Benign Prostate Hyperplasia

Benign prostatic hyperplasia (BPH), also called 'enlarged prostate,' generally affects men over age 50. In fact, nearly all men over the age of 50 have an enlarged prostate to some degree and by age 85, about 90 percent of all men will report lower urinary tract symptoms, also known as LUTS. Not all cases require treatment.

The prostate is a gland located under the bladder and behind the pubic bone. Its primary role is helping in the production and secretion of semen.  The prostate partially surrounds the urethra and gets larger with age. It causes many of the LUTS that men experience.

BPH occurs when noncancerous cells of the prostate divide to make more cells. While BPH is not associated with the development of cancer, the two often go together. Distinguishing between them is an important part of the diagnosis process.

Risk Factors

Age: It is common knowledge that the prevalence of BPH markedly increases with age.  The incidence of LUTS also increases with age. Studies have demonstrated incidence and progression rates increased with age.

Obesity: It has been observed that men who have increased levels of fatty tissue have larger prostates. In addition, increased weight as measured by how large your waist is.  For each 0.05 increase in waist-to-hip ratio (a measure of abdominal obesity) there was an associated 10% increased risk of BPH.

Diet: There is evidence to suggest that various macro- and micronutrients may affect the risk of BPH and LUTS development. Previously, the consumption of milk and other dairy related products have been associated with an increased risk of BPH. Fruit on the other hand has been shown to have a protective role in the body for the prevention of the development of BPH. In addition, the low occurrence of BPH in Asian populations as well as in vegetarians is due to a low-fat and high-fiber diet.

Metabolic Syndrome: Metabolic syndrome is a combination of several metabolic abnormalities, including central obesity, high cholesterol, high blood pressure, and diabetes.  Many of the factors, which are associated with developing cardiovascular problems, may also lead to BPH and LUTS. These are important as they may allow for novel treatment and prevention programs.


Men with BPH experience a variety of symptoms such as:

  • Needing to urinate frequently, particularly at night - also called nocturia
  • Feeling an urgent need to urinate shortly after urinating
  • Experiencing difficulty starting to urinate or maintaining the flow
  • Decreased force of urinary stream
  • Having a stop-start pattern in urinating (intermittency)
  • Feeling as though there is urine left in the bladder after urinating
  • Blood in the urine (called hematuria)

When symptoms become severe, you may find you cannot hold your urine long enough to find a toilet (urge incontinence) or may stop urinating entirely (urinary retention). Not urinating can sometimes lead to kidney damage.

LUTS secondary to BPH occurs because of the location of the prostate gland (a walnut-sized gland that is part of the male reproductive system) which sits under the urinary bladder. Urine must pass through the prostate on its way out of the body. BPH obstructs this flow, slowing the urine stream, making it harder to empty the bladder, and causing it to empty incompletely. If we do not treat BPH, the bladder is left constantly fighting the obstructed prostate. This can lead to worsening symptoms, urinary tract infections, and kidney problems.


The first and most important tool in the assessment of BPH is your medical history. This helps us analyze potential causes of your LUTS and relevant co-morbidities. A detailed medication history is also necessary as are your lifestyle habits, such as fluid intake.

We use several diagnostic tools.