Prostate Enlargement

The acronym used to describe prostate enlargement is BPH, and this may be an abbreviation for either benign prostatic hyperplasia (meaning an increase in the number of cells in the prostate) or benign prostatic hypertrophy (meaning an increase in the size of the prostate gland). In medical literature, hyperplasia and hypertrophy are used interchangeably to define BPH.

According to the American Heritage Dictionary, the word benign means: "of a kind and gentle disposition, of no danger to health, not recurrent or progressive, not malignant." This definition, though, is only partially correct: BPH is not malignant. However, BPH may not be "kind and gentle" because it can be a danger to health and may be recurrent and progressive.

BPH is one of the most prevalent health problems among aging men. It has been estimated that over 9 million men in the United States over the age of 50 and another 20 million men worldwide suffer from BPH. BPH symptoms include increased frequency of urination, a sudden urge to urinate, and difficulty in urinating or a weak flow of urine. It is possible that the excessive tissue growth can completely compress the urethra so that little or no urine can be passed.

At times, BPH may become so large that the growth pushes up and presses on the bladder. This pressure and squeezing can partially collapse the bladder and will decrease the volume of urine that the bladder can store. It may also cause a pool to be formed so that some residual urine is retained after the patient has voided.

BPH affects each man differently. Because each man is different and each manifestation of the disease is different, there is no single treatment for all men. There is also no absolute cure for BPH. Men who have the surgical transurethral resection procedure (TURP) may be free of symptoms for some time, but BPH may recur in some of them.

In the United States each year, about a half million men are treated for BPH with various types of surgery and drug therapy. The second greatest cost to Medicare, at over $2.5 billion a year, is for BPH treatments. Note: The single greatest cost to Medicare, at close to $3 billion per year, is for cataract treatments. The expense for cataracts is greater because it includes both men and women and both eyes are affected.

Symptoms of BPH
BPH has several symptoms. Depending on age, a man may have some or all of these symptoms; however, treatment may not be needed. Most of these symptoms may also be present in prostate cancer.

Decreased strength and force of the stream. One of the most notable symptoms is reduced urinary stream. This may be due to bladder outlet obstruction. The obstruction may also be caused by a compression of the urethra within the prostate gland.

Urinary frequency during the day. Some men are rarely able to pass a restroom without stopping to use it. Normally, urination should not be more than once every 2 hours during the day unless large amounts of liquids such as coffee, tea, or beer are being consumed. The prostate may be so large that it is pressing on the bladder so that the capacity of the bladder is diminished. The normal bladder in a man should have a capacity of 12-17 oz. (Most medical measurements are listed in milliliters or cubic centimeters, which are the same: 1 oz is 29.57 mL or 29.57 cc. The normal bladder will hold from 355 mL or cc and up to 502 mL or cc.)

Nocturia (needing to urinate several times at night). Most men, and many women, must get up at least once during the night to urinate, especially if they have consumed large amounts of fluids in the evening before bedtime. However, men who have BPH may need to get up several times during the night, only to void a small amount each time. It is possible that the prostate has become so enlarged that it presses on the bladder and prevents the bladder from holding as much as it normally should. If a man cannot get back to sleep, it may cause sleep deprivation. Nocturia is the most common BPH symptom that causes men to see their physician. Nocturia is not definitive that you do or do not have BPH. Even if a man has had a radical prostatectomy, he still may have to get up 2 or more times each night.

Urgency. There may be a feeling of urgency or that you cannot wait or need to urinate immediately.

Hesitancy. A man may require several seconds trying to find the right button to push to get urination started. Time and place may also make a difference. If in a crowded public restroom and it seems as if others are staring at you and your anatomy, finding the right button to push may be difficult even if you do not have BPH. If you have difficulty urinating, try sitting on the commode. In some men, sitting seems to help relieve the obstruction slightly.

Straining. Straining may be required to force urine through the constricted urethra. This can cause thickened bladder muscles. Constant straining may also cause the bladder muscles to simply not work at all. Many men wake up in the morning with an erection and an urge to urinate. In this case, straining is almost always required to start urination. The reason is that the bladder sphincter is designed to remain closed in the presence of an erection. This prevents any ejaculate that might occur from entering the bladder. After a TURP, this valve is usually damaged. When the valve is damaged, and an ejaculation occurs, quite often the semen takes the shorter route into the bladder. This is called retrograde emission (to be discussed in more detail later).

Dribbling and difficulty in stopping. One symptom is difficulty in starting urination, but there may also be difficulty in being able to stop, at least not completely stop. A man with BPH may think that urination is finished. However, almost immediately there will be leaking of urine. Leaking is often embarrassing and can be worsened by stress (e.g., being late for an important appointment or in a hurry).

Decreased size or caliber of the stream. The urine stream in a young man can be about a quarter of an inch in diameter. However, a man who has BPH might have a stream that is less than a sixteenth of an inch in diameter. This could be due to the constriction of the prostatic portion of the urethral tube.

A feeling of still needing to urinate. A man may have just finished urinating but still feel as if the bladder is not empty.

Dysuria (pain) or burning during urination. Any pain or burning sensation during urination could be due to irritation of the urethra. If the patient is unable to completely empty the bladder, it may lead to bacterial infection, which may cause pain and burning during urination. Pain and burning could also indicate an inflammation, prostatitis, bladder stones, or prostatic stones.

Complete retention of urine. The complete retention of urine is an emergency situation. The patient should be immediately hospitalized and treated. If there is nausea, dizziness, or unusual sleepiness, these symptoms may be caused by kidney damage due to urine blockage.


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