Benign prostatic hyperplasia (BPH) refers to a condition where the prostate gland becomes enlarged, leading to various urination disorders as urine cannot flow smoothly. BPH typically begins gradually after the age of 40, and is characterized by a rapid increase in the number of patients, affecting approximately 60-70% of men in their 60s.
When BPH develops, various urinary symptoms occur, causing significant inconvenience in daily life. These symptoms include a weaker urine stream than before, an an increase in the frequency of urination to more than 8 times a day, or waking up more than once during sleep to urinate. Since these urinary symptoms 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 quite effective. However, if symptoms are severe, surgical treatment is considered. Generally, urology specialists consider surgical intervention when the prostate gland's size is 35-40g or larger. Nevertheless, there are cases where BPH 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 urination disorders due to an increase in prostate size, symptoms can actually arise from various anatomical factors and functional issues beyond just the prostate's size. Typically, a normal prostate gland measures 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 enlarged, if the urine stream is weak, there is a large amount of residual urine, and medication has minimal effect, other underlying causes must be thoroughly evaluated.
Specifically, structural problems such as bladder neck stricture or prostatic protrusion into the urethra can act as primary causes of urination disorders. In such cases, improvement is difficult with simple drug therapy alone, making it crucial to identify the exact cause through uroflowmetry and cystoscopy. Uroflowmetry operates on the principle of measuring the maximum flow rate of urine during urination to assess for abnormalities in urinary function, with a normal maximum flow rate generally considered to be 15 mL/sec or higher.
If examination results reveal a narrowed bladder neck or prostatic protrusion into the urethra and bladder, surgical correction may be necessary. In many cases, improving urine flow through surgery leads to significant improvement in urinary function, such as the maximum flow rate returning to the normal range and the disappearance of residual urine. Therefore, rather than determining the treatment approach solely based on prostate size, it is crucial to comprehensively evaluate functional and structural abnormalities to implement personalized treatment.
Dr. Ryu Kyung-ho, director of Goldman Urology Clinic Gangnam Branch, stated, "To accurately identify the cause of urinary symptoms, it is advisable not to rely solely on ultrasound examinations but to also perform urethrocystoscopy." He added, "This is because the location and pattern of hypertrophic prostatic tissue vary for each patient, and since urinary dysfunction significantly impacts the quality of life for middle-aged men, it is best to decide whether to proceed with surgery through a systematic examination."