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Benign Prostatic Hyperplasia Without Lower Urinary Tract Symptoms

Benign Prostatic Hyperplasia Symptoms

Medical Treatment fro Benign Prostatic Hyperplasia (BPH)/Lower Urinary Tract Symptoms (LUTS)

Bladder outflow obstruction due to BPH can cause the muscular bladder walls to thicken. This increases pressure within the bladder, which causes pouches to form. This puts reverse pressure on the kidneys, leading to kidney problems over time. The bladder becomes unable to empty efficiently, triggering infections and bladder stones. Symptoms include:

  • Urination taking a long time
  • Feeling of incomplete bladder emptying
  • Needing to pass urine urgently
  • Passing only a little urine despite urgent need
  • Needing to pass urine frequently
  • Getting up in the night to pass urine
  • An increasing inability to pass urine

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When Is Bph Treatment Necessary

The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.

If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.

  • Inadequate bladder emptying resulting in damage to the kidneys
  • Complete inability to urinate after acute urinary retention
  • Incontinence due to overfilling or increased sensitivity of the bladder
  • Bladder stones
  • Recurrent severe hematuria
  • Symptoms that trouble the patient enough to diminish his quality of life

D Assessment Of Methodological Risk Of Bias Of Individual Studies

Risk of bias of eligible studies will be assessed using instruments specific to RCTs. We will develop an instrument based upon AHRQ guidance.20 Relevant items will include participant selection, method of randomization, attrition, blinding, allocation concealment, and appropriateness of analytic methods.

One investigator will independently assess risk of bias for eligible studies a second investigator will review the risk of bias assessment. Investigators will consult to reconcile any discrepancies in overall risk of bias assessments. Overall summary risk of bias assessments for each study will be classified as low, moderate, or high based upon the collective risk of bias inherent in each domain and confidence that the study results are believable given the study’s limitations.

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Personal And Family Medical History

Taking a personal and family medical history is one of the first things a health care provider may do to help diagnose benign prostatic hyperplasia. A health care provider may ask a man

  • what symptoms are present
  • when the symptoms began and how often they occur
  • whether he has a history of recurrent UTIs
  • what medications he takes, both prescription and over the counter
  • how much liquid he typically drinks each day
  • whether he consumes caffeine and alcohol
  • about his general medical history, including any significant illnesses or surgeries

What Causes An Enlarged Prostate


We still dont really know all the things that cause the prostate to grow. But we do know about two risk factors that can increase your risk of having an enlarged prostate.


Your risk of having an enlarged prostate increases as you get older. Many men aged 50 or over have an enlarged prostate, but they dont all get symptoms. And some men have symptoms that don’t bother them.

Hormone levels

The balance of hormones in your body changes as you get older. This may cause your prostate to grow.

Other factors

Some studies show that obese men and men who have diabetes may be more likely to develop an enlarged prostate. Regular exercise may help to reduce your risk of urinary symptoms. But we still need more studies into the causes of enlarged prostate to know for certain if, and how, we can prevent it.

There is also some research that suggests you may be more at risk of developing an enlarged prostate if your father or brother has one. Again, further studies are needed to confirm this.

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Does Having Benign Prostatic Hyperplasia Increase The Risk Of Prostate Cancer

Research shows that having BPH doesnt increase your risk of developing prostate cancer. However, BPH and prostate cancer have similar symptoms. If you have BPH, you may have undetected prostate cancer at the same time.

To help detect prostate cancer in its early stages, every person with a prostate should get a prostate screening every year between the ages of 55 and 69. You have an increased risk of getting prostate cancer if youre Black or have a family history of prostate cancer. If you have an increased risk of prostate cancer, you should start getting prostate screenings at age 40.

How Can I Reduce My Risk Of Developing Benign Prostatic Hyperplasia

The best ways to reduce your risk of developing BPH are to make lifestyle changes that improve your prostate and heart health and take supplements.

Exercising at least 30 minutes each day may help prevent BPH or slow prostate growth. Maintaining normal cholesterol, blood pressure and blood sugar levels is also important.

The following herbal supplements may also help reduce your risk of developing BPH:

  • Beta-sitosterol. Beta-sitosterol is a micronutrient in plants that may help keep your heart healthy.
  • Pygeum africanum. Pygeum africanum is an herbal extract from African cherry tree bark that may help shrink your prostate.
  • Flaxseed. Flax is a good source of dietary fiber and omega-3 fatty acids that may help lower your cholesterol.
  • Pumpkin seed oil. Pumpkin seed oil comes from pumpkin seeds. It may help shrink your prostate.

