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Benign Prostate Hyperplasia

Benign Prostate Hyperplasia (BPH)

BPH is the most common prostate disorder. Urinary symptoms due to BPH are thought to affect one third of men aged over 50 in the UK. The incidence of BPH increases with age.

BPH is caused by an excess growth of prostate tissue. The non-cancerous changes are due to:

  • An increase in the number of prostate cells
  • An increase in the size of prostate cells

As the prostate enlarges, it squeezes the urethra, which reduces the flow of urine from the bladder.

Signs and symptoms of BPH:

  • A weak urine stream
  • Hesitancy (the urine stops and starts)
  • Straining on urinating
  • Urination takes a long time
  • Incomplete emptying of the bladder
  • Urgency- you feel the need to urinate urgently
  • Frequent trips to the toilet (Frequency)
  • Getting up in the night to urinate (Nocturia)

These symptoms are all classed as lower urinary tract symptoms (LUTS).

Other conditions that can cause LUTS:

  • Overactive bladder syndrome (OAB)
  • Urinary tract infections (UTIs)
  • Problems with bladder function
  • Parkinson’s disease

Testing for benign prostatic hyperplasia (BPH)

  • Physical examination - A digital rectal examination (DRE): This examination is performed by your doctor. It is used to asses all prostate disease. Your doctor will pass a gloved, lubricated finger into the rectum to examine the prostate. Through the digital rectal examination, your doctor will assess whether the prostate:Urine test: Your doctor will take a urine sample to check for signs of infection or blood. This will help rule out urinary tract infection.
    • Feels enlarged
    • Is tender
    • Feels smooth
  • Blood tests: Occasionally, BPH can cause kidney problems; therefore, your doctor may test your blood to check your creatinine level. Your blood sugar levels may also be tested as diabetes can cause frequent urination. Your doctor will also check your Prostate Specific Antigen (PSA) levels. PSA is a protein found in the bloodstream that can indicate prostate cancer or prostatitis, but can also be caused by BPH. The larger your prostate, the higher your PSA level tends to be. If the PSA level is raised, your doctor may recommend that you have a biopsy.
  • Ultrasound scan: An ultrasound scan of your kidneys and bladder may be recommended if your doctor is concerned that you are not completely emptying your bladder.

Further Tests

Depending on the outcome of the tests already described, your doctor may perform more tests. These include:

  • Urodynamic measurements: A catheter is inserted through your penis/urethra orifice into the urethra and up the bladder. The pressure inside the bladder is measured so your doctor can decide whether your symptoms are due to obstruction from BPH or are caused by the bladder not working properly. The catheter is then removed.
  • Tranrectal ultrasonography (TRUS): Ultrasound is used to create an image of the prostate to measure its size.


Drug treatment

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP)

Open prostatectomy

Active surveillance

This may be recommended by your Urologist if your symptoms are mild or you are not too troubled by them. You will need to make small changes to your lifestyle that might help you. This means avoiding taking large amounts of fluid in the evening and avoiding tea, coffee and alcohol.

At regular intervals, usually yearly, you will have physical examination, blood and urine tests.