Benign Prostatic Hyperplasia (BPH)

The first anatomically accurate description of prostatic enlargement as a cause of urinary retention is attributed to Morgagni (1769). Treatments in the 18th and early 19th centuries involved catherization and, if that failed, percutaneous bladder puncture to relieve the obstruction.

The prostate gland is the reproductive organ only found in men, and It is responsible for creating and secreting semen. The prostate surrounds the urethra and lies beneath the bladder, so when it grows in size, so do urinary problems. The prostate is located directly beneath the bladder and in front of the rectum. Since the upper portion of the urethra passes through the prostate, if the gland becomes enlarged, it can obstruct the passage of fluid through the urethra and result in a weak stream, excessive daytime or nighttime urination, or complete inability to urinate (retention).

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. Benign prostatic hyperplasia is very common.

The condition itself is benign, but can become lethal once the growth reaches a point that it begins to impede the function of nearby tissues or organs. In the case of BPH, the prostate can eventually become large enough that it partially or completely blocks the urethra, leading to inability to urinate, urinary tract infections, bladder and kidney damage, and if left completely untreated, ultimately to death. On its own it isn’t a life-threatening condition as BPH is a treatable condition. BPH is not cancer, nor does it cause prostate cancer.

Symptoms

The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time.

The size of the prostate doesn't necessarily determine the severity of 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.

• 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

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

Causes

Experts do not yet know what causes BPH, but the condition may be related to the hormone testosterone and its relationship to other hormones that changes during the aging process.

Risk factors for prostate gland enlargement include:

• Aging. 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.
• Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

Complications of an enlarged prostate can include:

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

• 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.

Treatment

A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice depends on the size of the prostate, the person’s age and overall heath and the amount of discomfort or inconvenience it is causing.

Statistics:

• Globally, benign prostatic hyperplasia affects about 210 million males as of 2010 (6% of the population).
• The prostate gets larger in most men as they get older. For a symptom-free man of 46 years, the risk of developing BPH over the next 30 years is 45%. Incidence rates increase from 3 cases per 1000 man-years at age 45–49 years, to 38 cases per 1000 man-years by the age of 75–79 years. While the prevalence rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years.
• Mortality rates for deaths attributed to benign prostatic hypertrophy have fallen dramatically over the past three decades. This is likely to be a consequence of improvements in quality of care of men with the condition.
  • Over a similar period, mortality for prostate cancer initially increased, peaked in the 1990s, and since then has shown a decline.
• In the 1950s, the highest age adjusted (on the world standard population) mortality rates for BPH in Europe were in Denmark (22.8/100,000) and Germany (18.1), followed by Scandinavian countries, the UK, and Switzerland. Italy had rates around 10/100,000, and rates were lower in eastern and southern Europe (5-8/100,000). Between 1950 and 1990, a fall of over 90%, or even 95%, was observed in most western European countries. Thus, in the early 1980s, overall mortality from BPH ranged between 0.5 and 1.5/100,000 in most western European countries. In proportional terms, similar reductions were registered in other developed countries of North America, Asia (that is, Japan or Singapore), and Oceania. A fall in rates was also observed in eastern Europe and in Latin America, particularly from the late 1970s onwards, although these reductions were generally much smaller. Thus, in the early 1990s, most countries in these areas had BPH rates between 1 and 5/100,000. The pattern of trends was, at least qualitatively, similar at younger ages, although most falls were proportionally greater.
• There were 937 deaths due to BPH in California in the period 2001-2010, for an age-adjusted rate of 8 per million men, compared with 4 per million nationally.
• According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).

Sources & Additional Reading:

• Mayo Clinic - Benign Prostatic Hyperplasia (BPH)
• NCBI Mortality from benign prostatic hyperplasia: Worldwide trends 1950-92. By: C LaVacchia, F Levi & F Lacchin
• NAACCR Review - Benign Prostatic Hyperplasia Mortality in California
• The New York Times - For Men, Relief in Sight. by Gerald Secor Couzens, 13 May 2008
• Urology Care Foundation - Innovations in Treatment of BPH. by: Ivan Grunberger, MD. Posted 27 Feb 2018
• Wiley Online Library - Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979–2006, by Marie E Duncan, Michael J Goldacre. First published 23 Dec 2010.
• Prostate Condition Education Council - Elarged Prostate/Bph
• WebMD - Enlarged Prostate: A Complex Problem
• UCLA Health - Conditions Treated, Definition of BPH (Enlarged Prostate)
• Macabido - The Sexual Side Effects of an Enlarged Prostate
• Wikipedia - Benign prostatic hyperplasia

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