Benign prostate enlargement
ICD codes: N40 What is the ICD Code?
A frequent need to urinate, nighttime trips to the toilet, and the feeling that the bladder is never completely empty: these are typical symptoms of a benign enlarged prostate. The symptoms usually begin after the age of 50 and men who are affected may find it a great nuisance.
At a glance
- The typical symptoms of a benign enlarged prostate are a frequent need to urinate, a weak urine stream, taking longer to pass urine, and a feeling that the bladder is never empty.
- Older men are at the highest risk by a benign enlarged prostate.
- This is usually harmless but can significantly undermine quality of life.
- Various measures are available to treat a benign enlarged prostate.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is a benign enlarged prostate?
If men frequently have the urge to urinate, need to go to the toilet a lot during the night, and have the feeling that their bladder is never really empty, a benign enlarged prostate may be the reason.
A benign enlarged prostate usually occurs after the age of 50. The symptoms often increase with age.
Many men cope very well with the symptoms. Others find them more troublesome. Because they have to go to the toilet so often during the night, they don’t sleep enough and are very tired during the day. The frequent visits to the toilet can also disrupt everyday life if meetings or other activities keep needing to be interrupted.
Benign prostatic hyperplasia (BPH) is the medical term for a benign enlarged prostate. The term “benign prostate enlargement” is also often used. The word “benign” indicates that it is not prostate cancer. Hyperplasia describes the enlargement of the prostate.
What is an enlarged prostate?
This video explains more about the symptoms and treatment options for a benign prostate enlargement.
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What are the symptoms of a benign prostate enlargement?
When the prostate is significantly enlarged, it presses on the bladder and urethra. Typical symptoms include:
- The urge to urinate is more frequent and stronger than before, especially at night.
- It takes a while for the urine to start flowing.
- The urine stream is weaker.
- It takes longer to urinate.
- After going to the toilet, more urine leaks out.
- The bladder doesn’t feel completely empty.
The size of the prostate and the severity of the symptoms aren’t always directly related. Some men with a very enlarged prostate have few symptoms. In other men, a slightly enlarged prostate causes great problems.
What are the causes of a benign enlarged prostate?
The man’s prostate (prostatic gland) is located beneath the urinary bladder and encloses part of the urethra. It consists of many small glands and produces some of the sperm.
An enlarged prostate can press on the bladder, the urethra, and the bladder muscles. This can create a need to urinate even though the bladder is not yet full. The ongoing pressure can also weaken the bladder muscles and lead to the bladder never being completely emptied. The pressure of the prostate on the urethra may also prevent urine from flowing out normally.
It is normal for the prostate to get bigger with age. However, in some men it gets too big. Why this happens is unknown.
For more detailed information, for example on how a prostate works, go to gesundheitsinformation.de.
How common is a benign enlarged prostate?
A benign enlarged prostate rarely occurs in men below the age of 40. Around 20 in 100 men are affected between the ages of 50 to 59. An enlarged prostate occurs more and more frequently with increasing age. Up to 70 in 100 men over the age of 70 get symptoms.
How does a benign enlarged prostate develop?
Most men have mild to moderate symptoms. They can usually adjust well to this in everyday life. Symptoms can also temporarily improve.
The condition usually only progresses slowly. It can take a long time before it becomes clear whether the symptoms will remain at a level that the patient can live with or whether his quality of life is going to be too badly affected.
Some men with an enlarged prostate can have frequently recurring urinary tract infections. They may also have difficulties urinating, or find that they can’t urinate at all. This type of urinary retention is an emergency and needs to be treated quickly. A catheter is then used to relieve the bladder.
An operation is usually carried out a few days later to reduce the size of the prostate. This measure allows the urine to flow normally once more.
Important: Urinary retention is relatively rare, occurring in one to three percent of men with a benign enlarged prostate every five years.
How is a benign enlarged prostate diagnosed?
A benign enlarged prostate is the most common reason for difficulty with urinating but there may be other causes. To rule them out, the doctor will also ask the patient how often he has to urinate.
