Over six million men in the United States experience moderate to severe symptoms of a urological condition called Benign Prostatic Hyperplasia, or BPH. This is commonly called an enlarged prostate.

These images point out the difference between a normal prostate and an enlarged prostate. While the exact cause of enlarged prostate is not yet fully understood, it is known that as men reach middle age, cells within the transition zone of the prostate gland begin to grow at a faster rate. As the transition zone grows, urination can become more difficult.

Enlarged prostate is non-cancerous and not considered a life-threatening disease. But it does affect a man’ s day-to-day life in unpleasant ways. It can disrupt and limit normal daily routines, including work, family and recreational activities. If left untreated, it can lead to bladder infection and, in extreme cases, kidney dysfunction.

Common symptoms of an enlarged prostate include:

• Increased frequency of urination during the day and night
• A sudden urge to urinate
• Difficulty in starting urination
• Stopping and starting flow during urination
• Weak flow of urine
• Sensation of incompleteness in emptying the bladder

Testing:

Laboratory tests include renal function and urinalysis. Pyuria and bacteriuria on urinalysis may represent asymptomatic bacteriuria (see the section on urinary tract infection in Infectious Diseases). Urine cytology and cystoscopy are indicated if hematuria or pelvic pain is present. Tests for glucose, calcium, and vitamin B12 levels are optional.

A bladder diary provides baseline UI severity, the timing and circumstances of UI and typical voided volume, voiding frequency, and the total day and nocturnal urine output . In institutions, have staff record the patient's continence status (dry, damp, soaked) every 2 hours. If nocturnal diuresis occurs, seek causes (eg, pedal edema, heart failure). UI occurrence at a typical time of day suggests an association with medication, beverages, or activity.

Postvoiding residual volume (PVR) measurement is recommended. Men with a PVR volume > 200 should be screened for hydronephrosis.

A clinical stress test is best done with the bladder full, the patient relaxed, and using a single vigorous cough. It is specific for stress UI if leakage is instantaneous but insensitive if the patient cannot cooperate, is inhibited, or if bladder volume is low. If results are negative, consider repeating the test with the patient standing. On urine flow rate testing (if available), a peak flow 12 mL/sec with voided volume 150 mL excludes bladder outlet obstruction. Routine urodynamic testing is usually not needed. Precise diagnosis is most important when surgical treatment is being considered for stress UI or outlet obstruction, because surgery is ineffective for DO, DHIC, and detrusor weakness that present with similar symptoms. Geriatric UI is multi factorial, and lower urinary tract pathology is rarely the only cause. A focus on urodynamic diagnosis detracts from more relevant precipitants. Moreover, some treatments are effective for several types of UI (see the specific treatment strategies). Urodynamics also should be considered if the diagnosis is unclear or if empiric therapy has failed. Cystometry measures bladder proprioception, capacity, detrusor stability, and contractility; carbon dioxide cystometry may be unreliable. Simultaneous measurement of abdominal pressure is necessary to exclude abdominal straining and detect DHIC. Fluoroscopic monitoring, abdominal leak-point pressure, or profilometry tests detect and quantify stress UI. Pressure-flow studies are the criterion standard for obstruction.