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Benign Prostate Hyperplasia

Καλοήθη υπερπλασία προστάτη

Benign Prostatic Hyperplasia (BPH), also known as benign prostatic hypertrophy or enlarged prostate, is a noncancerous increase in the size of the prostate gland. This enlargement of the prostate can lead to urinary symptoms, as the enlarged gland may squeeze the urethra, which passes through the center of the prostate, leading to difficulties with urination.


Causes and Risk Factors

Causes and Risk factors of Benign Prostate Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, commonly affecting older men. This condition can lead to urinary symptoms due to the compression of the urethra, which passes through the prostate. Understanding the causes and risk factors of BPH is crucial for early detection and management. 

Causes of BPH

1. Hormonal Changes
   - Androgens: Testosterone and its more potent derivative, dihydrotestosterone (DHT), play significant roles in prostate growth. DHT, formed from testosterone by the enzyme 5-alpha reductase, is considered a primary factor in prostate enlargement.
   - Estrogen: As men age, the ratio of estrogen to testosterone increases. Some studies suggest that increased estrogen levels might contribute to prostate tissue growth.

2. Age
   - The most significant risk factor for BPH is aging. The prevalence of BPH increases significantly with age, particularly in men over 50. By age 60, about half of men will have some signs of BPH, and by age 85, up to 90% of men may be affected.

3. Genetic Predisposition
   - Family history of BPH can increase the likelihood of developing the condition. Genetic factors may influence the growth rate and size of the prostate.

Risk Factors for BPH

1. Age
   - The risk of BPH increases with advancing age. It is rare in men under 40 but becomes more common as men grow older.

2. Family History
   - Men with a family history of BPH or prostate cancer are at higher risk.

3. Ethnicity
   - Studies suggest that African American men are at higher risk for developing BPH compared to Asian men, who tend to have a lower risk. The reasons for these ethnic differences are not entirely understood but may involve genetic, dietary, and environmental factors.

4. Lifestyle and Diet
   - Obesity and a sedentary lifestyle are associated with an increased risk of BPH. Conversely, regular physical activity and a diet low in fat and high in fruits and vegetables may reduce the risk.
   - High consumption of red meat and high-fat dairy products may be linked to an increased risk of BPH, while regular intake of vegetables and fruits appears protective.

5. Medical Conditions
   - Conditions such as diabetes and heart disease have been linked to an increased risk of BPH. The exact mechanisms are not clear but may involve metabolic and hormonal pathways.

6. Hormonal Imbalances
   - Hormonal imbalances, particularly involving testosterone and estrogen, play a significant role in prostate growth and BPH development.

7. Inflammation
   - Chronic inflammation of the prostate, possibly due to infections or other medical conditions, may contribute to the development of BPH.


BPH is a common condition influenced by a variety of factors, primarily age and hormonal changes. Recognizing the risk factors such as family history, ethnicity, lifestyle, and associated medical conditions can help in the early detection and management of BPH. Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can potentially reduce the risk and severity of BPH symptoms. If you experience symptoms suggestive of BPH, such as difficulty urinating, increased urinary frequency, or nocturia, it is important to seek medical evaluation and appropriate treatment.


Symptoms of Benign Prostate Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH), also known as prostate gland enlargement, is a common condition as men get older. It can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract, or kidney problems. The symptoms of BPH vary, but the most common ones include:

  1. Frequent or urgent need to urinate: This includes a frequent need to urinate during the night (nocturia).

  2. Increased frequency of urination at night (Nocturia): Needing to get up several times during the night to urinate.

  3. Difficulty starting urination: Experiencing hesitancy or straining to begin the urine stream.

  4. Weak urine stream or a stream that stops and starts: The flow of urine may be weaker than usual or may stop and start.

  5. Dribbling at the end of urination: Involuntary leakage of urine immediately after urination.

  6. Inability to completely empty the bladder: A feeling of partial bladder emptying after urination.

  7. Urinary retention: The inability to urinate despite an urge to go.

  8. Urinary tract infections (UTIs): Recurrent UTIs may occur due to incomplete emptying of the bladder.

  9. Blood in the urine (hematuria): This can be a sign of BPH or other more serious conditions like cancer.

  10. Bladder stones: These are small stones that form in the bladder from the urine that's not completely emptied from the bladder.