Many people then realize that this is not very easy to answer. It can therefore be useful to keep track of this for one or two days before visiting the doctor. When talking to the doctor, the patient also needs disclose any medication he is taking as urinary tract problems can be a side effect of some medication.
The first step of the physical examination involves the doctor feeling the prostate by inserting a finger into the rectum while wearing a disposable glove (rectal examination). This allows the doctor to assess the size and structure of the prostate.
Indications of a prostate or urinary tract infection can be identified from a urine sample. They can cause symptoms that are similar to those that come with an enlarged prostate. A urine test can also indicate some other illnesses.
Important: The blood test often measures the PSA level (PSA = prostate-specific antigen). PSA is a protein that is only formed in the prostate. When the PSA level is high, prostate cancer is suspected. However, there can be many other reasons for this level, such as a benign enlarged prostate. For this reason, the PSA test is not very reliable and its use is controversial. It is therefore a good idea to carefully consider the pros and cons of this test.
Another procedure is a urinary flow rate measurement. This measures how much urine per second is excreted. When the patient’s bladder is as full as possible, he urinates into a special device that measures the flow speed of the urine.
An ultrasound examination can clarify how enlarged the prostate is. It can also identify how much urine is left over in the bladder after emptying it (residual urine measurement).
How is a benign enlarged prostate treated?
The best form of treatment depends on the enlarged prostate symptoms. One factor is whether there are any complications such as frequent urinary tract infections, and how affected men and their doctors assess the pros and cons of the treatment.
The possible therapies include:
- Actively monitoring symptoms: in around 30 out of 100 men with mild symptoms and no complications, it is enough to adapt their everyday life and have a checkup about once a year.
- Herbal remedies: most of these products have not been well researched, but there are various herbal remedies that are said to alleviate BPE symptoms. They can be obtained without a prescription. As some products show no impact on prostate problems, as a rule the German Society of Urology does not recommend their use in treatment.
- Treatment using drugs: around 70 in 100 men who seek medical advice opt to be treated with drugs. Normally, tamsulosin is used. It gets the prostate and bladder muscles to relax, making urination easier.
- An operation: various surgical techniques can be used to remove or destroy prostate tissue to reduce the size of the prostate.
Information about the pros and cons of surgery can be found at gesundheitsinformation.de.
What can be done if living with a benign enlarged prostate?
Prostate problems normally develop over a number of years. Because of the slow progression, many men find it easier to adjust to the change. However, some men still find it unpleasant, and are embarrassed about needing to go to the toilet frequently and having problems that are related to their sexual organs.
An enlarged prostate doesn’t need to get in the way of a fulfilled sex life for men and their partners, though. Couples should talk openly about age-related changes. In this way they can develop shared strategies to deal better with the situation.
- Alexander CE, Scullion MM, Omar MI et al. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; (12): CD009629. doi: 10.1002/14651858.CD009629.pub4.
- Bschleipfer T, Bach T, Berges R et al. S2e-Leitlinie der Deutschen Urologen: Instrumentelle Therapie des benignen Prostatasyndroms [S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]. Urologe A. 2016 Feb;55(2):195-207. German. doi: 10.1007/s00120-015-3983-0. PMID: 26518304.
- Höfner K, Bach T, Berges R et al. S2e-Leitlinie der Deutschen Urologen: Konservative und medikamentöse Therapie des benignen Prostatasyndroms [S2e guideline of the German urologists: Conservative and pharmacologic treatment of benign prostatic hyperplasia]. Urologe A. 2016 Feb;55(2):184-94. German. doi: 10.1007/s00120-015-3984-z.
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- Van Exel NJ, Koopmanschap MA, McDonnell J et al. Medical consumption and costs during a one-year follow-up of patients with LUTS suggestive of BPH in six european countries: report of the TRIUMPH study. Eur Urol 2006; 49(1): 92-102. doi: 10.1016/j.eururo.2005.09.016. Epub 2005 Nov 2.
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- Wilt TJ, N'Dow J. Benign prostatic hyperplasia. Part 1: Diagnosis. BMJ 2008; 336(7636): 146-149. doi: 10.1136/bmj.39421.685023.AE.
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In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).
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