Ask the Doctors Men's Health

Ask the Doctor: Benign Prostatic Hypertrophy

Prostate health topics are important to discuss with a doctor, but for many people, it is difficult to have these conversations with their health care provider. At Washington University School of Medicine in St. Louis, urologic surgeons diagnose and treat enlarged prostate – also called benign prostatic hypertrophy (BPH). Charles U. Nottingham, MD, of Washington University Urology, answers questions about BPH. The medical term for an enlarged prostate is benign prostatic hyperplasia (BPH). An enlarged prostate is not a medical problem, but it is a condition patients should understand. Treatment options exist to reduce the symptoms of urinary obstruction that may occur as a result of BPH.

What is benign prostatic hypertrophy?

A benign prostatic hypertrophy (BPH), also known as an enlarged prostate, is a condition where the prostate is larger than the average prostate size. Variation in organs and tissues does not indicate a health problem, because some differences exist naturally in human populations. Just as breasts vary in size, people can have prostates of varying sizes. The average prostate is 20 cc in size. Prostates over 30 cc are considered enlarged.

What are the symptoms of benign prostatic hypertrophy, and what does it feel like?

Someone with BPH usually does not know that their prostate is large because they are asymptomatic, meaning they experience no symptoms for the condition. The enlargement is detected by digital rectal examination or by imaging. People with voiding problems might have a normal sized, tight prostate.

BPH can cause obstructive symptoms during urination. The urine flows from the bladder through the tube in the middle of the prostate, called the prostatic urethra, and then out through the penile urethra. As the prostatic urethra narrows with age, the urinary stream can be partially obstructed. Symptoms of an obstructed prostatic urethra include:

  • Frequent urination
  • Slow stream
  • Straining to urinate
  • Sense of incomplete emptying or urgency to urinate
  • Urinary frequency or nocturia (getting up at night to urinate)
  • Splayed urinary stream

Prostate size is not related to constipation or other gastrointestinal problems.

Men's bathroom sign
Symptoms of BPH is an increase in urinary frequency and a sense of urgency to urinate

What causes benign prostatic hypertrophy? Are there risk factors?

Prostate development and growth is dependent on the presence of the androgen sex hormone dihydrotestosterone (DHT). DHT is catalyzed from testosterone, the primary “male” hormone that all people have at different levels during their lives. Different levels of hormones can therefore impact the development of tissues like the prostate. While the exact mechanisms aren’t known, research has indicated prostatic enlargement may occur when DHT binds to androgen receptors in the cell nuclei, potentially resulting in BPH. However, testosterone levels decrease with age, yet BPH increases with age, suggesting there may be a different cause. Possible molecular factors include metabolic syndrome, hyperinsulinemia, norepinephrine, angiotensin II, and insulin-like growth factors.

The likelihood that a person will develop BPH increases with age. Almost all people with prostates experience prostate enlargement as they get older.

Are there complications to benign prostatic hypertrophy?

While BPH does not pose serious health risks, it causes urinary and bladder habits to change and can impact quality of life.

Can a prostate’s size be reduced naturally? How is it treated?

There is no reason to treat asymptomatic BPH. Treatment is intended to improve symptoms related to prostatic narrowing. People with normal sized prostates can also be symptomatic.

Obstructive voiding symptoms can be treated with medication and surgical procedures. Medication often prescribed for BPH includes:

Alpha Blockers

  • Alpha blockers relax the prostate and improve voiding symptoms and flow rate
  • These agents work within 1 – 2 weeks and have few side effects
  • Common medications include Flomax, Rapaflo, Uroxatrol, Cardura, Hytrin

5 alpha reductase inhibitor

  • These agents block the conversion of testosterone to DHT
  • With a reduced DHT level, the prostatic glandular tissue shrinks and results in a wider prostatic urethra
  • Medications include Finasteride and Avodart.

Medications often aren’t enough to fully improve BPH symptoms. In addition to medications, minimally invasive surgical treatments have been developed.

Surgical options offered by Washington University urologists include laser treatments, such as GreenLight Laser Therapy, to open the prostate, allowing patients to have better bladder habits. Procedures such as laser treatment can be performed with limited healing time and can even be an out-patient appointment. These treatments also do not have any risk of incontinence or erectile dysfunction.

Prostatic Urethral Lift procedure is another minimally invasive surgery that helps reduce BPH symptoms. This is an endoscopic therapy for resolving bladder obstruction by widening the opening of the urethral channel from the bladder neck through the prostate. A cystoscope places a small implant in the anterior and lateral aspects of the prostatic urethral lumen, tethering the compressed tissue to the prostatic capsule. This establishes an open lumen in the prostatic urethra.

Dr. Blatnik in Surgery
Minimally invasive surgery is one option to reduce BPH

Another surgery uses a transurethral needle ablation technique. By injecting sterile water vapor into the adenoma of BPH, Rezūm techniques use the heat from water vapor to disrupt prostate cell membranes, leading to eventual cell death. Similar to Prostatic Urethral Lift, this procedure can be performed under local anesthesia in the outpatient setting.

What doctors treat benign prostatic hypertrophy?

Urologists specialize in conditions involving the prostate. Washington University Urology can provide options and treatments for prostate enlargement. Our urologists also offer advanced diagnostic tests such as urodynamics, which can help determine how an enlarged prostate is affecting a patient’s bladder habits.

BPH Consultation at Washington University

Experiences of BPH are variable and require different care. Dr. Nottingham and all physicians at Washington University take time to discuss urologic conditions with their patients before deciding on treatment options. To request an appointment, please fill out this online form or call 314-362-8200.