It's important to note that the size of the prostate does not always determine the severity of the symptoms. Some men with slightly enlarged prostates can have significant symptoms, while others with very enlarged prostates can have only minor urinary symptoms.
If you're experiencing any of these symptoms, it's important to see a healthcare provider. They can provide a diagnosis and help manage symptoms through medication, lifestyle changes, or surgery if necessary.

Benign Prostate Hyperplasia (BPH) Symptoms

Complications of Benign Prostate Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) can lead to several complications if not managed appropriately. Some of these complications include:

  1. Acute Urinary Retention (AUR): This is a sudden inability to urinate, which can be triggered by medications, alcohol, cold temperatures, or a prolonged period of immobility.

  2. Chronic Urinary Retention: This refers to the incomplete emptying of the bladder after urination, which can lead to urinary frequency, urgency, or the sensation of incomplete emptying.

  3. Urinary Tract Infections (UTIs): Stagnation of urine due to incomplete bladder emptying can become a breeding ground for bacteria, leading to infections.

  4. Bladder Stones: These are hard masses of minerals in the bladder that can form when urine is retained. They can cause pain, blood in the urine, and can further obstruct urine flow.

  5. Bladder Damage: Chronic retention can weaken the bladder muscles over time, affecting its ability to contract and fully expel urine.

  6. Kidney Damage: Prolonged bladder obstruction due to BPH can cause back-pressure on the kidneys, leading to kidney infections, kidney stones, or even kidney failure in severe cases.

  7. Hematuria: Presence of blood in the urine, which can result from the increased vascularization of the enlarged prostate or from bladder stones.

  8. Recurrent Urinary Retention: Even after treatment for an episode of urinary retention, some men may experience repeated episodes.

  9. Bladder Diversions: In extreme cases, when other treatments aren't effective, it might be necessary to surgically create an alternate way for urine to exit the body.

It's essential for men with symptoms suggestive of BPH to seek medical evaluation and treatment to avoid these potential complications. Effective treatments, ranging from medications to minimally invasive procedures and surgeries, are available to manage BPH and reduce the risk of complications.

Benign Prostate Hyperplasia (BPH) Complications

Diagnosis of Benign Prostate Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH), commonly referred to as an enlarged prostate, is diagnosed through a combination of clinical evaluation, symptom assessment, and specific diagnostic tests. Here are the steps typically involved in diagnosing BPH:

  1. Medical History: The doctor will start by asking the patient about their medical history, especially about urinary symptoms, any medications they are on, and any previous surgeries.

  2. Symptom Assessment: A commonly used tool is the International Prostate Symptom Score (IPSS) questionnaire. It asks about the frequency and severity of common BPH symptoms.

  3. Digital Rectal Examination (DRE): The doctor will insert a gloved, lubricated finger into the rectum to feel the size, shape, and consistency of the prostate.

  4. Urine Tests: A sample of urine can be analyzed (urinalysis) to rule out infections or other conditions that could be causing the symptoms.

  5. Prostate-Specific Antigen (PSA) Test: This blood test measures the level of PSA, a protein produced by the prostate. Elevated levels may suggest BPH, prostate inflammation, or prostate cancer.

  6. Uroflowmetry: Measures the strength and amount of urine flow.

  7. Postvoid Residual Volume Test: Measures the amount of urine left in the bladder after urinating.

  8. Imaging Tests: These might include ultrasound, especially transrectal ultrasound, to visualize the prostate and measure its size.

  9. Cystoscopy: A procedure where a thin tube with a camera (cystoscope) is inserted into the urethra to examine the bladder and prostate.

  10. Pressure Flow Study: Evaluates the pressure in the bladder during urination.

It's important to note that BPH is a benign condition and is not prostate cancer. However, the symptoms of BPH can be similar to those of prostate cancer, so it's crucial to get an accurate diagnosis. Always consult with a urologist or medical professional to get a proper diagnosis and treatment recommendations.

