BPH: How to Know When It’s Time for Treatment


Unfortunately, the progression of benign prostatic hyperplasia (BPH) cannot be predicted with accuracy. Symptoms and objective measurements of urethral obstruction can remain stable for many years and may even improve over time in as many as a third of men. In a large evaluation of BPH treatments, called the Medical Therapy of Prostatic Symptoms (MTOPS) study, only 14 percent of untreated men in the placebo group experienced worsening symptoms during an average follow-up time of 4.5 years.

Men who eventually need treatment for BPH typically experience a progressive decrease in the size and force of their urinary stream or a sensation of incomplete emptying of the bladder when they urinate. Although frequent nighttime urination is one of the most annoying symptoms of BPH, it does not predict the need for future treatment. If urethral obstruction worsens and is left untreated, complications can occur. Potential complications include a thickened bladder with a reduced ability to store urine, infected residual urine, bladder stones, and a backup of pressure that damages the kidneys.

Treatment decisions for BPH are based on the severity of symptoms as assessed by the International Prostate Symptom Score questionnaire, the extent of urinary tract damage, and the man’s age and overall health.

In general, no treatment is needed for men who have only a few symptoms and are not bothered by them. However, treatment-usually surgery-is required when there is kidney damage due to inadequate bladder emptying; a complete inability to urinate after treatment of acute urinary retention; incontinence due to overfilling or increased bladder sensitivity; bladder stones; infected residual urine; or recurrent blood in the urine despite treatment with medication. Surgery may be required if a man continues to experience symptoms despite treatment with medication and those symptoms are troublesome enough to diminish his quality of life. Treatment decisions are most difficult for a man who has moderate symptoms. A man must determine whether the symptoms bother him enough or interfere with his life enough to merit treatment.