Talk to your healthcare provider before taking any new supplements. They may adversely react to other supplements or medications youre currently taking.

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What Is The Difference Between Benign Prostatic Hyperplasia And Benign Prostatic Enlargement

BPH is the name of a condition that causes your prostate to increase in size.

Benign prostatic enlargement is a term that healthcare providers use to describe the increased size of your prostate gland due to BPH.

A note from Cleveland Clinic

Benign prostatic hyperplasia is a very common condition that affects men and people assigned male at birth. BPH usually develops around the age of 55. If you have mild BPH, you and your healthcare provider may choose to monitor your symptoms through regular appointments. If BPH affects your quality of life, treatments can help shrink your prostate.

Talk to your healthcare provider if you have symptoms of BPH. Together, you can discuss the best course of action.

Surgical Treatment Of Bph

Benign Prostatic Hyperplasia

Surgery is normally recommended for patients with complications from BPH, who do not respond to medical therapy or who choose to have surgery as part of a definitive treatment.

A number of new developments are being researched, but at the time of writing there are three main options:

  • Transurethral resection of the prostate
  • Requires general or epidural anaesthetic.
  • Surgeons insert a resectoscope into the urethra to see the prostate.
  • The prostate is scraped away using an electrified wire loop. Afterwards a catheter is inserted and is left in place for up to 48-hours.
  • TURP reduces the symptoms of BPH in 70-90% of patients, and peak urine flow rates of 15-20ml/second can be achieved reliably.
  • However, in many men the prostate grows back and may necessitate a further TURP to reduce symptoms.
  • Men cannot have children after this procedure.
  • Possible complications include retrograde ejaculation , which affects most men after the procedure, erectile dysfunction, which affects 2-4% of patients, and occasionally incontinence or bleeding.
  • Transurethral incision of the bladder neck
  • Works best for patients without much prostate enlargement who still experience urine flow obstruction.
  • Requires general or epidural anaesthetic.
  • Surgeons view the bladder through a cystoscope inserted into the urethra.
  • Surgeons make incisions from inside the bladder to a point just above where the prostatic ducts enter the urethra, relieving the obstruction and allowing the bladder neck to open.
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    What Questions Should I Ask My Healthcare Provider

    • How can you tell that I have BPH?
    • If I dont have BPH, what other condition might I have?
    • What can I do to help reduce the size of my prostate?
    • Do I need treatment?
    • Whats the best treatment for me?
    • What supplements do you recommend?
    • Will these supplements affect any other medications or supplements that Im taking?
    • Should I see a urologist?

    What Are The Symptoms Of Benign Prostatic Hyperplasia

    Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include

    • urinary frequencyurination eight or more times a day
    • urinary urgencythe inability to delay urination
    • trouble starting a urine stream
    • a weak or an interrupted urine stream
    • dribbling at the end of urination
    • nocturiafrequent urination during periods of sleep
    • urinary incontinencethe accidental loss of urine
    • pain after ejaculation or during urination
    • urine that has an unusual color or smell

    Symptoms of benign prostatic hyperplasia most often come from

    • a blocked urethra
    • a bladder that is overworked from trying to pass urine through the blockage

    The size of the prostate does not always determine the severity of the blockage or symptoms. Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.3

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    Figure 1 Analytical Framework For Newer Medications For Luts/bph

    Figure 1: This figure depicts the key questions within the context of the PICOTS described in the previous section. In general, the figure illustrates how newer medications work in men with LUTS/BPH to improve LUTS, prostate-related quality of life, and prevent or delay BPH progression. Also, adverse events may occur at any point after the treatment is initiated.

    History And Physical Examination

    (PDF) Effect of Photoselective Vaporization Prostatectomy on Lower ...

    In men with bothersome lower urinary tract symptoms, a history should be performed to establish the severity of symptoms, evaluate for causes other than BPH , and identify contraindications to potential therapies. The American Urological Association Symptom Index is a validated seven-question instrument that can be used to objectively assess the severity of BPH.6

    Clinical finding
    Prostate cancer Mechanical obstruction

    Symptomatic men should have a digital rectal examination to assess the size and contour of the prostate.6 Prostate volume predicts the response to finasteride therapy. Finasteride is more effective if the prostate volume is greater than 40 mL8 . A palpable nodule suggests prostate cancer and requires biopsy. Abnormal sphincter tone suggests a neurologic abnormality, which may contribute to urinary symptoms.6 Cognitive or ambulatory impairment may exacerbate incontinence problems.

