Introduction to benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the condition that occurs when the prostate gland is increasing in size without there being any malignant cause. As the prostate enlarges it leads to compression and then obstruction of the urethra, which in turn affects urinary flow. The symptoms include urinary frequency, urinary urgency, hesitancy in urination, poor stream and incomplete bladder emptying. Partial obstruction can ultimately become complete causing acute urinary retention and the urgent requirement for a bladder catheter. BPH is not however a pre-malignant condition.

This condition becomes increasingly common with age and has an impact on the quality of life for a considerable number of men aged over fifty years.

Traditionally, BPH has been managed with lifestyle changes and medication in the first instance but if the symptoms progress or become severe then surgery may be required. However, as this is an age-related condition fitness and suitability for surgery is often an issue. The process by which the prostate begins enlarging starts around the age of 30 and up to 50% of men will show histological signs (changes within the tissues) of BPH by 50 years of age. By 80 years of age this rises to 75% although not all of these men will have symptoms. Symptomatic BPH occurs in up to 50% of men of middle age or older.

Symptoms of BPH

The symptoms of BPH fall into two broad categories
• Voiding (weak stream, hesitancy, stop and start micturition)
• Storage (frequency, urgency, nocturia, leaking)

Benign prostatic hyperplasia (BPH)

Post PAE contrast enhanced MRI scan shows that the troublesome central ‘adenoma‘ or benign growth causing the symptoms has become devascularized or lost its blood supply. This leads to gland shrinkage and an improvement in urinary flow and a reduction in night and day time urinary frequency