally invasive treatment

  • Transurethral incision of the prostate (TUIP)
  • Laser treatment – Used to cut or destroy prostate tissue; multiple laser types are available, including green light, holmium, and thulium, and each has its own strengths and weaknesses
  • Transurethral microwave therapy (TUMT) – Generates heat that causes cell death in the prostate, leading to prostatic contraction and volume reduction
  • Transurethral needle ablation of the prostate (TUNA)
  • High-intensity ultrasonographic energy therapy – Currently in the clinical trial stage
  • Prostatic stents – Flexible devices that expand when put in place to improve the flow of urine past the prostate
  • Laparoscopic prostatectomy
  • Implanted devices to relieve prostatic obstruction (eg, UroLift)
  • Prostate artery embolization – Performed by a radiologist; this technique has yet to become established as a standard-of-care therapeutic option.

Background

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Cellular accumulation and gland enlargement may result from epithelial and stromal proliferation, impaired preprogrammed cell death (apoptosis), or both.

BPH involves the stromal and epithelial elements of the prostate arising in the periurethral and transition zones of the gland (see Pathophysiology). The hyperplasia presumably results in enlargement of the prostate that may restrict the flow of urine from the bladder.

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.

The voiding dysfunction that results from prostate gland enlargement and bladder outlet obstruction (BOO) is termed lower urinary tract symptoms (LUTS). It has also been commonly referred to as prostatism, although this term has decreased in popularity. These entities overlap; not all men with BPH have LUTS, and likewise, not all men with LUTS have BPH. Approximately half of men diagnosed with histopathologic BPH report moderate-to-severe LUTS.

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. Complications occur less commonly but may include acute urinary retention (AUR), impaired bladder emptying, the need for corrective surgery, renal failure, recurrent urinary tract infections, bladder stones, or gross hematuria. (See Presentation.)

Prostate volume may increase over time in men with BPH. In addition, peak urinary flow, voided volume, and symptoms may worsen over time in men with untreated BPH (see Workup). The risk of AUR and the need for corrective surgery increases with age.

Patients who are not bothered by their symptoms and are not experiencing complications of BPH should be managed with a strategy of watchful waiting. Patients with mild LUTS can be treated initially with medical therapy. Transurethral resection of the prostate (TURP) is considered the criterion standard for relieving bladder outlet obstruction (BOO) secondary to BPH. However, there is considerable interest in the development of minimally invasive therapies to accomplish the goal of TURP while avoiding its adverse effects [2(see Treatment).

Anatomy

The prostate is a walnut-sized gland that forms part of the male reproductive system. It is located anterior to the rectum and just distal to the urinary bladder. It is in continuum with the urinary tract and connects directly with the penile urethra. It is therefore a conduit between the bladder and the urethra. (See the image below.)

The gland is composed of several zones or lobes that are enclosed by an outer layer of tissue (capsule). These include the peripheral, central, anterior fibromuscular stroma, and transition zones. BPH originates in the transition zone, which surrounds the urethra.

Pathophysiology

Prostatic enlargement depends on the potent androgen dihydrotestosterone (DHT). In the prostate gland, type II 5-alpha-reductase metabolizes circulating testosterone into DHT, which works locally, not systemically. DHT binds to androgen receptors in the cell nuclei, potentially resulting in BPH.

In vitro studies have shown that large numbers of alpha-1-adrenergic receptors are located in the smooth muscle of the stroma and capsule of the prostate, as well as in the bladder neck. Stimulation of these receptors causes an increase in smooth-muscle tone, which can worsen LUTS. Conversely, blockade of these receptors (see Treatment) can reversibly relax these muscles, with subsequent relief of LUTS.

Microscopically, BPH is characterized as a hyperplastic process. The hyperplasia results in enlargement of the prostate that may restrict the flow of urine from the bladder, resulting in clinical manifestations of BPH. The prostate enlarges with age in a hormonally dependent manner. Notably, castrated males (ie, who are unable to make testosterone) do not develop BPH.

The traditional theory behind BPH is that, as the prostate enlarges, the surrounding capsule prevents it from radially expanding, potentially resulting in urethral compression. However, obstruction-induced bladder dysfunction contributes significantly to LUTS. The bladder wall becomes thickened, trabeculated, and irritable when it is forced to hypertrophy and increase its own contractile force.