Benign Prostate Hyperplasia (BPH) Diagnosis



The treatment of Benign Prostatic Hyperplasia (BPH) aims to alleviate symptoms, improve quality of life, and prevent complications. The choice of treatment depends on the severity of symptoms, the size of the prostate, overall health, and patient preferences. Treatment options range from lifestyle changes and medications to minimally invasive procedures and surgery.

Lifestyle Changes

1. Dietary Modifications: 
   - Reducing the intake of caffeine, alcohol, and spicy foods can help minimize bladder irritation and reduce symptoms.
   - Drinking less fluid in the evening can reduce nighttime urination (nocturia).

2. Bladder Training:
   - Scheduled urination and double voiding (urinating, then waiting a few moments and trying again) can help manage symptoms.

3. Regular Physical Activity:
   - Exercise can improve overall health and may help reduce urinary symptoms by improving bladder function and reducing inflammation.


1. Alpha Blockers:
   - Examples: Tamsulosin, Alfuzosin, Doxazosin, Terazosin
   - Function: Relax the muscles of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction.
   - Side Effects: Dizziness, fatigue, retrograde ejaculation.

2. 5-Alpha Reductase Inhibitors:
   - Examples: Finasteride, Dutasteride
   - Function: Reduce the size of the prostate by inhibiting the conversion of testosterone to dihydrotestosterone (DHT).
   - Side Effects: Decreased libido, erectile dysfunction, reduced semen volume.

3. Combination Therapy:
   - Combining alpha blockers and 5-alpha reductase inhibitors can be more effective for some men, especially those with larger prostates.

4. Phosphodiesterase-5 Inhibitors:
   - Example: Tadalafil
   - Function: Originally used for erectile dysfunction, it can also improve BPH symptoms by relaxing the smooth muscles of the bladder and prostate.

Minimally Invasive Procedures

1. Transurethral Microwave Thermotherapy (TUMT):
   - Uses microwave energy to heat and destroy excess prostate tissue.
   - Advantages: Outpatient procedure, quick recovery.
   - Disadvantages: May need to be repeated, temporary urinary symptoms post-procedure.

2. Transurethral Needle Ablation (TUNA):
   - Uses radiofrequency energy to heat and destroy excess prostate tissue.
   - Advantages: Minimally invasive, quick recovery.
   - Disadvantages: Possible need for retreatment, temporary urinary symptoms.

3. Prostatic Urethral Lift (PUL):   - Example: UroLift System   - Involves the placement of implants to hold the prostate lobes apart, reducing urethral obstruction.   - Advantages: Minimally invasive, preservation of sexual function.   - Disadvantages: Potential for temporary urinary symptoms, need for additional treatment.

Θεραπεία Urolift

Surgical Treatments

1. Transurethral Resection of the Prostate (TURiS):
   - The most common surgical procedure for BPH, involving the removal of prostate tissue using a resectoscope inserted through the urethra.
   - Advantages: Effective symptom relief, long-term results.
   - Disadvantages: Risk of bleeding, infection, retrograde ejaculation, and, rarely, incontinence.

TURiS Προστατεκτομή

2. Holmium Laser Enucleation of the Prostate (HoLEP):   - Uses a laser to enucleate and remove excess prostate tissue.   - Advantages: Effective for larger prostates, reduced bleeding, shorter hospital stay.   - Disadvantages: Requires specialized equipment and expertise.

HoLEP Προστατεκτομή

3. Laparoscopic or Robot-Assisted Prostatectomy:   - Involves the surgical removal of the inner portion of the prostate through an abdominal incision.   - Advantages: Effective for very large prostates.   - Disadvantages: More invasive, longer recovery, higher risk of complications.

Λαπαροσκοπική Αδενωματεκτομή Προστάτη
- Ρομποτικά Υποβοηθούμενη Αδενωματεκτομή Προστάτη

Emerging Treatments

1. Water Vapor Therapy:
   - Example: Rezūm System
   - Uses water vapor to destroy excess prostate tissue.
   - Advantages: Minimally invasive, preservation of sexual function.
   - Disadvantages: Temporary urinary symptoms, potential need for retreatment.

