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BPH (General Overview)

Benign prostatic hyperplasia (BPH) is a pathological growth in the male prostate that does not spread to other tissues or organs; in other words, it is a tumor that does not metastasize. BPH is a common urological condition affecting men over 40–50 years old, often associated with urinary disorders and requiring regular monitoring, diagnosis, and early management. Risk factors include genetic predisposition, chronic prostatitis, hormonal changes in men over 50, decreased testosterone levels, sedentary lifestyle, and dietary influences. This condition is a major factor affecting men’s quality of life, sexual health, and overall urinary function.

Manifestations of Benign Prostatic Hyperplasia

The growth of the prostate resembles the formation of a capsule within it and is associated with an increase in the number of paraurethral glands. There are four forms of BPH, each with characteristic symptoms and impact on urinary function:

• Subvesical – growth of the gland toward the rectum. Painful symptoms are minimal or may not be felt at all. This form is often detected during routine prostate ultrasound or preventive medical check-ups.
• Intravesical – growth of the prostate into the bladder. Over time, this can cause almost constant discomfort in the bladder due to excessive residual urine, potentially leading to urinary tract infections, cystitis, or pyelonephritis if untreated.
• Retrotigonal – a tumor that obstructs urine outflow from the bladder and compresses the urethra. Early symptoms include involuntary delays before urination and weak urine stream. Untreated, these symptoms intensify and may result in complete urinary retention, requiring emergency catheterization.
• Multifocal prostatic hyperplasia – the most painful form of BPH, combining all the symptoms described above and potentially causing complications in the kidneys and ureters.

Etiology of Benign Prostatic Hyperplasia

The exact causes of BPH are not fully understood, but correlations exist with multiple risk factors that increase disease progression:

• Prostate tissue growth due to long-term chronic prostatitis, which alters prostate structure and urinary function.
• Coexisting health conditions such as cardiovascular disorders, genitourinary disorders, type 2 diabetes, obesity, metabolic syndrome, hypertension, and endocrine imbalances.
• Dysfunction of endocrine glands (hormonal imbalance), reduced testosterone levels, and androgen metabolism disorders that stimulate prostate tissue growth.
• BPH is also promoted by low or absent physical activity, unhealthy habits (alcohol consumption, smoking), overweight, poor nutrition, and lack of knowledge about self-care. These issues may be worsened by chronic stress or hypothermia. Excessive sun exposure can trigger or worsen symptoms of prostatitis, chronic prostatitis, and BPH.
• Age. Global statistics show that the risk of developing BPH rises with age: 7–8% of men under 50 are affected, 30% of men aged 51–60, and over 75% of men by age 70. Age-related changes in prostate tissue directly influence symptom severity, urinary function, and the need for regular medical examination.

BPH and carcinoma, or prostate cancer, are two distinct diseases. To date, no direct connection has been established, though regular prostate check-ups and monitoring of PSA levels help exclude malignant processes and guide early intervention.

Symptoms of BPH in Men

Symptoms of prostate diseases vary, but all reflect the inability to fully empty the bladder. Key clinical manifestations include:

• Frequent and urgent urges to urinate, both day and night, affecting sleep quality and overall well-being.
• Difficulty initiating urination, often requiring a pause and conscious contraction of the muscles around the prostate and bladder to push urine through the narrowed prostatic urethra.
• Nocturnal urination more than once per night, associated with bladder irritability and residual urine.
• Interrupted urine flow, reduced urine stream velocity, and higher risk of urinary tract infections.
• Thinned urine stream during urination, reflecting weakened urinary pressure.
• Painful urethral discomfort, sometimes with burning sensation, irritation, or post-urination pain.
• Persistent discomfort in the bladder area and just below it, including pressure, heaviness, and incomplete emptying sensations.
• Small urine volume per void, residual urine accumulation, increasing the risk of cystitis and pyelonephritis.
• A feeling of incomplete bladder emptying, with residual urine remaining, necessitating regular urological monitoring and early management.

Diagnosis of Benign Prostatic Hyperplasia

Neglecting proper examination is unwise. Many patients doubt the effectiveness of the numerous BPH treatments, especially those who have undergone unsuccessful treatment for chronic prostatitis.

