Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia, also known as Benign Prostatic Hypertrophy (BPH), is a noncancerous overgrowth of the prostate gland that occurs in 19% of men between 55 to 74 years old. Although the exact cause of BPH is unknown, research suggests that it is related to hormonal changes due to aging. As the prostate increases in size, the lumen of the urethra narrows and obstructs urine outflow which can cause incomplete bladder emptying. This may lead to complications such as infection, calculus formation, hydronephrosis, and decrease renal function. 

Signs and Symptoms of Benign Prostatic Hyperplasia

BPH symptoms are often progressive and are collectively known as lower urinary tract symptoms (LUTS). These include:

• urinary frequency
• nocturia
• urinary urgency
• hesitancy
• intermittency

Some patients may also have urinary retention with bladder distension and abdominal discomfort. Many of these symptoms are caused by incomplete bladder emptying and rapid refilling. In general, BPH does not cause pain or dysuria. As the symptoms progress, it may cause incontinence or complete urinary retention. 

Risk factors for Benign Prostatic Hyperplasia

The biggest risk factor for developing BPH is age - men under 40 years old rarely develop BPH and approximately half of men over 80 years old have some degree of BPH. Other risk factors for developing BPH include family history, diabetes/heart disease, and obesity all increase your risk of BPH.

Drug Treatment of Benign Prostatic Hyperplasia

Many prescription and over the counter medication worsen BPH and should be stopped. These include sympathomimetics, anticholinergics, and opioids. For patients with mild to moderate BPH symptoms, alpha-adrenergic blockers such as Uroxatral (alfuzosin), Flomax (tamsulosin), Cardura (doxazosin), and Hytrin (terazosin) can help with obstructive symptoms. Propecia/Proscar (finasteride) and Avodart (dutasteride) are 5 alpha-reductase inhibitors that can decrease prostate size and voiding symptoms. However, this therapy may take months, especially for patients with larger prostate glands. Your doctor may recommend a combination of alpha-adrenergic blockers and 5-alpha-reductase inhibitors as the 2 medication in combination is shown to be more effective than either medication alone. Daily tadalafil is used for patients who have BPH and erectile dysfunction. 

There are many over-the-counter supplements and natural health products that claim to treat BPH but none of these options have been demonstrated to be more efficacious than placebo.