What is Benign Prostatic Hypertrophy?

The prostate gland is part of the male reproductive system. This small two-lobed gland is located below the bladder, and during ejaculation, secretes a fluid which makes up a large part of the ejaculate. A condition called benign prostatic hypertrophy, in which the prostate gland becomes enlarged, develops in most men as they age. Benign prostatic hypertrophy is not a cancerous condition, cannot turn into prostate cancer, and does not increase the risk of cancer developing.

Enlargement of the prostate causes problems because the gland wraps around the urethra as it exits the bladder. The enlarged prostate begins to press on the urethra, with several effects. First, the walls of the bladder may thicken and become more sensitive to irritation. Second, because the prostate gland presses on the urethra, the bladder contracts more frequently. In addition, these two effects cause the bladder to become weaker; it does not empty completely during urination, which can cause further problems.

Prostate enlargement begins in the 20s for most men, but rarely causes symptoms before the age of 40. More than 50% of men have some prostate enlargement symptoms by their mid-60s, and up to 90% of men over 85 have symptoms. Around 30 million men worldwide have symptoms of prostate enlargement.

The most common benign prostatic hypertrophy symptoms relate to urination. These include increased need to urinate, especially at night, coupled with a reduced amount of urine passed. The stream of urine may be weak and may frequently interrupt during urination. It may be more difficult to urinate, even when the bladder feels full. Dribbling or leakage of urine is also more likely to occur.

Benign prostatic hypertrophy may be complicated by a condition called acute urinary retention, in which urination is completely blocked. In many cases, this is the first time a man notices symptoms of prostate enlargement. Acute urinary retention can be triggered by decongestant medications, as these drugs sometimes prevent the bladder emptying. Other possible complications of prostate enlargement include chronic urinary tract infections, bladder stones, kidney or bladder damage, and incontinence.

Treatment for an enlarged prostate includes medication and surgery, as well as a number of non-invasive procedures which can provide temporary relief. Benign prostatic hypertrophy medications include drugs which inhibit a hormone called DHT, which plays a role in enlargement of the prostate. These drugs can prevent further prostate growth, and in some cases can actually shrink an enlarged prostate.

When medication is ineffective, certain minimally-invasive procedures may be used to treat the condition. One of these is transurethral needle ablation, in which radiofrequency energy is directed at the prostate to burn off some of the excess tissue. Another is water thermotherapy, which uses heated water to destroy targeted portions of excess prostate tissue.

Several types of benign prostatic hypertrophy surgery may provide more permanent relief. The preferred procedure is called transurethral resection of the prostate. This procedure takes around 90 minutes, and involves the use of an instrument called a resectoscope. This instrument is inserted into the penis to the prostate, and along with an electrical wire loop, is used to burn away overgrown tissue. Full recovery from prostate surgery may take up to two months. Some men lose a small amount of sexual function after the procedure, but most regain complete sexual function within one year of surgery.