Making a mistake is not frightening; being misled is. Accurate and thorough diagnostics are essential, as effective methods exist for treating prostatitis and BPH. One of these methods is described on this site.

Comprehensive diagnostics include:

• Consultation with a qualified and experienced physician for a digital rectal examination. This allows assessment of prostate tissue consistency, partial evaluation of size (enlarged or not), tenderness, and the presence of a groove between the lobes.
• Laboratory tests, including urinalysis, blood test for prostate-specific antigen (PSA), and general biochemical blood analysis.
• Urination rate (uroflowmetry) – a relative indicator. For accuracy, it should be measured under different conditions: after rest, after meals, after sleep, and following certain physical activities such as walking, running, swimming, or other habitual exercises.
• Ultrasound examination – essential for understanding the overall picture of the disease. Objective results require proper skills and knowledge. Be selective when choosing ultrasound equipment, as readings can be affected by environmental conditions. The most accurate method is transrectal ultrasound (probe inserted into the rectum). Avoid excessive fluid intake before the procedure; 700–800 ml is sufficient. Excess fluid can cause bladder spasm and misleading results. Avoid remaining immobile for long periods before the examination; walking actively to the clinic is recommended. Transrectal ultrasound will assess the presence of foreign bodies in the bladder and prostate, organ volume (in cubic centimeters or grams), and residual urine. Normal prostate volume is 18–20 cm³, weight approximately the same.
• Radiography can determine the presence of complications.

Overall Manifestations (Clinical Symptoms)

There are three stages in the development of BPH, and each stage following the first significantly worsens the patient’s condition.

• The first stage is the compensated stage. In this stage, the male prostate is only slightly enlarged. Symptoms appear as a brief delay before urination, requiring straining of the pelvic muscles to relieve tension. The general condition prevents full relaxation and may cause psychological discomfort. Frequent, sometimes unpredictable, urges to urinate may force the patient to carefully plan outdoor routes. The prostate boundaries and lobes are clearly palpable, and its consistency is firm. Palpation does not cause pain. This stage can last one, three, or even more years.
• The second stage is called the subcompensated stage. The upper part of the urethra is compressed, preventing complete bladder emptying, and the patient physically senses residual urine in the bladder. Frequent straining thickens the bladder walls, reducing its functional capacity. Involuntary urination may occur. The constant presence of residual urine can lead to complications such as kidney and bladder stones or kidney failure.
• The third stage is decompensated. This stage is extremely dangerous. The continuously increasing volume of residual urine deforms the bladder significantly. Urination may occur only drop by drop. This leads to irreversible kidney dysfunction. The patient’s condition may be accompanied by foul-smelling urine, chronic constipation, loss of appetite, weight loss, and a cascade of other health problems.

Treatment of Prostatitis and Benign Prostatic Hyperplasia

Treatment of Chronic Prostatitis

The link between chronic prostatitis and BPH is evident. Often, BPH develops as a result of ineffective treatment of long-term chronic prostatitis. Therefore, treatment options for chronic prostatitis are described here. The disease is classified into four forms:

• Chronic bacterial prostatitis;
• Chronic asymptomatic prostatitis;
• Chronic prostatitis presenting as pelvic pain syndrome;
• Granulomatous prostatitis of a similar type.

Treating these conditions is challenging for urologists. Therapeutic measures typically include antibacterial medications taken for one to one and a half months. Pain is managed with suppositories or tablets. In cases of difficult urination, alpha-1-adrenergic blockers (such as Doxazosin, Tamsulosin, Omnic, and others) are recommended. However, this therapy usually does not provide complete results; antibiotics alone often fail, and the disease may progress again over time. Achieving effective results requires strengthening the immune system through a healthy lifestyle. This is a meticulous and prolonged effort, but it is worthwhile. Measures include regular, moderate physical activity (special exercises, running, swimming, walking), a balanced diet, and complete elimination of harmful habits.

