you notice that you're getting up more frequently at night to go to the toilet to pee
does it take you a longer period of time to pee and empty your bladder are you going more
frequently in the daytime is it a bit of a trickle or gravity fed if you've answered yes to any of
these questions it is possible that you could be suffering from a benign enlargement to your
prostate or bph hi my name is dr charles schubert i'm a urologist and i'm a director of the prostate
clinic the following video is here to highlight and to explain for you a really common condition
that affects men as they progress through life namely bph or benign prostatic hyperplasia
this model highlights some of the anatomical considerations to be aware of bladder above pubic
bone below and here's the prostate in essence the prostate is shaped like a donut in that there is a
central cavity through which passes the urethra the urethra is the outlet pipe of the bladder
there are several zones inside the prostate too of which you need to be aware of this this central
part here is called the transition zone and this is the area of the prostate that is prone to bph
the cells within this area multiply gradually and progressively through life and take up
more and more space it acts a little bit like a clamp on the pipe and causes urinary symptoms
the outer part of the prostate is away from the pipe and it's this area or the peripheral
zone where the majority of prostate cancers arise from the following image highlights a
sagittal view of a multi-parametric mri taken of an individual with significant urinary symptoms
highlighted by the cursor is a very large intravascycle median lobe that is part of
the prostate that has grown extensively into the bladder causing an obstruction
the pelvic floor is at the base of the image we can also see that the bladder wall is
thickened and this happens in individuals with chronic bladder outlet obstruction
bph is very uncommon the younger a man is and it doesn't increase in frequency and become
clinically relevant for the majority of people until men progress beyond the age of 40. a man
is 80 years of age around 80 percent of men in that age bracket will have some evidence
some histological evidence of bph as there is progressive and gradual obstruction to the outlet
pipe of the bladder there is the development of urinary symptoms we characterize urinary
symptoms into two main categories those that are related to the obstruction of the bladder
and those that are related to storage of the urine or irritated symptoms as there is
progressive obstruction to the bladder the flow or the pressure a man generates will be slower
it can take longer for him to pee and sometimes the stream can be intermittent symptoms that
are due to the bladder arise because of changes that happen in the bladder wall
as you can imagine every pee that a man does it day in and day out over the course of several
years if there is increasing outlet resistance the pressure that the bladder needs to generate to try
and force urine out beyond that obstruction needs to increase so for every p over a long
period of time trying to generate more pressure to expel urine from the bladder results in increased
deposition of muscle fiber or development of the bladder wall muscle which is called the detrusor
muscle and that muscle actually gets thicker with time and as it gets progressively thicker the
bladder wall loses its elasticity and therefore loses its compliance what that means in essence
is instead of being a big elastic floppy bag the bladder then becomes stiffer and more rigid
what happens in that situation is that a man's perception of fullness happens at a lower capacity
an urgency can get severe enough to the point where men race or rush to the toilet and they
get caught short they don't make it to the toilet in time and they leak urine before
they actually make it there same thing can happen at night and that's called nocturia
and nocturia is the situation where men need to get up multiple times at night to go and pee
by and large when i'm talking to men about their urinary symptoms the thing that causes them the
biggest bother relates to bladder dysfunction the need to get up multiple times at night or
alternatively to rush to the toilet in the day so there you have it to summarize with
bph it's a very common condition the increases in frequency as we as men progress through life
it is a benign enlargement of the prostate a non-cancerous enlargement but so treatment
choices for the management of this condition really relate to quality of life and the degree
of inconvenience that a man perceives related to his voiding function i hope you've enjoyed this
video please give it a thumbs up if you have don't forget to subscribe and please switch on
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