BENIGN PROSTATE HYPERPLASIA (BPH)
The prostate is a walnut-sized gland located just below the urinary bladder. Its primary function is to secrete seminal fluid, or semen, which nourishes and protect sperms. Because of its location, however, the prostate is also intimately involved in urination. In fact, prostatic diseases such as benign prostatic hypertrophy (hyperplasia), more commonly known as BPH, often manifest as difficulties with urination. Those with an enlarged prostate might find that they have to strain more than they did in the past 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, one must understand the process of urination. When men attempt to urinate, they contract the urinary bladder and relax the urinary sphincter. 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, sometimes referred to as the prostatic urethra. Thus, the prostate is a conduit through which the urine must flow to leave the body. By virtue of its location just below the bladder, the prostate, to a certain extent, is involved in the retention of urine in the bladder or what one can think of as the male continence mechanism or male urinary sphincter.
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. This results in the obstruction 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 necessarily correlate with urinary symptoms or obstruction.
BPH is the nonmalignant enlargement of the prostate gland. Prostatic growth and enlargement is a natural process that occurs in all normal middle age men. It occurs in varying degrees from person to person. However, in some men growth can be excessive and can obstruct the urethra and thus the flow of urine.
BPH primarily affects men over the age of 50, of all races and ethnic backgrounds. 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 require some form of medical or surgical treatment.
Daniel Khouri, M.D.
1200 West Wall Street