Benign prostatic hyperplasia (BPH) refers to a condition where the prostate gland becomes enlarged, leading to various voiding dysfunctions as urine cannot flow smoothly. BPH typically begins gradually after the age of 40, and its prevalence rapidly increases, affecting approximately 60-70% of men by their 60s.
When benign prostatic hyperplasia develops, various voiding dysfunction symptoms emerge, causing significant inconvenience in daily life. These symptoms include a weaker urine stream than before, an increase in urination frequency to more than 8 times a day, or waking up more than once during sleep to urinate. As these voiding symptoms can significantly diminish the quality of life for middle-aged men, active treatment is highly recommended.
In the early stages of benign prostatic hyperplasia, medication can be sufficiently effective. However, if symptoms are severe, surgical treatment is considered. Generally, urology specialists consider surgical treatment when the prostate size is 35-40g or more. Nevertheless, there are instances where benign prostatic hyperplasia surgery should be considered even if the prostate size is only around 20-25g. Why is this the case?
While benign prostatic hyperplasia is commonly understood to cause voiding dysfunction due to an increase in prostate size, in reality, symptoms can also manifest from various anatomical factors and functional problems, not solely prostate size. Generally, a normal prostate size is approximately 15-20g, and if it deviates only slightly from this range, surgical treatment is not necessarily considered. However, even if the prostate size is not significantly large, if the urine stream is weak, there is a substantial amount of residual urine, and the effect of medication is minimal, other underlying causes must be thoroughly evaluated.
In particular, structural problems such as bladder neck stenosis or prostatic protrusion into the urethra can act as primary causes of voiding dysfunction. In such cases, improvement is challenging with simple medication alone, making it crucial to identify the exact cause through diagnostic tests like uroflowmetry and cystoscopy. Uroflowmetry operates on the principle of measuring the maximum flow rate of urine during urination to evaluate for any abnormalities in voiding function, with a normal maximum flow rate generally considered to be 15 mL/sec or more.
If examination results reveal a narrowed bladder neck or prostatic protrusion into the urethra and bladder, surgical correction may be necessary. When urinary flow is improved through surgery, there are numerous cases where voiding function significantly improves, with the maximum flow rate recovering to the normal range and residual urine disappearing. Therefore, rather than determining a treatment plan based solely on prostate size, it is crucial to comprehensively evaluate both functional and structural abnormalities to implement a personalized and effective treatment approach.
Director Ryu Kyung-ho of Goldman Urology Clinic Gangnam Branch stated, "To accurately identify the cause of voiding dysfunction symptoms, one should not rely solely on ultrasound examinations; it is also advisable to perform urethrocystoscopy. This is because the location and pattern of hypertrophied prostatic tissue vary for each patient. Given that voiding dysfunction significantly impacts the quality of life for middle-aged men, it is highly recommended to determine whether to proceed with surgery through a systematic and thorough examination."