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    How Common Is Benign Prostatic Hyperplasia

    Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.2

    C Data Abstraction And Data Management

    Data fields to be extracted will include author, year of publication, sponsorship, setting, subject inclusion and exclusion criteria, intervention and control characteristics, sample size, follow-up duration, participant baseline age, race, and AUA/IPSS scores, and results of primary outcomes and adverse effects. Relevant data will be extracted into web-based extraction forms created in Microsoft Excel. Data will be analyzed in RevMan 5.3 software.19 Data will be extracted to evidence and outcomes tables by one investigator and reviewed and verified for accuracy by a second investigator.

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    What Is Benign Prostatic Hyperplasia

    Benign prostatic hyperplasiaalso called BPHis a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

    The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a mans life. Benign prostatic hyperplasia often occurs with the second growth phase.

    As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retentionthe inability to empty the bladder completelycause many of the problems associated with benign prostatic hyperplasia.

    Why It Is Important To Do This Review

    Living with an Enlarged Prostate, or Benign Prostatic Hyperplasia (BPH)

    The Cochrane Urology Group has developed four reviews of studies comparing each individual MIT to TURP and other therapies Kang 2020) however, these reviews found few headtohead comparisons. Hoffman 2012, the largest review, included several trials comparing TUMT to TURP and sham procedures included two trials one comparing PUL to TURP and another one to sham and Kang 2020 included a single trial comparing CRFWVT to a sham procedure. A recent systematic review and network metaanalysis evaluated surgical therapies for BPH, but it covered only invasive therapies such as different forms of TURP and laser ablation . We found no systematic review and network metaanalysis to date that has used the same rigorous methods used in a Cochrane Review, which includes application of the GRADE approach and focus on patientimportant outcomes . A network metaanalysis could improve the precision of estimates for each pairwise comparison, create estimates for comparisons for which no headtohead trial was found, and provide ranking of available interventions . In contemporary practice, with the availability of numerous MITs to treat BPH, the findings of this Cochrane Review are expected to be relevant to policymakers, healthcare providers, and patients.

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    What Causes Benign Prostatic Hyperplasia

    The cause of benign prostatic hyperplasia is not well understood however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

    Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

    Another theory focuses on dihydrotestosterone , a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

    What Other Problems Might An Enlarged Prostate Cause

    A small number of men may find it difficult to empty their bladder properly this is called urine retention. If youve been diagnosed with an enlarged prostate, your doctor will look at your test results to see if youre at risk of urine retention. You may be more likely to get urine retention if:

    • youre aged 70 or over
    • your prostate is very large
    • you have a raised prostate specific antigen level
    • you have severe urinary symptoms and a very slow flow.

    Chronic urine retention

    This is where you cant empty your bladder fully, but can still urinate a little. It usually develops slowly over time. Chronic means long-lasting. The first signs often include a weak flow when you urinate, or leaking urine at night. You may feel that your abdomen is swollen, or that youre not emptying your bladder fully.

    Chronic urine retention is usually painless. But the pressure of the urine can slowly stretch your bladder muscle and make it weaker. This can cause urine to be left behind in the bladder when you urinate. If you dont empty your bladder fully, you might get a urine infection, need to urinate more often, leak urine at night, or get painful bladder stones. You might also see some blood in your urine. Chronic urine retention can damage your bladder and kidneys if it isnt treated.

    There are treatments for chronic urine retention, including:

    • passing a thin, flexible tube called a catheter to drain urine from your bladder
    • surgery to widen the urethra.

    Acute urine retention

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    Benign Prostatic Hyperplasia And Lower Urinary Tract Symptoms A Review Of Current Evidence

    • 1 Servicio de Urología, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: [email protected].
    • 2 Servicio de Urología, Complejo Hospitalario Universitario de Granada, Granada, España.
    • 3 Servicio de Urología, Hospital General Universitario Morales Meseguer, Murcia, España.

    How Might An Enlarged Prostate Affect My Life

    (PDF) The Diagnosis and Treatment of Lower Urinary Tract Symptoms due ...

    Having an enlarged prostate affects men in different ways. Some men can manage mild symptoms and dont need treatment. Other men find they need to stay near a toilet. This can make it difficult to work, drive, be outdoors and attend social events. If you need the toilet a lot during the night, this can affect your sleep and make you feel more tired during the day.

    Some men with an enlarged prostate find their symptoms improve over time without treatment. But for most, the symptoms will stay the same or slowly start to cause more problems over time unless they have treatment.

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