Rezum (Θεραπεία με ατμό)

2. Prostate Artery Embolization (PAE):
   - Involves blocking the blood supply to the prostate, causing it to shrink.
   - Advantages: Minimally invasive, can be done under local anesthesia.
   - Disadvantages: Limited availability, variable outcomes.


The treatment of BPH is highly individualized, taking into account the severity of symptoms, patient preferences, and overall health. While lifestyle changes and medications are effective for many men, minimally invasive procedures and surgery offer additional options for those with more severe symptoms or those who do not respond to initial treatments. Regular follow-up with a healthcare provider is essential to monitor the condition and adjust treatment as needed.


Prevention of Benign Prostate Hyperplasia

While Benign Prostatic Hyperplasia (BPH) is a common condition associated with aging, certain lifestyle modifications and preventive measures can potentially reduce the risk or delay the onset of symptoms. Although it may not be entirely preventable, the following strategies can contribute to prostate health and overall well-being.

Lifestyle Modifications

1. Healthy Diet:
   - High in Fruits and Vegetables: Consuming a diet rich in fruits, vegetables, and whole grains provides essential nutrients and antioxidants that support overall health, including prostate health.
   - Low in Saturated Fats: Reducing intake of red meat and high-fat dairy products can be beneficial. Opt for lean proteins, such as fish and plant-based sources.
   - Rich in Omega-3 Fatty Acids: Foods like salmon, flaxseeds, and walnuts are high in omega-3 fatty acids, which have anti-inflammatory properties.

2. Regular Exercise:
   - Maintain a Healthy Weight: Obesity is associated with an increased risk of BPH. Regular physical activity helps in weight management and improves overall health.
   - Exercise Routine: Engage in regular exercise, including both aerobic activities (such as walking, jogging, or swimming) and strength training exercises.

3. Adequate Hydration:
   - Drink plenty of water throughout the day, but reduce fluid intake in the evening to minimize nighttime urination (nocturia).

4. Limit Caffeine and Alcohol:
   - Both caffeine and alcohol can irritate the bladder and worsen urinary symptoms. Limiting their intake can help reduce these symptoms.

Healthy Habits

1. Avoid Smoking:
   - Smoking is linked to several health issues, including increased risk of bladder and prostate problems. Quitting smoking can improve overall health and reduce the risk of BPH.

2. Regular Medical Check-ups:
   - Regular visits to a healthcare provider can help monitor prostate health and detect any early signs of BPH or other prostate-related issues. Early detection can lead to better management and outcomes.

3. Manage Stress:
   - High stress levels can contribute to a variety of health issues, including urinary symptoms. Practices such as yoga, meditation, and mindfulness can help manage stress effectively.

Monitoring and Early Detection

1. Regular Screening:
   - Men over the age of 50, or those with a family history of prostate issues, should consider regular prostate screenings, including PSA (Prostate-Specific Antigen) tests and Digital Rectal Exams (DRE).

2. Awareness of Symptoms:
   - Be aware of the symptoms of BPH, such as frequent urination, difficulty starting urination, weak urine flow, and feeling that the bladder is not completely empty. Early reporting of symptoms to a healthcare provider can lead to prompt evaluation and management.

Natural Supplements

1. Saw Palmetto:
   - Some studies suggest that saw palmetto may help reduce urinary symptoms associated with BPH. However, more research is needed to confirm its effectiveness.

2. Beta-Sitosterol:
   - A plant sterol found in fruits, vegetables, nuts, and seeds, beta-sitosterol may help improve urinary symptoms in men with BPH.

3. Pygeum:
   - Extracted from the bark of the African plum tree, pygeum has been used traditionally to treat urinary problems. Some evidence supports its use for BPH symptoms.


While BPH may not be entirely preventable, adopting a healthy lifestyle, maintaining regular medical check-ups, and being aware of symptoms can significantly reduce the risk or delay the onset of BPH. Healthy dietary choices, regular exercise, and avoiding smoking are key preventive strategies. Regular screening and early detection are crucial for effective management. If you experience any symptoms of BPH, it is important to seek medical advice for appropriate evaluation and treatment.

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