Benign Prostatic Hyperplasia

February 1, 2017

Benign Prostatic hyperplasia or BPH, is a condition in men, in which the prostate gland is enlarged. BPH also known as benign prostatic hypertrophy is a histological diagnosis characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi.

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 man’s 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 retention––the inability to empty the bladder completely, that cause many of the problems associated with benign prostatic hyperplasia.

What is Prostate Gland?

The prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a man’s fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.

If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes). This can affect how you pass urine and may cause:

  • Difficulty starting urination
  • A frequent need to urinate
  • Difficulty fully emptying the bladder

BPH is the most common prostate disease. BPH usually starts after the age of 40 years and is more common in older men; it affects nearly all men at some time in their many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Some men do not have any symptoms even though their prostate has grown larger. BPH usually becomes more of a problem over time, with symptoms getting worse if they are not treated.


The prostate gland consists of glandular and stromal elements. The stroma contains smooth muscle and connective tissue. BPH involves an increase of all elements of the gland, but with a relatively greater increase of prostatic stroma.

The prostate requires male hormones (testosterone and dihydrotestosterone) to grow. These hormones do not cause BPH, but are necessary for it to develop.

Aging and male hormones are the only proven risk factors for developing BPH. Any man with normal prostate and functioning testes will develop BPH if he lives long enough.

Testosterone is converted to dihydrotestosterone in the prostate gland. The prostate gland is much more sensitive to dihydrotestosterone than testosterone. An enzyme called 5-alpha reductase mediates this conversion of testosterone to its active form. 5-Alpha reductase is specific to the prostate gland (it is not found anywhere else in the body) and can be manipulated medically (see treatment section).

Dihydrotestosterone causes the formation of growth factors within the prostate gland, which in turn lead to an imbalance between cell growth and programmed cell death (apotosis).

The net effect of all this is a slow progressive enlargement of the prostate gland over time. While the majority of older men have clinically enlarged prostate glands, this per se does not necessarily lead to symptoms or complications.

A common household chemical called citral may cause BPH. Citral is now synthesized commercially and has found widespread use in products as diverse as shaving cream, dishwasher detergent and air freshener.

Men with the following factors are more likely to develop benign prostatic hyperplasia:

  • Age 40 years and older
  • Family history of benign prostatic hyperplasia
  • Medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes
  • Lack of physical exercise
  • Erectile Dysfunction



BPH may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptom –

  • Urinary frequency
  • Urinary urgency
  • Hesitancy – Difficulty initiating the urinary stream; interrupted, weak stream.
  • Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination.
  • Straining – The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder.
  • Decreased force of stream – The subjective loss of force of the urinary stream over time.
  • Dribbling The loss of small amounts of urine due to a poor urinary stream.

Men with BPH are often unable to completely empty their bladders, allowing urine to stagnate. This increases risks of urinary tract infections and bladder stones. If the obstruction is persistent, pressure can build in the urinary tract and damage the kidneys.

Some over-the-counter drugs, including antihistamines and cold remedies, can affect urine flow and bladder function, and cause a temporary blockage in men with BPH.

Less common signs and symptoms include –

  • Urinary tract infection
  • Inability to urinate
  • Blood in the urine



Medications – A health care provider or urologist may prescribe medications that stop the growth of or shrink the prostate or reduce symptoms associated with benign prostatic hyperplasia –

  • Alpha blockers – These medications relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage:
    • Terazosin (Hytrin)
    • Doxazosin (Cardura)
    • Tamsulosin (Flomax)
    • Alfuzosin (Uroxatral)
    • Silodosin (Rapaflo)

Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).

  • Phosphodiesterase-5 inhibitors – Urologists prescribe these medications mainly for erectile dysfunction. Tadalafil (Cialis) belongs to this class of medications and can reduce lower urinary tract symptoms by relaxing smooth muscles in the lower urinary tract. Researchers are working to determine the role of erectile dysfunction drugs in the long-term treatment of benign prostatic hyperplasia.
  • 5-alpha reductase inhibitors – These medications block the production of DHT, which accumulates in the prostate and may cause prostate growth –
    • Finasteride (Proscar)
    • Dutasteride (Avodart)

Side effects include retrograde ejaculation.

