Benign Prostatic Hyperplasia (BPH): Quick Revision
Benign prostatic hyperplasia (BPH) is present in as many as 60% of men in their 60s and 90% of men older than 70 years. BPH describes nonmalignant prostate tissue growth and commonly causes lower urinary tract symptoms (LUTS). Not all men with BPH have LUTS, however, and not all men with LUTS have BPH.
Although BPH is considered a normal part of the aging process, it often impairs quality of life.
Metabolic syndrome, obesity, hypertension, and genetic factors contribute to the development of BPH. Hyperglycemia and insulin resistance have also been shown to increase the risk for BPH and LUTS.
No clear racial differences in BPH have been determined, but some data suggest that Asian men have a decreased risk for clinical BPH compared with White men. Studies of Black men in the United States have found an increased prostate transition zone and total volume compared with White men.
Prostate volume may increase over time in men with BPH. In addition, peak urinary flow, voided volume, and symptoms may worsen over time in men with untreated BPH. The risk for acute urinary retention and the need for corrective surgery increase with age.
Symptoms often attributed to BPH can be caused by other disease processes, and a history and physical examination are essential in ruling out other etiologies of LUTS. When the prostate enlarges, it may act like a “clamp on a hose,” constricting the flow of urine. Nerves within the prostate and bladder may also play a role in causing these common symptoms:
- Urinary frequency: The need to urinate frequently during the day or night (nocturia), usually voiding only small amounts of urine with each episode
- Urinary urgency: The sudden, urgent need to urinate, owing to the sensation of imminent loss of urine without control
- Hesitancy: Difficulty initiating the urinary stream; interrupted, weak stream
- Incomplete bladder emptying: The feeling of persistent residual urine, regardless of the frequency of urination
- Straining: The need to strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder
- Decreased force of stream: The subjective loss of force of the urinary stream over time
- Dribbling: The loss of small amounts of urine due to a poor urinary stream
