Benign Prostate Hyperplasia (BPH)

Benign prostatic hyperplasia is diagnosed and treated by the Urology Division at Premier Medical Group.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH), is the term for an enlarged prostate gland.

The prostate is normally a walnut sized gland located beneath the bladder sitting in front of the rectum in men. It is made up of two types of tissue, epithelial cells that form glands interspersed with smooth muscle cells. Surrounding this is a fibrous tissue layer called the prostatic capsule. The urethra (tube that transports urine and semen out the body) passes from the base of the bladder through the prostate to the tip of the penis. The exact role the prostate plays in human physiology is not entirely known, however, it certainly plays a major part in sexual function and fertility.

Approximately 25 to 30% of the volume of the semen comes from the prostate, 60 to 65% of the fluid from the seminal vesicle (two organs attached to the prostate) and very small portion from the testicles (where the sperm is produced). The prostate also secretes many enzymes, one of which is called prostate specific antigen, or PSA. Also secreted in high concentrations is zinc.

What are the causes of benign prostatic hyperplasia?

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Benign prostatic hyperplasia is probably a normal part of the aging process in men. It is caused by changes in hormone balance and cell growth. It is difficult to determine the exact incidence and prevalence of BPH because research groups often use different criteria to define the condition. According to the National Institutes of Health, benign prostatic hyperplasia affects more than 50% of men over the age of 60 and as many as 90% of men over the age of 70.

How does benign prostatic hyperplasia occur?

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The prostate enlarges by the increased number of cells of the prostatic smooth muscle and epithelial cells that surround the urethra. The growth of these cells forms discreet nodules that surround the urethra. As these nodules continue to enlarge, the urethra becomes compressed and squeezed resulting in inhibited urine flow. Why some men develop BPH and others don’t is not clear. Prostate growth begins at approximately age 30 and continues thereafter. By age 50, 50% of men have microscopic evidence of BPH and 75% show signs by age 80. About 50% of these patients develop the clinical symptoms of BPH.

What are the symptoms of benign prostatic hyperplasia?

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As BPH progresses men begin to experience a hesitant, slow urine stream, straining to void, frequent urination, sensation of incomplete bladder emptying, overactive bladder symptoms (urgency, frequency, urgency incontinence) and nocturia (getting up to urinate). If the disease goes untreated, the patient can develop complications such recurrent gross blood in the urine, recurrent urinary infections, bladder stones, kidney failure and urinary retention (the inability to pass urine).

Although some of the signs of BPH and prostate cancer are the same, having BPH does not seem to increase the chances of developing prostate cancer. The National Cancer Institute and the American Cancer Society recommend that all men over the age 50 have their serum PSA tested once a year to screen for prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time, or may develop prostate cancer in the future. As a general rule, patients with an elevated PSA, prostate cancer should be ruled out before initiating treatment for BPH.

To learn more about BPH, click here.

How is benign prostatic hyperplasia diagnosed?

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To diagnose BPH your Doctor will begin by asking questions about your symptoms and health history, and by performing a physical exam. Questions he may ask include how often you have symptoms of BPH, how severe they are, and how much they affect your life. A helpful tool to help your physician gage the severity of your symptoms is a simple questionnaire, the AUA (American Urologic Association) symptom score. It is based on a score of 0 to 35. 0 to 7 is mild, 8 to 19 is moderate, and greater than 20 indicates severe symptoms. If your symptoms are considered mild to moderate and do not bother you much, home treatment may be all that you need to help keep them under control. Your doctor may want to see you regularly to check on your symptoms and make sure other urologic problems haven’t developed.

Diagnosing BPH in its early stages can lower the risk of developing complications from BPH. Delay in diagnosis can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical exam, diagnostic procedures for BPH may include the following:

Digital Rectal Exam (DRE)

A procedure in which the physician inserts a gloved finger into the rectum to examine the rectum and the prostate for signs of cancer, such as a hard firm nodule on the prostate gland.

