The burden of BPH

Louise de Winter

CEO, The Urology Foundation

Many men will experience trouble urinating properly as they age. Benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate, is a common cause of this.

The prostate lies between the penis and bladder, and wraps around the urethra (the tube that passes urine out of the body), so by increasing in size, it puts pressure on the bladder making it difficult to pee.

BPH is a gradually progressive disease that often affects men aged 40 and above. It is generally said that 50% of men over 50, and 80% of men over 80 will suffer from it.

In the UK, 25,000 individuals undergo surgery to relieve bladder outflow obstruction caused by BPH every year. In 2008, the estimated total annual direct medical costs of BPH were £180.8 million, with around 60% of these costs incurred in secondary care as a direct result of managing BPH complications. With life expectancy of men rising, this common condition will become even more prevalent.

BPH often requires medication or surgery but some men chose to live with the symptoms

The symptoms of BPH are disruptive and impact on a man’s wellbeing. It often needs to be treated by either medication or surgery. Sometimes it can lead to the inability to pass urine at all, prompting an emergency admission to hospital for insertion of a catheter, often followed by surgery. It causes a reduced quality of life for aging men and is expensive to treat, placing a considerable burden on the health service.

In the UK, 25,000 individuals undergo surgery to relieve bladder outflow obstruction caused by BPH every year.

Some men might be tempted to put up with and live with symptoms, such as getting up frequently in the night to pee, if they are not too bothersome. But, if not treated and monitored, BPH can lead to other problems such as urinary tract infections or even kidney disease. Some of the symptoms of BPH are similar to those for prostate cancer, so men should always see their GP to get checked and to rule this out.

Erectile dysfunction may be a side effect of treatment

There are several treatment options for BPH, from medication through to minimally invasive procedures and surgery. However, in some cases the treatments themselves can also cause side effects, ranging from incontinence to loss of libido or erectile dysfunction, making the choices for men hard. To date there are no options for personalised therapies.

Despite the prevalence of BPH among older men, there is still very little understanding of the disease or who is more prone to suffer. This is why The Urology Foundation is funding a major three-year research study into BPH. Our researchers hope to unlock the genetic drivers of the disease in order to develop personalised and targeted drug treatments that have fewer side effects, and also to identify those men who may have genetic risk factors and who may benefit from earlier treatment, thereby delaying or preventing progression of this pernicious disease.

Signs and symptoms of BPH

• Hesitancy (difficulty starting urination)
• Weak stream
• Straining to pass urine
• Urination taking a long time
• Feeling of incomplete bladder emptying
• Needing to pass urine urgently
• Passing only a little urine despite urgent need
• Needing to pass urine frequently
• Getting up in the night to pass urine
• An increasing (sudden or slow building) inability to pass urine