Benign prostatic hyperplasia (BPH), also known as benign prostate enlargement, is a non-cancerous and common consequence of the natural aging process for many men and may be related to changes in sex hormones that naturally occur as a man gets older. Approximately half of all men between the ages of 50-60 will develop BPH, which sharply increases to about 70 percent in men aged 60-69 and up to 80 percent in men over 70.
The prostate is a small, walnut-sized gland that sits directly below the urinary bladder and surrounds the urethra, the small tube that carries urine away from the bladder and out of the body. If the prostate gland grows large enough, it can place pressure on the urethra and surrounding tissue structures, potentially leading to common symptoms associated with BPH, including:
- A more frequent than usual need to urinate, especially at night
- Weak urine stream and dribbling
- Involuntary stopping and starting of the urine stream
- Blood in the urine (medically referred to as hematuria)
- A sensation of incomplete bladder emptying
When determining whether BPH is an issue that needs to be emergently addressed, urologists often want to answer these top four questions:
1. What types of symptoms is the man experiencing? For some men, the experience of BPH produces no symptoms at all, and for other men, the associated symptoms can be severe. In my medical field, I often have patients fill out a document called the AUA (American Urological Association) Symptom Score. This exercise helps quantify the degree of lower urinary tract symptoms a man might be experiencing because of BPH.
2. How large has the prostate become? To determine the size of the prostate, volumetric measurements of it can be obtained by ultrasonography or MRI. Prostate volume measurement, done by transrectal ultrasound, is an excellent way to determine if the prostate is getting larger over time. However, the performance of this type of ultrasound requires special skills.
3. To what degree has the BPH caused bladder muscle hypertrophy? Bladder muscle hypertrophy means the thickening of the bladder muscle. The more hypertrophy or thickening of the bladder muscle, the more likely a man will develop urinary incontinence, urgency, and frequency of urination in relation to BPH.
4. Is there a Post Void Residual? Some men with more advanced BPH are unable to empty their bladder completely. The residual amount of urine left over in the bladder after urinating is called Post Void Residual (PVR). This excess urine amount can be measured by ultrasound. All men and women typically have a small amount of PVR, usually only about one ounce. However, with BPH, the PVR may be elevated, and eventually, BPH may lead to urinary retention or infection.
As the urologist investigates a man’s symptoms related to BPH with the tools and technologies available, men can also track their symptoms. If you’re concerned that BPH may be to blame for your symptoms, pay attention to how many times a night you get up to go the bathroom. Also, track the amount of time between bathroom visits during waking hours. Make particular note of whether the urge to urinate is so strong that you develop urinary leakage before reaching the bathroom.
The development of an overwhelming urge to urinate that is accompanied by urinary leakage is often an ominous sign. It usually signifies the late result of untreated enlarged prostate. Men with bothersome symptoms such as these should undergo medical or surgical treatment. Even after treatment, men should still have regular check-ups with their urologist to determine whether there have been any changes or improvements in the symptoms. Men with mild symptoms who prefer no treatment should also see their urologist regularly to determine if their symptoms are progressing to the point that may warrant treatment consideration.
It is crucial for men to remain proactive when it comes to their urologic health so we as urologists can help resolve potential issues from becoming more significant problems. By working together, you and your body can age like a fine wine.
Dr. Ramin’s answers to Giddy Media Interview on 11/7