Treatment of Benign Prostatic Hyperplasia

Making mistakes is not frightening if one analyzes and corrects them. What is extremely negative is to live under misconceptions for years. Often, after initial diagnostics, a patient consulting a urologist—especially with mild symptoms—is advised to adopt a wait-and-see approach and not treat BPH. This is incorrect. Such recommendations exist partly because, in the early stage, hyperplasia may not progress for years, and partly because medications alone often do not produce noticeable results. Regular monitoring and active treatment of the prostate are required.

Medication Therapy for Benign Prostatic Hyperplasia

For BPH, two main types of medications are typically prescribed:

• Alpha-1-adrenergic blockers;
• 5-alpha-reductase inhibitors.

Alpha-1-adrenergic blockers target the alpha-1 adrenoceptors located in the bladder neck, urethra, and prostate stroma. Their main function is to relieve smooth muscle spasm and consequently improve bladder function. Resistance symptoms in the urethra are minimized.

5-alpha-reductase inhibitors block the conversion of testosterone into dihydrotestosterone, reducing prostate tissue volume. The effect usually appears within six months to a year, but there is a significant chance that it may not occur. Known side effects include depression and changes in the voice (which may become higher-pitched).

Method of Alternative (Non-Surgical) Treatment

There is a long-established method for treating chronic prostatitis and BPH, fully presented on this specialized website. The essence of this approach lies in a correct understanding of physiological processes in the male body and their precise application. This treatment is safe, painless, highly effective, and leads over time to a stable, healthy condition. The foundation of this approach is therapeutic physical exercise.

The benefits of exercise can vary, and in some cases, little or no benefit may be observed. Careful adherence to the recommended methods significantly enhances the body’s defenses, improves blood circulation, and stabilizes the function of the heart and endocrine glands. Relaxation techniques further strengthen these effects. The human body is an interconnected system, and restoring organs to their normal state constitutes true health.

Engaging in this type of exercise is only restricted in cases of kidney stones. Following a proper dietary regimen is also essential. A hearty breakfast and early dinner, avoiding overeating, and monitoring body weight should be standard practices. The diet should minimize animal fats and increase the proportion of foods rich in omega-3 polyunsaturated fatty acids and lycopene. Be selective when buying vegetables, choose the best quality possible, and consume them daily in sufficient quantities. Red meat consumption should be minimized. Following the full set of measures described in the methodological instructions will gradually restore a stable, healthy condition.

Surgical Intervention

Surgery is required only when the course of the disease cannot be altered, typically when the condition approaches a critical state, such as acute urinary retention. Transvesical adenomectomy involves excision of prostate tissue and is performed in the most advanced stages of BPH. The procedure accesses the prostate through an incision in the bladder wall. It is highly invasive, requiring extended recovery, monitoring, and care.

Although it is claimed that this surgery can cure BPH, it is not noted that it carries numerous, sometimes unforeseen, side effects. Minimally invasive procedures are now the preferred standard because they are less traumatic. They do not require incisions and involve partial removal (enucleation) of the prostate using specialized equipment, such as a holmium laser of a specified power.

In recent years, embolization of the prostate blood supply has become more common. This procedure blocks the arteries supplying blood to the prostate. However, the actual death of the organ in a living body, due to lack of blood supply, cannot be considered true treatment.

Surgical intervention should always be regarded as a last resort when all other treatment options are exhausted. Surgery is not a panacea and does not represent the best outcome for this condition.

Complications from any type of surgery include:

• Urinary incontinence;
• Sexual dysfunction (impotence);
• Retrograde ejaculation, in which semen enters the bladder;
• Unpredictable hormonal imbalance.

Statistics indicate a low percentage of fatal outcomes.

Prevention of Chronic Prostatitis and Benign Prostatic Hyperplasia

Awareness of these conditions is important from a young age. A hereditary factor exists, of course, but a healthy lifestyle—including regular physical activity, avoiding deliberate harm to the body, and living with minimal stress—plays a significant role in prevention and reduces the risk of this challenging diagnosis.

To prevent acute urinary retention in BPH, it is recommended to:

• Avoid both hypothermia and excessive heat, including direct sun exposure;
• Refrain from alcohol consumption;
• Avoid overeating, especially in the second half of the day;
• Prevent overfilling of the bladder;
• Prevent constipation.

Respectfully, the author of the website, Gennadiy Plotyan.

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