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Benign Prostatic Hyperplasia (BPH)

The prostate is a walnut-sized gland in the male reproductive system. This gland is located beneath the bladder and surrounds the urethra, the tube that carries urine out of the body.

It is common for a man's prostate gland to grow as he ages. This non-cancerous enlargement of the prostate is called Benign Prostatic Hyperplasia, or BPH.

The prostate has 2 periods of growth over a lifespan. The first is during puberty when the prostate nearly doubles in size. Around age 25, the prostate again begins to slowly grow. This prostatic growth can produce symptoms later in life. When the prostate becomes enlarged, it can put pressure on the urethra and cause lower urinary tract symptoms including problems urinating. However, BPH rarely causes symptoms before the age of 40. BPH affects 25% of men in their 40's, 50% of men in their 50's, 70% of men in their 60's, and 80% of men in their 70's

Signs and Symptoms

The symptoms of BPH vary, but most commonly involves obstruction of the normal flow of urine. Some men with BPH don't experience any symptoms at all.

If symptoms do occur, they may include:

  • Sensation of not emptying your bladder completely after you have finished urinating
  • Having to urinate again less than 2 hours after you have finished urinating
  • Having to stop and start again several times during urination
  • Finding it difficult to postpone urination
  • Having a weak urinary stream
  • Having to push or strain to begin urination
  • Having to get up to urinate at night after going to bed
  • Having an urgent need to urinate

Symptoms are significant if they interfere with getting enough sleep, going to places with no toilet, playing outdoor sports, going to church or the movies.

Causes and Risk Factors

The causes of BPH are not well known. However, risk factors include, age, family history, and race (BPH is more common among black men and white men than Asian men).

Diagnosis

You may notice symptoms of BPH yourself or your provider may find it during a routine exam. The tests performed may vary from patient to patient. Most likely, they will include the following:

Your provider may perform a digital rectal exam by inserting a lubricated gloved finger gently into the rectum to feel for any abnormalities on the surface of the prostate.

Your provider may also order a urine test to help rule out infections, such as bladder infection, inflammation of the prostate, or kidney disease.

Other tests that may be performed to diagnosis BPH are:

  • Cystoscopy: A small tube with a light is gently inserted into the urethra after a local anesthetic is administered so your doctor can see the size of your prostate gland and identify any obstructions.
  • Transrectal Ultrasound (TRUS): An ultrasound probe is inserted into the rectum after a lubricant is applied. Sound waves bouncing off your prostate create an image of your prostate gland. This test helps determine the size of the prostate and also helps in diagnosing prostate cancer.
  • Pressure Flow Urodynamic Studies: Tests the pressure inside the bladder during urination.
  • Urine Flow Study: This test measures the speed of urination. A reduced flow may indicate BPH.
  • Postvoid Residual Volume Test: Measures the amount of urine left in the bladder after urination. This test is performed either using a catheter (tube) that is inserted into the urethra into the bladder or using an ultrasound.
  • Prostate-Specific Antigen (PSA) Blood Test: The prostate gland normally produces PSA, a protein that is found in the blood. A high PSA level may indicate BPH, although men with BPH don't always have elevated PSA. This test is also used to detect prostate cancer in men.

When to see a doctor

If you have any of the symptoms mentioned above you should talk to your primary care provider or urologist. Treatments vary from person to person and can be determined by speaking with your doctor. The tests mentioned help the doctor identify the problem and decide whether surgery is needed.

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