Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland as men age and usually begins in the third or fourth decade of life. By age 60 more than half of men have BPH, and this increases to 90% by age 85.  As the prostate enlarges this may cause urinating symptoms secondary to bladder outlet obstruction (BOO).

A prostate that is not enlarged is the size and shape of a walnut. It is part of the male reproductive system that functions to produce some of the seminal fluid that nourishes and carries sperm from the testicles and out of the penis during ejaculation. Its position in the body is just below the bladder and the urethra (the tube that carries urine and semen out of the penis…also known as the “water channel”) runs through the center of the prostate. Think of the prostate as a donut and the water channel as the hole in the donut, with this donut residing just below the bladder. Just like when a donut enlarges the hole in the donut becomes smaller, when the prostate enlarges the portion of the water channel that runs through the prostate becomes smaller, thus restrictive to the flow of urine. This restriction may lead to problems urinating.

The most common symptoms of BPH are:

  • - a weak or slow urinary stream.
  • -a feeling of incomplete bladder emptying
  • -a delay in starting urination (hesitancy)
  • -frequent urination
  • -urinary urgency
  • -awakening at night to urinate
  • -a urinary stream that starts and stops
  • -the need to strain to urinate

The symptoms of BPH are due to the relationship of the enlarging prostate restricting the flow of urine with the strength of the bladder muscle. The bladder is basically a hollow muscle that functions to store urine then empty completely. In the early stage of prostate enlargement the bladder muscle is able to force urine through the narrowed water channel by contracting more forcefully. Like other muscles, the bladder can become stronger; however as this happens the bladder muscle becomes thicker and overly sensitive, causing a need to urinate more frequently and urgently. However once the bladder becomes as strong as it can, then it may start weakening, making symptoms even worse, and may result in an inability to empty.  Imagine the bladder as a balloon. When one inflates and balloon and releases the air promptly the balloon retains its elasticity. However if one waits a while before releasing the air, after releasing the air the balloon may lose much of its elasticity and become a floppy balloon. A bladder that has been obstructed for quite some time may behave in much the same manner. Even after the obstruction has been relieved and the bladder allowed emptying, it may have been subjected to permanent damage and end up like the floppy balloon with minimal strength or elasticity. In worst case scenarios this is known as a flaccid neurogenic bladder and bladder emptying can only be accomplished by catheter draining.

Evaluation of BPH

Treatment of BPH

Various Options For BPH Treatment