The prostate is normally a walnut-sized gland located just below the urinary bladder. Its primary function is the secretion of seminal fluid, or semen, which functions to nourish and protect sperm. Because of its location, however, it is also intimately involved in urination. In fact, prostatic diseases such as benign prostatic hypertrophy, more commonly known as BPH, often manifest as difficulties with urination. For example, those with an enlarged prostate might find they have a decreased flow of urine or that they have to strain more than they did previously to start their urinary stream. In addition, they might find that they have to get up once, twice, or even three times during the night to urinate.

In order to understand diseases of the prostate and how they affect urination the normal process of urination must be understood. When men attempt to urinate, the urinary bladder contracts and the urinary sphincter relaxes. This allows urine to pass from the bladder and out of the body through the urethra, a tube that runs from the bladder through the prostate and the penis. The prostate completely surrounds the first part of the urethra. Thus, it is a conduit through which the urine must flow before leaving the body. Also, by virtue of its location just below the bladder, the prostate is involved to a certain degree in holding urine or what one can think of as the male continence mechanism or male urinary sphincter.

BPH is the nonmalignant enlargement of the prostate gland. Prostatic growth and enlargement is a natural process that occurs in all normal men. It occurs to varying degrees; in some men growth can be excessive and can obstruct the flow of urine.

The prostate is tightly confined within the body by a capsule and cannot expand outward. Therefore, as the prostate enlarges it is forced inward, into the urethra (the urine passage). The result is the blockage of the urethra and the flow of urine. In some cases, obstruction of urine flow may occur without dramatic prostatic enlargement. For other patients, significant enlargement of the prostate can be present without noticeable urinary symptoms. Although urinary problems are more common as men age and the prostate enlarges, prostate size does not always directly correlate with urinary symptoms or obstruction.

BPH primarily affects men over the age of 40, of all races and ethnic backgrounds. In fact, approximately 80% of men over the age of 70 have some degree of BPH. Fortunately, not all men will suffer bothersome symptoms. Currently, it is estimated that 25%-50% of men with an enlarged prostate have some degree of bothersome urinary symptoms and can benefit from some form of medical or surgical treatment.

First & Foremost

Benign enlargement of the prostate, or BPH (benign prostatic hyperplasia), is a common condition in older men. Significant enlargement of the prostate may occur before causing symptoms. The first symptoms of BPH are usually slow urinary flow, frequent urination, and the need to return to the bathroom shortly after voiding.

Occasionally BPH causes urine to be retained in the bladder. When this happens, urine may back up into the kidneys, which can result in kidney failure, inability to empty the bladder (urinary retention), formation of stones within the bladder, or urinary tract infections (that are otherwise rare in men.)

Initial treatment of BPH involves medications, with other, more effective and more invasive options available for treatment if medications are not effective or not tolerated because of side effects. Improvement of symptoms by medications is all that is used for treatment in most cases.