What is BPH?

What is Benign Prostatic Hyperplasia

Nearly half (43%) of men over the age of 65 have either urinary symptoms or a reduced urinary flow due to benign prostatic hyperplasia (BPH).

BPH is characterized by the benign (non-cancerous) overgrowth of prostate cells, with the effect that the middle portion of the prostate progressively enlarges.

The result is that the part of the urethra that is surrounded by the prostate becomes constricted, so the urinary flow is reduced and the man finds that his urine stream becomes weaker and it is more difficult to empty his bladder.

In response to the increasing obstruction, the bladder’s walls, which are muscular, thicken and then become stronger.

Furthermore, the pressure inside the bladder needed to produce urinary flow has to increase in order to overcome the effect of the obstruction, and this high pressure may cause pouches or ‘diverticula’ to form.

Less commonly, the raised pressure results in what is known as “back pressure” on the kidneys, causing problems with kidney function.

If BPH is not treated, either chronic urinary retention (characterized by a painless but massively distended bladder) or acute urinary retention (the sudden and painful inability to pass any urine) may develop. In either situation, hospital admission, catheterization and often prostate surgery are usually required.

Bladder stones can also occur as a result of this condition. As the bladder becomes more obstructed its ability to empty fully decreases, leaving some urine behind. It is this incomplete emptying which puts the patient at a higher risk of stone formation.

Why do some men suffer more than others?

Recent work has clarified some risk factors making it more likely a man with BPH will go on to develop complications such as acute retention of urine, urinary tract infections or stones in the bladder.

Firstly, having a large prostate gland (usually quoted as an estimate of more than 30-40cc on digital rectal examination) or a PSA higher than 1.4ug/ml are linked to more complications.

Secondly, as a consequence of a large prostate, there is an inability of the bladder to empty fully. This can give rise to a poor stream and a large amount of residual urine left in the bladder after voiding, which makes complications more likely.

Finally, BPH is not a static condition and therefore the longer the symptoms are present the more likely the patient will run into problems. Although not all men suffer progressive deterioration, in the majority of cases the symptoms gradually become worse over time.