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Benign Prostatic Hyperplasia

By Sasha de Beausset Aparicio, MSc

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Benign Prostatic Hyperplasia

What Is Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia, commonly referred to as BPH, is a condition that determines an increase in the size of the male prostate gland. Its name has been given because it manifests as a hyperplasia – increase in the number of cells in a given tissue – of the prostatic stromal and epithelial cells. This creates discrete nodules in the periurethral region of the gland. The nodules press on the urinary canal and can cause partial or complete blocking of the flow of urine.

BPH is very common among males. After the age of thirty most male begin slowly developing the condition. By the age of fifty approximately 50 percent of males experience it to a certain degree and 75 percent at the age of eighty. Overall, half of the affected persons perceive it as being a problem.


It is generally accepted that the presence of testosterone promotes the development of the condition, but it is not the main cause and it cannot trigger it alone. It has been observed that persons that were castrated did not show signs of developing this condition. Another important point is that administering testosterone does not increase the rate of development or the risk of appearance, so the concentration of testosterone required for prostate growth proliferation is thought to be minimal.

A metabolite of testosterone called Dihydrotestosterone is suspected to be important in the creation of the nodules because several studies have shown that if you inhibit the enzyme that synthesizes the substance from testosterone, you reduce prostatic growth. No correlation has been found between BPH and other hormones, including estrogen.

In recent years it has been proposed that the local levels of testosterone may be up to 100 times greater than serum levels. This would explain why the overall concentration may be small and still cause prostate growth. The mechanism that has been proposed is an increase in hydrostatic pressure in the spermatic veins due to inefficient drainage. Research is still being done, but if fully confirmed this will have dramatic implications on the treatments of BPH.

While being very common and almost every male over seventy develops the condition, the severity and significance of it varies greatly based on the physical activity, stress levels and diet of the patient. High stress levels are particularly associated with accelerated prostate growth.

Signs & Symptoms

Most symptoms related to benign Prostatic Hyperplasia are related to urination. Many patients feel the need to urinate more frequently and feel that they cannot postpone urination every time. Some even become incontinent. Most of them also wake up during the night to relieve themselves. Other symptoms include a urinary stream that is intermittent or a large period of waiting time needed before urination. Urine may even come as dribbles and the man can even struggle to get the urine stream going. It is very uncommon for patients to feel any pain regarding these symptoms.

Severe complications will arise if the condition is left untreated in its final stages. The retention of urine can cause bladder damage and infections and in severe cases renal failure, which can be fatal.

Diagnosis Benign Prostatic Hyperplasia

Standard BPH diagnosis begins with the rectal examination of prostate size. If an enlarged prostate is found, blood tests are performed to check if malignant signaling substances are present. Transrectal ultrasonography can also be used as a tool of early detection. Ultrasound investigations of testicles, kidneys, and prostate are commonly performed in order to rule out other related conditions.

Symptoms commonly considered a sign of BPH in medical forms are: increased effort during urination, weak urination, urinary hesitancy, chaotic need of urination, long but incomplete emptying of the bladder, dribble, irritation, bladder pain, dysuria, incontinence, problems related to ejaculation, frequent urination, and the need to urinate at night.

Treatment for Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia is a serious condition that requires the immediate attention of a certified specialist. You are not advised to try and treat this condition on your own in order to avoid dangerous complications.

One of the first things that doctors recommend is a series of lifestyle choices that can decrease the severity of the symptoms and ease treatment. It is therefore recommended that you do not drink fluid before bedtime and avoid caffeine and alcohol as much as possible. It is also mandatory that you urinate based on a strict schedule, in order to mitigate the chaotic nature of the symptoms.

On the medication side of things, the most common prescribed drugs in Europe and North America are alpha blockers. These pills relax the muscles that press on the urinary tract, reducing net pressure, and improving urination related symptoms. Depending on the brand that you choose to take, side effects may range from weakness, headaches, and nasal congestion to problems in ejaculation. In spite of the side effects, it is still the most common way of dealing with BPH symptoms.

Another way to approach the problem is to use medication that inhibits the formation of Dihydrotestosterone. Their effects take longer to appear but persist for many years. They do, however, have significant side effects on libido and sexual performance.

If no medical treatment has the desired effects, there are a few radiological treatments that aim to kill the excess cells and cause the dead tissue to be absorbed by the body. These treatments are still under close research and the most frequent final solution remains surgery.

The most common surgical procedure is Transurethral Resection of Prostate – TURP. This procedure removes part of the prostate through the urethra. It is the oldest way of achieve this effect but it remains the most widely known and safe effective procedure. Other alternatives that are being studied are: ethanol injection, visual laser ablation, laser transurethral resection and electrovaporization. There is strong hope in the fact that at least some of these procedures will be eventually considered viable. For now, TURP remains the standard solution.
Alternative medicine has also been tackling this problem for quite some time. There are several herbal remedies that have been approved for use in Europe. The United States has not approved any of these. The most studied is Saw Palmetto extract, but research has had mixed results so far. Other herbs are being studied but none have been demonstrated to work.