​Benign prostatic hyperplasia (BPH) is a common condition that exists in men as they age where lower urinary tract symptoms (LUTS) develop due to enlargement of the prostate gland. Roughly 50 percent of men above of the age of 60 and 90 percent of men above the age of 85 will develop BPH. One is more likely to develop BPH if there is a strong family history of the condition but there also seems to be some modifiable risk factors associated with its development including the presence of diabetes and obesity.

The prostate gland is found below the bladder. It produces seminal fluid, and it grows as one ages. The urethra, which helps pass urine and semen out of the body, passes through the prostate’s center. As the prostate enlarges, it can block the urethra and if left untreated, this can lead to complications including the development of acute urinary retention, blood in the urine, bladder stones, recurrent urinary tract infections and kidney failure. In some cases, the bladder may become so damaged over time, that it may completely lose its ability to empty on its own, necessitating catheterization.

The primary cause of BPH is multifactorial with the exact cause largely unknown. However, it seems be related to be hormonal changes, particularly declining testosterone with rising levels of dihydrotestosterone (the more potent form of testosterone) and androgen receptor. Other factors may also play a role in the development of BPH including circulating estrogens and growth factors as well as sympathetic nervous system and inflammatory pathways.

Men with BPH experience symptoms that are generally classified as storage or voiding. Storage symptoms include sudden and strong urges to urinate, frequent urination, waking up multiple times at night to urinate, and in severe cases, urgency urinary incontinence, where urine leaks out involuntarily. Voiding symptoms include difficulty starting urination (hesitancy), a weak urinary stream, a need to push to initiate or maintain urination, and a urine flow that starts and stops intermittently.

Technically speaking, BPH is a histological diagnosis (seen by examining tissue under a microscope) which may lead to benign prostatic enlargement. However, not all men with microscopic BPH will develop enlargement of the prostate. As the prostate grows, it may cause obstruction but not all men with enlargement will develop obstruction. To make things more confusing, many men without any BPH at all may develop prostate obstruction and this may occur in the setting of a dysfunctional bladder neck, a bladder neck contracture or urethral stricture disease. Further, men may present with LUTS in the absence of obstruction such as in the setting of an overactive bladder or a neurogenic bladder. Thus, it is important to seek the advice of a Urologist if you develop bothersome LUTS, particularly if you do not respond to first-line medical management.

At the initial evolution, your doctor will take a full medical history from you in order to determine what other factors may be contributing to your symptoms and what other diagnostic tests should be ordered. A common way for your doctor to quantify how bothered you are by your symptoms is by having you fill out a validated questionnaire, the most common one being the International Prostate Symptom Score. This will allow your doctor to obtain a baseline of your symptoms and repeating the same questionnaire over time can give valuable information about symptom progression or response to medical therapy.

Urinary flow tests, post-void residual urine measurement, urine analysis, prostate-specific antigen (PSA) blood tests, and digital rectal exams are other common tests used in the workup of patients with BPH. PSA is an antigen made by the prostate, and generally speaking, it rises when the prostate is enlarged, swollen or in the presence of prostate cancer. Your physician may also perform other, specialized studies such as cystoscopy and/or urodynamic studies to fully evaluate your lower urinary tract anatomy and function.

Once the diagnosis of BPH has been made, patients may be counseled on behavioral and lifestyle modifications, treatment with medications and/or procedural options. Medical therapy for BPH includes alpha-blockers such as tamsulosin, 5-alpha reductase inhibitors such as finasteride and phosphodiesterase inhibitors such as tadalafil. In some cases, particularly if storage symptoms predominate, you may also be offered anticholinergic medication such as oxybutynin or a beta-3 agonist such as mirabegron.

If medication does not relieve your symptoms or if they are not tolerated due to their bothersome side effects, various procedural options may be recommended in an attempt to open up your bladder outlet The most common such procedure performed worldwide is transurethral resection of the prostate (TURP). Here, a small camera is inserted into your urethra and the obstructive tissue is removed using a special electrocautery device. This is usually performed at a hospital or an outpatient surgery center, either under general or regional anesthesia. Many other options exist to treat BPH including transurethral incision of the prostate, transurethral vaporization of the prostate, photo selective vaporization of the prostate, prostatic urethral lift, water vapor thermal therapy, laser enucleation and prostatic artery embolization. For patients with very large prostates, open, laparoscopic or robotic assisted prostatectomy may be considered.

​Urological health focuses on the urogenital system, which consists of the organs that produce, store, and excrete urine, such as the kidneys, the bladder, and the urethra. The urogenital system also includes sexual function organs like the prostrate, testicles, and penis. Lifestyle factors like physical activity, hydration, and diet can have a dramatic impact on your urological health. Poor lifestyle choices may result in or contribute to a variety of conditions such as chronic renal insufficiency, sexually transmitted infections, kidney stones, sexual dysfunction and urinary incontinence.

Exercise improves general health and improves the health of the genitourinary system. Not only does regular exercise improve blood circulation to the vital organs but also to the muscle and fascial layers which surround and support them. It helps with weight management, reducing the likelihood of obesity, which contribute to urinary incontinence, cystocele formation and chronic kidney disease. Further, pelvic floor physiotherapy and Kegel exercises strengthen the pelvic muscles thereby improving urinary continence and bladder control. Obesity, diabetes and hypertension also contribute to sexual problems such as erectile dysfunction and male hypogonadism (low testosterone).

Nutrition also affects kidney health. Adopting a balanced diet can prevent urological diseases, while unhealthy food choices may result in poor urological health consequence. Excessive consumption of caffeine, alcohol and tobacco tend to irritate the bladder and may worsen certain urological conditions such as overactive bladder and interstitial cystitis. Studies have shown that the consumption of high-protein diets, particularly red meat diets, may result in an increased risk of chronic kidney disease. Urinary citrate is a strong inhibitor of calcium stone formation and the excretion of citrate is determined by urinary pH. The excessive consumption of red meat exerts high acid loads on the kidneys which may, in turn, lead to kidney stone formation. Fruits and vegetables, on the other hand, confer an alkali load to the urine, thereby, increasing citrate in the urine and decreasing the risk of kidney stone formation.

Hydration is also instrumental to urogenital health. Drinking adequate amounts of water helps to dilute certain constituents in the urine, reducing the risk of kidney stone formation. It is also protective against the development of acute renal insufficiency, particularly when other risk factors for this condition are present such as diabetes, IV contrast administration for imaging studies and the consumption of certain types of medications. Monitoring the color of your urine can serve as a simple indicator of hydration status; light-colored urine typically signifies adequate hydration, while darker urine may suggest the need for increased fluid intake.

Chronic stress and mental health challenges may significantly impact genitourinary function, leading to or contributing to conditions such as chronic prostatitis, chronic orchialgia, erectile dysfunction, premature ejaculation, and chronic pelvic pain syndrome. Elevated stress levels may increase urinary urgency, frequency, and discomfort due to the body's heightened fight-or-flight response. Stress-reduction techniques like mindfulness, yoga, meditation, and relaxation exercises may help alleviate these symptoms by promoting muscle relaxation and enhancing bladder control. Prioritizing mental well-being through these practices supports genitourinary health and improves overall quality of life.