This increased sensitivity (detrusor overactivity), even with small volumes of urine in the bladder, is believed to contribute to urinary frequency and LUTS. The bladder may gradually weaken and lose the ability to empty completely, leading to increased residual urine volume and, possibly, acute or chronic urinary retention.

In the bladder, obstruction leads to smooth-muscle-cell hypertrophy. Biopsy specimens of trabeculated bladders demonstrate evidence of scarce smooth-muscle fibers with an increase in collagen. The collagen fibers limit compliance, leading to higher bladder pressures upon filling. In addition, their presence limits shortening of adjacent smooth muscle cells, leading to impaired emptying and the development of residual urine.

The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately 70% of the seminal volume. The secretions produce lubrication and nutrition for the sperm. The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize the acidic vaginal environment.

The prostatic urethra is a conduit for semen and prevents retrograde ejaculation (ie, ejaculation resulting in semen being forced backwards into the bladder) by closing off the bladder neck during sexual climax. Ejaculation involves a coordinated contraction of many different components, including the smooth muscles of the seminal vesicles, vasa deferentia, ejaculatory ducts, and the ischiocavernosus and bulbocavernosus muscles.

Epidemiology

BPH is a common problem that affects the quality of life in approximately one third of men older than 50 years. BPH is histologically evident in up to 90% of men by age 85 years. As many as 14 million men in the United States have symptoms of BPH. [3Worldwide, approximately 30 million men have symptoms related to BPH.

The prevalence of BPH in white and African-American men is similar. However, BPH tends to be more severe and progressive in African-American men, possibly because of the higher testosterone levels, 5-alpha-reductase activity, androgen receptor expression, and growth factor activity in this population. The increased activity leads to an increased rate of prostatic hyperplasia and subsequent enlargement and its sequelae.

Prognosis

In the past, chronic end-stage BOO often led to renal failure and uremia. Although this complication has become much less common, chronic BOO secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi.

Patient Education

For patient education information, see the Prostate Health Center and Kidneys and Urinary System Center, as well as Enlarged Prostate, Bladder Control Problems, and Inability to Urinate.

Lifestyle and home remedies

To help control the symptoms of an enlarged prostate, try to:

  • Limit beverages in the evening.Don’t drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
  • Limit caffeine and alcohol.They can increase urine production, irritate the bladder and worsen symptoms.
  • Limit decongestants or antihistamines.These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
  • Go when you first feel the urge.Waiting too long might overstretch the bladder muscle and cause damage.
  • Schedule bathroom visits.Try to urinate at regular times — such as every four to six hours during the day — to “retrain” the bladder. This can be especially useful if you have severe frequency and urgency.
  • Follow a healthy diet.Obesity is associated with enlarged prostate.
  • Stay active.Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
  • Urinate — and then urinate again a few moments later.This practice is known as double voiding.
  • Keep warm.Colder temperatures can cause urine retention and increase the urgency to urinate.

BPH drugs

When lifestyle changes aren’t enough to relieve your symptoms, your doctor may recommend medication. There are several medications that can help to both treat the symptoms of BPH and BPH itself. These medications include alpha-1 blockers, hormone reduction medications, and antibiotics. Learn more about BPH medications.

Alpha-1 blockers

Alpha-1 blockers are medications that relax the muscles of the bladder and prostate. Alpha-1 blockers relax the neck of the bladder and make it easier for urine to flow. Examples of alpha-1 blockers include:

  • doxazosin
  • prazosin
  • alfuzosin
  • terazosin
  • tamsulosin

Surgery for BPH

There are different types of surgical procedures that can help treat BPH when medications are not effective. Some procedures are either not invasive or minimally invasive and can often be done in your doctor’s office or clinic (outpatient procedures). Others are more invasive and need to be done in a hospital (inpatient procedures). Learn more about BPH surgery options.

Outpatient procedures

Outpatient procedures involve inserting an instrument into your urethra and into the prostate gland. They include:

  • Transurethral needle ablation (TUNA): Radio waves are used to scar and shrink prostate tissue.
  • Transurethral microwave therapy (TUMT): Microwave energy is used to eliminate prostate tissue.
  • Water-induced thermotherapy (WIT): Heated water is used to destroy excess prostate tissue.
  • High-intensity focused ultrasonography (HIFU): Sonic energy is used to eliminate excess prostate tissue.

