Urinary Conditions in Younger Men that are often Misdiagnosed as BPH or Enlarged Prostate
As a urologist specializing in prostate health, it is important that I help men of all ages understand how their prostate and bladder function, and what to watch out for when something is wrong. Men under 50 often pay little attention to their prostate or urologic health. For the most part, that's ok. Prostate and other urologic problems don't typically present in younger men. But sometimes, they are. So, knowing what to look for before an issue arises is prudent health advocacy for everyone.
In the normal anatomical development of the human male, the prostate gland experiences two natural growth cycles. The first cycle of prostate growth occurs in early puberty, and the second begins around age 25. These two cycles result in the development of a normal prostate in adults that is about the size and shape of a small strawberry. However, in many men, the prostate takes on an exponential and abnormal growth phase after age 50. This type of growth is defined as benign prostate hyperplasia (also known as BPH). BPH is often characterized by obstruction of the flow of urine out of the bladder since the enlarged prostate gland is blocking the bladder's normal function. The symptoms associated in with BPH, or an abnormally enlarged prostate that occur in older men are:
- Slow urinary stream
- A sensation of incomplete bladder emptying
- Having to strain during urination
- Stop and start the urinary stream
- Delay in starting the urinary stream
- The sensation of increased urgency to get to the bathroom
- Frequency of urination
- Urinary leakage with a severe urge to get to the bathroom
- Complete closure and inability to urinate (urinary retention)
Men with BPH may have varying degrees of one or many of the above symptoms. Though uncommon, some younger men in their 20s and 30s may experience these symptoms as well. And unfortunately, these men are often misdiagnosed as having BPH or an enlarged prostate. It is essential to distinguish the symptoms of urinary problems from diagnosing the actual medical condition known as BPH. As mentioned, BPH involves an enlargement of the prostate which leads to urinary symptoms. However, there are other conditions that can involve BPH symptoms, despite a normally sized prostate. In fact, upon evaluation, most young men with BPH-type symptoms do not have an enlarged prostate and therefore do not have BPH. Consequently, it is crucial to distinguish between the diagnosis of BPH and the symptoms listed above.
Conditions in younger men that can cause BPH-like symptoms:
1. Elevated Bladder Neck:
An elevated bladder neck is a condition characterized by the misalignment of the connection between the prostate and the bladder's opening. This condition in young men is most commonly misdiagnosed as BPH. When functioning normally, the prostate and the bladder neck opening are a straight pathway. As the bladder contracts, the urine quickly exits the bladder neck opening and enters the prostate fossa (the tube in the prostate that urine travels through to reach the urethra). However, in patients with an elevated bladder neck, the prostate is higher than the bladder neck's opening, creating a roadblock or a speed bump, impeding the urine from exiting the bladder neck to enter the prostate fossa.
An elevated bladder neck is a congenital problem, meaning a person is born with it. From a young age, men experiencing this condition have more frequency of urination, and it usually takes them longer to empty the bladder. Frequently, young men or their parents do not mind this problem, or their doctor diagnoses them with a "shy bladder" or a "small bladder." But by the time they reach their 20s or 30s, the condition may have caused damage to the bladder muscle wall, resulting in increased urinary symptoms. At this point, a misdiagnosis of BPH may occur. The best way to diagnose the actual problem is for a urologic expert to perform a cystoscopy or a pelvic ultrasound.
2. Urethral Stricture:
Another condition that may cause BPH-like symptoms in younger men is a urethral stricture. In this case, the urethra becomes obstructed due to the development of thick scar tissue, reducing its luminal diameter. The causes of stricture can be prior urethral instrumentation, injury to the perineal area, pelvic fractures, or sexually transmitted infections (STIs) like gonorrhea or chlamydia.
3. Bladder Cancer:
Tumors in the bladder can also obstruct the flow of urine and may affect frequency and urgency. While bladder tumors are rare in younger men, it is important to diagnose them early. In younger men with urinary symptoms, there is usually less attention paid to such a possible diagnosis. Unfortunately, this leads to more advancement of the cancer before he is actually diagnosed.
Men with uncontrolled diabetes tend to have increased levels of Glucose (sugar) in their urine. Sugar is very irritating to the inner lining of the bladder, causing increased urgency and frequency of urination. It is important to have a high level of suspicion for this diagnosis, when a younger man presents with BPH like symptoms.
5. Median Lobe Hyperplasia:
Of all the conditions discussed above, this is the closest to “BPH”. This condition can be classified as a particular form of BPH that may present at younger ages (30's and 40's) and is called median lobe hyperplasia. In this case, the middle part of the prostate grows like a round marble. This central portion then protrudes into the bladder neck area, essentially closing off the opening of the bladder. In this case, urine will have a difficult time exiting the bladder, because the neck or opening of the bladder is being blocked by the marble-sized portion of the prostate growing into this opening. Since, in this case, there is an actual overgrowth of a part of the prostate, it can be called BPH. However, this condition does NOT cause a global enlargement of the entire prostate. In the case of median lobe hyperplasia, only a tiny amount of overgrowth at the bladder neck area will be sufficient to cause moderate to severe BPH symptoms.
If in fact all these conditions lead to the same symptoms as having an enlarged prostate, then why is it important to correctly diagnose them? The reason is that the treatments for these conditions are different than the treatment for BPH. If a patient’s true underlying cause of urinary symptoms is not diagnosed, then their condition may progress and worsen.
Younger men are often the most likely to wave off minor health issues as no big deal. Now is a good time to stop doing that. The sooner you have a health issue evaluated by an expert, the sooner it can be solved and treated – before it gets worse or becomes more complicated to treat. Whether it's BPH, a UTI, or an STI, prioritize your health and have it looked at. Your future self will thank you.
Email answers provided by Dr. Ramin on 10/17.