Benign Prostatic Hyperplasia
What is BPH?
Benign prostatic hyperplasia (BPH), also known as lower urinary tract symptoms (LUTS), is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.
What are some of the symptoms associated with BPH?
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
How is BPH diagnosed?
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is — ranging from mild to severe.
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:
- Prostate specific antigen (PSA), a blood test to screen for prostate cancer.
- Urinary cytology, a urine test to screen for bladder cancer.
- A measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating.
- Uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates.
- Cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope.
- Urodynamic pressure-flow study that tests the pressures inside the bladder during urination.
- Ultrasound of the kidney or the prostate.
Risk factors for developing BPH include increasing age and a family history of BPH.
When should the person see a doctor about BPH?
A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.
Credit: National Institute of Health.