Benign Prostatic Hypertrophy

What is Prostatic hypertrophy?

Prostatic hypertrophy is a non-life threatening (benign) enlargement of the prostate gland. The incidence of prostatic hypertrophy increases with age, usually affecting men over 50.

While the exact cause is unknown, it is believed to be related to hormonal changes associated with aging. Enlarging prostate tissue gradually compresses and distorts the urethra (tube leading urine out of the bladder), obstructing the flow of urine. The bladder muscle initially becomes overdeveloped in an attempt to force urine through the obstructed urethra. Eventually, the bladder is unable to expel all the urine, causing the bladder to become distended and unable to empty completely.

This urinary retention may result in abdominal pain and the ability to pass only a few drops of urine at a time. Overflow of small quantities of urine causes incontinence, or the bladder may instead become overactive, resulting in the need to urinate frequently. When enlargement of the prostate is present, carcinoma (cancer) of the prostate must be ruled out.

How is it diagnosed?

History: Symptoms may include a decrease in the force and caliber (diameter) of urine stream, difficulty starting urination (hesitancy), dribbling, the need to urinate frequently at night (nocturia), and incomplete emptying of the bladder creating the need to urinate frequently. Urine retained in the bladder often leads to urinary tract infection. Inflammation of the bladder (cystitis) causes symptoms of flank (side) pain, fever, or painful urination.

Physical exam: Enlarged prostate can be detected during a digital rectal exam (gloved finger is inserted into the rectum). The lower abdomen is palpated (examined by pressing with hands) for a distended bladder.

Tests: Urinalysis and microscopic examination of the urine is done to rule out infection. Blood chemistries (including BUN and creatinine) measure kidney function. Prostate-specific antigen (PSA) is measured to rule out cancer. Ultrasound scanning, pyelography (x-ray of the kidneys using radiopaque dye), and uroflometry (recording of the strength of urine flow) may be performed to give additional information about the severity of the obstruction and to rule out defects elsewhere in the urinary system.

How is prostate enlargement treated?

Prostate enlargement that produces only mild symptoms does not require treatment. If symptoms are more severe, treatment to reduce the size of the prostate may include drugs (alpha-1 and alpha-2 blockers), or hormonal manipulation using bilateral orchiectomy (surgical removal of testes) or anti-androgen medication.

Surgical options to remove prostatic tissue include transurethral resection of the prostate (TURP), transurethral incision of the prostate, open prostatectomy, laser prostatectomy, transurethral balloon dilatation of the prostate, transurethral needle ablation (removal of tissue), or insertion of prostatic stents (devices to support or hold the tissue in place). When cystitis (bladder inflammation) is involved, treatment is directed towards controlling the infection with antibiotics. Urine retention is relieved by urinary catheterization until the condition can be corrected. If the individual is unable to undergo surgery due to advanced age or ill health, a catheter to drain the urine may need to be kept in place permanently.

Medications

• Propecia (Finasteride) is recommended for treatment for mild to moderate disease.
• Alpha-adrenergic blockers, hormonal agents and antiandrogens may be prescribed.
• Antibiotics if you develop a urinary-tract infection.
• Read labels on all non-prescription medicines. Avoid those that state “not recommended if you have prostatic hypertrophy” (examples are antidiarrheals and antihistamines).

Information	Brand	Generic	Label	Rating
	Propecia	Finasteride

Cardura (Doxazosin), Flomax (Tamsulosin)

What might complicate it?

Complications include inflammation of the bladder (cystitis), kidney (pyelonephritis), hydronephrosis (when urine collection, due to obstruction, forms a cyst in the kidney), and possible formation of kidney stones (renal calculi) from stagnant urine.

Predicted outcome

With treatment, most individuals with prostatic hypertrophy will have complete recovery.

Alternatives

Conditions with similar symptoms include cancers of prostate or bladder, urethral stricture, bladder neck contractures, bladder calculi (stones), or neurologic disease.

Appropriate specialists

Urologist and radiologist.

Last updated 22 December 2015