Inpatient procedures

Inpatient procedures might be recommended if you have any of the following symptoms:

  • kidney failure
  • bladder stones
  • recurrent urinary tract infections
  • incontinence
  • a complete inability to empty the bladder
  • recurrent episodes of blood in the urine

Inpatient procedures include:

  • Transurethral resection of the prostate (TURP): It is the most commonly used surgical treatment for BPH. Your doctor inserts a small instrument through your urethra into the prostate. The prostate is then removed piece by piece.
  • Simple prostatectomy: Your doctor makes an incision in your abdomen or perineum, which is the area behind your scrotum. The inner part of your prostate is removed, leaving the outer part. After this procedure, you may have to stay in the hospital for up to 10 days.
  • Transurethral incision of the prostate (TUIP): This is similar to TURP, but your prostate isn’t removed. Instead, a small incision is made in your prostate that will enlarge your bladder outlet and urethra. The incision allows urine to flow more freely. You aren’t always required to stay in a hospital with this procedure.

Benign prostatic hyperplasia (BPH)?

Complications of BPH

Many men ignore their symptoms of BPH. However, early treatment can help you avoid potentially dangerous complications. Call your doctor if you’re noticing symptoms of BPH. Men who have a long-standing history of BPH may develop the following complications:

  • urinary tract infections
  • urinary stones
  • kidney damage
  • bleeding in the urinary tract
  • a sudden inability to urinate

Sometimes urinary obstruction from BPH is so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction. It can be dangerous because urine trapped in the bladder can cause urinary tract infections and damage your kidneys.

BPH vs. prostate cancer

BPH and prostate cancer can share many symptoms. Prostate cancer is a more serious condition than BPH. In most cases, prostate cancer needs to be treated. That’s why it’s important to contact your doctor if you have symptoms of BPH. Your doctor can test to make sure that your symptoms aren’t related to prostate cancer. Learn more about the similarities and differences of BPH and prostate cancer.

Living with BPH

BPH is not life-threatening, but it can be bothersome. There are also some complications that can occur. These include:

  • inability to urinate
  • incontinence
  • blood in the urine
  • urinary tract infections
  • bladder or kidney damage
  • bladder stones.

Sometimes men have urinary symptoms that are not related to BPH. They could be the signs of a more serious condition, including prostate cancer. See your doctor right away f you notice any of the following symptoms:

  • complete inability to urinate
  • painful, urgent, and frequent need to urinate
  • blood in your urine
  • pain in the lower abdomen and/or urinary tract
  • fever or chills along with any of the above symptoms.

Prostatitis

Prostatitis indicates inflammation of the prostate and covers a whole spectrum of clinical entities. It is not always due to infection and does not always cause symptoms. At one end of the spectrum is acute bacterial prostatitis, which presents with fever, feeling acutely unwell and sudden difficulty urinating. This is a medical emergency, requiring intravenous antibiotics and drainage of the bladder via a catheter. At the other end of the spectrum is chronic non-bacterial prostatitis, characterized by pain in the pelvic area. It is often not certain whether these symptoms are due to prostatitis at all, and is now termed chronic pelvic pain syndrome. Such symptoms may be relieved by treatments such as anti-inflammatory medication or pelvic physiotherapy. In addition, sometimes prostatitis is diagnosed on a prostate biopsy without the patient having any symptoms at all.

Like BPH and prostate cancer, prostatitis can also elevate the PSA, as well as cause it to fluctuate.

Sometimes BPH can lead to retention of urine in the bladder, causing more than just bothersome symptoms. Bladder stones, recurrent urine infections and impaired kidney function may all be due to bladder outlet obstruction caused by BPH. In these cases, surgery is required. Alternatives to TURP include laser prostatectomy (link), and open (not radical) prostatectomy, where the inner portion of a very large prostate is removed via an incision in the lower abdomen.

Importantly, BPH is the most common cause of an elevated PSA between 4 and 10. It can therefore be difficult to distinguish it from prostate cancer unless a biopsy of the prostate is performed, as cancer typically raises PSA also.

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