How do you know if your BPH is serious enough to require treatment? The International Prostate Symptoms Score was developed to help men evaluate the severity of their BPH symptoms. Johns Hopkins encourages you to take this self-administered test and then read this Health Alert before talking with your urologist about your BPH treatment options.
The progression of benign prostatic hyperplasia (BPH) cannot be predicted for any individual. 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 the Medical Therapy of Prostatic Symptoms (MTOPS) study, only 14% 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 their bladder. 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 capacity to store urine, infected residual urine, bladder stones, and a backup of pressure that damages the kidneys.
Decisions regarding BPH treatment are based on the severity of symptoms (as assessed by the International Prostate Symptom Score questionnaire, see Do You Have BPH?), 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 BPH symptoms and are not bothered by them.
Treatment -- usually surgery -- is required in the following situations:
- kidney damage due to inadequate bladder emptying
- a complete inability to urinate after treatment of acute urinary retention
- incontinence due to over filling or increased bladder sensitivity
- bladder stones
- infected residual urine
- recurrent blood in the urine despite treatment with medication
- symptoms that have not responded to medication and are troublesome enough to diminish quality of life
