What other disorders can mimic BPH?

Other underlying disorders can mimic the symptoms of BPH. A neurogenic bladder, or bladder with impairment of its nerve supply, can cause a patient to void either frequently or infrequently depending on the nature of the neurologic problem. At times, a neurogenic bladder can cause the patient to be unable to urinate or go into urinary retention.

Diabetes mellitus can cause frequent urination, as many patients with diabetes make a greater volume of urine per 24 hours. With long-standing diabetes, bladder damage can occur that results in a decreased ability of the bladder to contract and therefore causes less frequent urination.

A urinary tract infection can cause urinary frequency and burning with urination. A urethral stricture or scar tissue in the urethra from old infections or trauma can cause a decrease in the urinary stream.

The following is a list of additional disorders that may mimic BPH:

• Other causes of bladder outlet obstruction:

• Bladder neck obstruction

• Prostate cancer

• Mullerian duct cysts—congenital abnormalities— if the cysts are large, they may compress the urethra, making it difficult to void

• Urethral stricture—scar tissue in the urethra causing narrowing and resistance to the flow of urine

• Urethral valves—congenital leaflets in the urethra that balloon out, like the sails of a sailboat, when one is urinating and obstruct the outflow of urine

• Impaired detrusor contractility—a bladder that does not contract well

• Overactive bladder—occurs in 40-70% men with bladder outlet obstruction

• Painful bladder syndrome

• Inflammatory and infectious conditions:

• Cystitis—infection/inflammation of the bladder

• Carcinoma in situ of the bladder—an early cancer in the bladder that may cause the bladder to be overactive

• Prostatitis (see Question 61)

What damage can BPH cause?

Enlargement of the prostate, BPH, increases the resistance to the flow of urine out of the bladder. Thus the bladder needs to work harder to push urine beyond the resistance. In order to accomplish this, the bladder pressures must increase. As a result of this need for increased force there is hypertrophy of the bladder muscle. The increased work that the bladder muscle needs to do to empty the bladder may lead to the development of overactive bladder (Questions 41 and 42). This increased pressure that the bladder needs to generate can be transmitted backwards from the bladder to the kidneys, and in some individuals it may impair the drainage of the kidneys, causing swelling of the kidneys/ hydronephrosis and a decrease in kidney function. If the bladder cannot create enough pressure and/or cannot maintain the elevated pressure, then the bladder may not empty completely. This residual urine may put some men at risk for bladder stones, bladder infections (UTI), and if the residual is significant, urinary leakage. Over the course of time, in some males, the bladder decompensates and acute urinary retention may occur, in which the male is unable to urinate. In some men, this is reversible with relief of the obstruction, in others, the bladder never recovers.

When does BPH need to be treated?

The need to initiate treatment for BPH is divided into absolute and relative indications. Absolute indications refer to objective medical reasons to intervene. These include impaired renal function because of prostatic obstruction, hydronephrosis or dilation of the ureters and kidneys, recurrent urinary tract infections, bladder stones, and inability to void (urinary retention).

These absolute and relative indications for the treatment of BPH appear in Table 11.

The relative indications are for improvement in quality of life if the symptoms of BPH are bothersome and the patient wishes to try to improve them.

Table 11. Indications for BPH Treatment

Source: Loughlin, P. 100 Questions and Answers About Prostate Disease. Jones and Bartlett Publishers, LLC, 2007.