Bladder Scan

A non-invasive test in which a transducer is passed over the lower abdominal to scan the bladder using sound waves to see how well you are emptying your bladder. This is called a post-void residual. High residuals greater then 150 cc’s are significant and could indicate BPH.

Bladder Ultrasound

A non-invasive test using sound waves to give an image of the bladder. It looks for bladder stones, and measures bladder volume, bladder wall thickness, and size of the prostate, all of which can suggest BPH. Some bladder tumors can also be seen on this test as well.

Kidney Ultrasound

This test is used to determine the size and shape of the kidney’s, assess for any evidence of tumors, stones, cysts, and/or swelling in the kidneys (commonly referred to as hydronephrosis).

Cystoscopy (also called cystourethroscopy)

An examination in which a flexible tube with a viewing device is inserted into the urethra to examine the bladder and urinary tract for abnormalities (such as bladder stones, bladder tumors) or obstruction do to an enlarged prostate.

Urine Flow Study

A test in which the patient urinates into a special device that measure how quickly the urine is flowing. A reduced flow rate may suggest BPH.

Prostate-Specific Antigen (PSA)

This is a blood test that may help rule out prostate cancer. Prostate cancer and BPH are not related, but they can cause some of the same symptoms.

How is benign prostatic hyperplasia treated?

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Treatment will be determined by you and your physician, based on:

  • Your age, overall health, and medical history.
  • Potential side effects of specific medication, procedures, and therapies.
  • Expectations for the course of the disease.
  • Your opinion or preference.

When the gland is just mildly enlarged, treatment may not be needed, as research has shown that symptoms can sometimes on their own clear up. Eventually, BPH symptoms usually require some kind of treatment. This determination can only be made by your physician after careful evaluation of your individual condition. Regular checkups are important to watch for developing problems.


Treatment for BPH may include…


There are three standard classes of medications available to treat BPH.

Proscar (finasteride), Avodart (Dutasteride)

These medications are designed to shrink or stop the growth of the prostate without using surgery. These medications take about 3 to 6 months to begin to see signs of improvement in your urinary symptoms.

Flomax (Tamsulosin), Uroxatral (Alfuzosin) and Rapaflo (Silodosin)

They are called alpha blockers. These medications work by reducing the muscular tension in the prostate. Usually you can see positive results within a few days.

Cialis (Tadalafil)

Cialis, a drug that is also used to treat erectile dysfunction, has been FDA-approved for the treatment of enlarged prostate, or BPH. When taken daily, as prescribed by your physician, Cialis may help improve the symptoms of BPH, such as frequent urination, hesitant or slow urine stream, straining to void, and nocturia (the need to get up during the night to urinate). FDA approval was based on clinical research trials, the outcome of which showed that a daily dose of 5 milligrams of Cialis significantly reduced the symptoms of BPH.

Cialis may be used simultaneously to treat both ED and the symptoms of BPH. Because BPH can have a large impact on a patient’s quality of life, this new finding provides men with another option for treatment. Those men, who also have ED, will have a dual benefit.

It is very important to inform your physician if you are taking nitrate-based drugs, such as nitroglycerin, because taking Cialis in conjunction with these drugs can lead to dangerous drops in blood pressure. Another risk factor is taking Cialis in conjunction with alpha-blockers. These medications have not been tested together and could have adverse effects

UroLift® System Treatment

The UroLift® System is a proven option for patients looking for an alternative to drugs or major surgery. The straightforward UroLift System treatment is often performed in the doctor’s office using tiny implants to hold open the obstructed pathway that’s blocking urine flow, addressing the blockage, not just continuously treating enlarged prostate (BPH) symptoms.

It is the only BPH treatment that does not require ongoing medication, heating, cutting or removal of the prostate tissue. The UroLift System offers a proven treatment with minimal risk of side effects while preserving sexual function5. The goal of the UroLift System treatment is to relieve symptoms so you can get back to your life and resume your daily activities.


Minimally Invasive Surgery

Surgery used to remove the enlarged tissue that is pressing against the urethra, while leaving the rest of the inside tissue and the capsule left intact.