Benign Prostatic Hyperplasia, also known as BPH, is defined as a benign, i.e. non-cancerous, growth of the prostate. This growth can cause discomfort related to urination, such as having to urinate very frequently, having a very thin stream of urine, having to squeeze to get the urine out or leakage of urine, among others.
Urinary discomfort is very common among men, especially after the age of 50. It is estimated that approximately one third of men over the age of 60 will have urinary discomfort requiring treatment.
What are the causes of BPH?
There are several different causes for a person to have uncomfortable symptoms related to urination. Most often in men, however, it is due to an obstruction of the outflow of urine from the bladder caused by a benign growth of the prostate. This growth is called Benign Prostatic Hyperplasia or BPH.
Sometimes there is more than one cause involved in a patient’s discomfort, such as a narrowing of the urethra, a stone or foreign body in the urinary tract or alterations in the functioning of the bladder, among others. For this reason, it is very important that your physician makes a complete evaluation of the different possible causes of your symptoms.
The urethra is the tube through which urine passes from the bladder to the outside. The prostate is located below the bladder and completely surrounds the urethra, as if it were a tire.
What happens in the case of BPH is that the prostate decreases the caliber of the urethra. When prostate enlargement occurs, the lumen of the urethra may become partially obstructed.
It is important to know that the size of the prostate is not always directly related to the degree of obstruction. In some cases, there may be a small prostatic enlargement that obstructs the urethra and causes significant urinary discomfort. In these cases, even though the prostate is small, treatment is necessary.
The opposite can also happen. There are people who, in an ultrasound scan, are found to have a very large prostate, but do not have any discomfort when urinating. In these cases, no matter how large the prostate is, if there are no symptoms, treatment is not necessary.
What symptoms can BPH present?
In order to understand the causes and better define the treatments, the symptoms of patients with BPH are usually classified into two groups:
Voiding symptoms: those perceived during urination and the main ones are:
- A weak or thin stream
- Delay or difficulty in starting urination.
- Having an interrupted or interrupted or choppy stream
- Having to squeeze or strain to get the urine to come out
These symptoms are more directly related to an obstruction in the outflow of urine from the bladder.
Filling symptoms: These are those perceived during the time when the bladder is filling, i.e. between voiding and voiding. The main ones are:
- Increased daytime voiding frequency or the need to urinate more times during the day.
- Nocturia or the need to wake up at night to urinate.
- Urgency or the onset of a rapid and intense urge to urinate that is difficult to hold.
- Incontinence, involuntary leakage of urine.
As a general rule, these symptoms are due to a malfunction of the bladder, which could be caused by a problem directly in the bladder or by a poor adaptation of the bladder to the obstruction of urine outflow produced by the prostate for a long time.
How is BPH diagnosed?
The first thing to do is to find out important information about the patient such as diseases, medications taken regularly, lifestyle, and emotional and psychological factors that may affect how a person urinates.
There are different tests that will help to clarify the origin of the patient’s problems.
- A urinalysis will help to rule out medical problems such as urinary tract infection, blood in the urine or diabetes mellitus.
- To assess the volume of the prostate, either a digital rectal examination or an imaging test can be performed, the most frequently used being ultrasound. Knowing the prostate size is important to select the appropriate treatment, both medical and surgical, as we will see in the following videos.
- A blood test is useful to assess the prostate specific antigen or PSA, which helps us to evaluate the risk of prostate cancer, as well as the risk of prostate growth. It also allows us to assess that the kidneys are functioning properly, through the creatinine level. This is important because patients with BPH are at a higher risk of having problems with kidney function.
- One test that provides very useful information is flowmetry. This test consists of assessing the rate of urine flow among other parameters. It consists of urinating in a device that performs the measurement.
These are the most commonly used tests in the initial evaluation of a patient with symptoms compatible with BPH. These are not all the tests that exist and it is very important to know that none of these tests alone can make the diagnosis of BPH. The tests must be evaluated as a whole and especially considering the clinical and characteristics of each patient.