Benign Prostatic Hyperplasia (BPH)/Enlarged Prostate

Factors that contribute to an increased risk for BPH include:

• Obesity
• Physical inactivity
• Erectile dysfunction
• Aging
• Family history of BPH

Men with BPH may experience the following symptoms:

• Incontinence
• Leaking or dribbling of urine
• More frequent urination, especially at night
• Urgency to urinate
• Urine retention (inability to urinate)
• Hesitant, interrupted, weak urine stream
• Difficulty beginning to urinate
• Feeling of incomplete bladder emptying
• Inability to postpone urination once the urge begins
• Pushing or straining to urinate

Diagnosing BPH in its earlier stages can lower the risk of developing complications. Delay can lead to: incontinence, kidney damage, bladder damage, urinary tract infections, bladder stones, and the inability to pass urine at all. Your BWH urologist may complete the following diagnostic tests:

• Medical and physical examination
• Prostate specific antigen (PSA), a blood test to screen for prostate cancer
• Urinary cytology, a urine test to screen for bladder cancer
• Measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
• Uroflowmetry, or urine flow study, the measurement of how fast urine flows. A reduced flow may suggest BPH.
• Cystoscopy, examination of the urethra and/or bladder using a small flexible scope
• Urodynamic pressure-flow study, a test of the pressures inside the bladder during urination
• Ultrasound of the kidney or the prostate to view the enlargement

Visit us if you are experiencing bothersome symptoms with urination. Our urologic surgeons will talk with you about the best course of treatment to reduce urinary frequency and urinary urgency. Treatment may include:

• Watchful waiting/active surveillance, for patients with mild symptoms of BPH. Changes in medication and diet can help.
• Medications for BPH/Enlarged Prostate
  • Alpha blockers relax the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction.
  • 5-alpha-reductase inhibitors partially shrink the enlarged prostate by lowering the major male hormone level inside the prostate.
  • Combination therapy: both alpha blockers and 5-alpha-reductase inhibitors are superior to single drug therapies in men with larger prostates, though with more side effects.
  • Anticholinergics
  • PDE5 inhibitors
• Minimally Invasive Therapies for BPH/Enlarged Prostate
  • Photoselective vaporization of the prostate (“Greenlight”) uses a high-powered laser that vaporizes the obstructing prostate tissue.
  • Catheterization temporarily drains urine. Catheters can be placed intermittently every six to eight hours or left in place for one to three months at a time.
• Surgery for BPH/Enlarged Prostate For some patients, surgery is the only option to successfully treat BPH. Your urologist will describe your recommended surgical treatment which may include:
  • Transurethral resection of the prostate (TURP) removes the prostate’s innermost core. TURP is performed under a spinal or general anesthesia.
  • Transurethral incision of the prostate (TUIP) makes cuts in the prostate instead of removing prostate tissue to reduce prostate pressure on the urethra, making urination easier.
  • Open simple prostatectomy If the prostate is very large, an open prostatectomy may be necessary. An incision is made in the skin of the lower abdomen and the inner core of the prostate is removed.
  • Robotic simple prostatectomy is similar to the open simple prostatectomy but utilizes robotic surgery technology to achieve the same goal through keyhole incisions. This robotic approach has the advantage of reduced recovery time and catheterization.

Watch video case study of a robotic-assisted radical prostatectomy.

You will receive a thorough diagnostic examination and receive clinically-proven treatment by a board-certified urologic surgeon who specializes in BPH. Appointments are confidential and private.

Brigham and Women’s Hospital practices a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your urologist discovers that an underlying illness has contributed to your BPH, you will be referred to an appropriate BWH physician for an evaluation.

Go to our online health library to learn more about urology diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.