  • Combination medications – Several studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two classes of medications, instead of using just one, can more effectively improve symptoms, urinary flow, and quality of life. The combinations include –
    • Finasteride and Doxazosin
    • Dutasteride and tamsulosin (Jalyn), a combination of both medications that is available in a single tablet
    • Alpha blockers and Antimuscarinics

Minimal Invasive Procedures – Researchers have developed a number of minimally invasive procedures that relieve benign prostatic hyperplasia symptoms when medications prove ineffective. These procedures include –

  • Transurethral needle ablation – This procedure uses heat generated by radiofrequency energy to destroy prostate tissue.
  • Transurethral microwave thermotherapy – This procedure uses microwaves to destroy prostate tissue.
  • High-intensity focused ultrasound – For this procedure, a urologist inserts a special ultrasound probe into the rectum, near the prostate. Ultrasound waves from the probe heat and destroy enlarged prostate tissue.
  • Transurethral electrovaporization – For this procedure, a urologist inserts a tubelike instrument called a resectoscope through the urethra to reach the prostate.An electrode attached to the resectoscope moves across the surface of the prostate and transmits an electric current that vaporizes prostate tissue. The vaporizing effect penetrates below the surface area being treated and seals blood vessels, which reduces the risk of bleeding.
  • Water-induced thermotherapy – This procedure uses heated water to destroy prostate tissue.
  • Prostatic stent insertion – This procedure involves a urologist inserting a small device called a prostatic stent through the urethra to the area narrowed by the enlarged prostate.


Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:


  • Semen flowing backward into the bladder instead of out through the penis during ejaculation
  • Temporary difficulty with urination
  • Urinary tract infection
  • Bleeding
  • Erectile dysfunction
  • Very rarely, loss of bladder control (incontinence)


Surgery to remove enlarged prostate tissue includes

  • transurethral resection of the prostate (TURP)
  • laser surgery
  • open prostatectomy
  • transurethral incision of the prostate (TUIP)



Alternative Treatment

  • Detoxification – The underlying cause of most disease and health conditions is chemical and heavy metal toxicity. Prostate problems can result from cadmium toxicity, which induces zinc deficiency and enlarged prostate. Cadmium is a substance that is becoming more and more of a problem in our environment due to industrial dumping. BPH will no doubt be helped by detoxing heavy metals and industrial chemicals, built up in your system over your lifetime that are irritating or contributing to this condition. In the process, you will greatly increase your overall health and prevent future diseases from developing, namely cancer.
  • Supplements
    • Prostacine – This supplement contains saw palmetto, bovine prostate nucleoprotein as well as synergistic nutrients to enhance its effectiveness. Glandular products like Prostacine contain polypeptides which have been shown to enhance prostate organ and gland activity.
    • Saw palmetto (Serenoarepens) – Studies show that saw palmetto can shrink the size of the prostate, promoting healthy prostate function.
    • Zinc – Zinc is the number one mineral for prostate health. If you have prostate issues, you must supplement with zinc. Most male reproductive and prostate problems have zinc deficiency as part or all of the cause. The prostate gland accumulates zinc more than any other tissue of the body. These conditions include prostatitis, enlarged prostate, prostate cancer, erectile dysfunction and low testosterone. Zinc reduces the size of the prostate gland and diminishes symptoms in most patients. It has also been shown to be a 5-alpha-reductase inhibitor, which stops the prostate from growing if inhibited.
    • Willow herb (Epilobiumparviflorum) – This herb has been shown to have an inflammation-inhibiting and healing effect on acute and chronic inflammation of the prostate and BPH.
    • Pygeum (Pyguemafricanum) – It has long been known that a standardized extract of the bark of Pygeumafricanum, a large evergreen tree native to southern Africa, is effective in reducing the symptoms and clinical signs of enlarged prostate. This extract contains a variety of fat-soluble sterols and fatty acids that are believed to reduce prostatic inflammation and draw out deleterious substances that bind to the walls of the prostate.
    • Stinging nettle root (Urticadioica) – Stinging nettle is a common herb, not to be confused with the completely different stinging nettle that is native to the southeastern United States. Extracts of U. dioica have long been used in the treatment of urinary-tract disorders, as well as gout and rheumatism. This herbal remedy has also been found to be effective against the symptoms of enlarged prostate, especially when used in combination with pygeum extract.
    • Green tea extract – Epidemiological studies show that in Asian countries, the incidence of prostate cancer is low compared to the West, and they indicate that green tea is a possible explanation for the difference.
    • Selenium – Selenium is a mineral that is essential for the proper functioning of many bodily systems, including the prostate gland.
    • Lycopene – This is the now-famous “tomato chemical” that has received so much attention for its anticancer properties — especially against prostate cancer. It is a powerful antioxidant. Increased consumption of tomato products and other lycopene-containing foods might reduce the occurrence or progression of prostate cancer.




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