An enlargement of the prostate gland that is not cancerous (malignant) is called benign prostatic hyperplasia (BPH). Recently, the term LUTS, an acronym for "lower urinary tract symptoms," has been introduced as an alternative term for BPH, since many patients with typical symptoms of BPH have small prostates Figure 01. The prostate gland, found in men only, surrounds the tube through which urine leaves the bladder (the urethra). BPH is usually progressive because the prostate tends to enlarge as a man ages. Such enlargement may lead to obstruction of the urethra and interfere with urine flow. In patients with small prostates, increased tone of the smooth muscle in the bladder neck, rather than enlargement of the prostate, causes symptoms. Symptoms, whether from a large or a small prostate, are divided into three stages: mild, moderate, or severe.
BPH is not life-threatening, but it is important that it be diagnosed early. Severe BPH causes significant amounts of urine to be retained in the bladder after voiding. Severe BPH may also reflect a major obstruction that could lead to repeated urinary tract infections along with bladder and/or kidney damage. Early detection along with treatment greatly reduces the risk for these complications.
BPH is common in men after age 50; in fact, it affects two-thirds of men over 55 years of age. A specialist is not usually required to treat BPH. A general physician can treat an uncomplicated case. Many patients with BPH live with their symptoms and do not seek medical help, although this is not recommended.
Figure 01. The prostate gland
Increasing age and the presence of normal male hormones (testosterone and dihydrotestosterone [DHT]) are the best-known factors that contribute to BPH. A hormone known as 5α-reductase converts testosterone into DHT in the prostate gland, which results in prostate enlargement. DHT concentrations in BPH tissue have been shown to be increased when compared with normal prostate tissue. Of great interest is the fact that BPH does not occur in males who are castrated before age 40, indicating the great importance of the male hormone in this disorder.
BPH occurs with nearly equal frequency in all races and cultures with the exception of Asians, in whom it occurs much less often. The cause for this is suspected to be environmental, since Asians who migrated to the U.S. developed an equal frequency of BPH. The average age for detection is somewhat earlier in African-Americans (60 years) than in whites (65 years).
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