According to Deters, L. A., & Kim E.D.

2016, Benign prostatic hyperplasia (BPH), also

known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of
the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to
BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross
hematuria, and bladder calculi. Also, Gerber et. al (2014) states that The prostate is a small organ
about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the
urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to
nourish sperm as part of the semen (ejaculatory fluid).Prostate problems are common in men 50
and older. Most can be treated successfully without harming sexual function. A urologist is a
specialist in diseases of the urinary system, including diagnosing and treating problems of the
prostate gland.

BPH is the most common prostate disease. BPH usually starts after the age of 40 years
and is more common in older men; it affects nearly all men at some time in their lives. Some
men do not have any symptoms even though their prostate has grown larger. BPH usually
becomes more of a problem over time, with symptoms getting worse if they are not treated. The
causes of BPH are not well understood. Some research shows that there may be genetic links, as
sons of men diagnosed with BPH are more likely to develop prostate disease.Older age and the
male sex hormone testosterone are linked with BPH but may not be the cause. It is known that
BPH only happens when testosterone, which is made in the testes, is present. A number of men
with BPH do not have many or any symptoms. The men who do have symptoms of BPH usually
notice changes to their urination because BPH affects the part of the prostate that surrounds the
top part of the urethra.LUTS (lower urinary tract symptoms) is a common term used to describe
a range of urinary symptoms. LUTS linked to BPH can be obstructive or irritative, but other
symptoms may also happen.Obstructive symptoms include a delay or straining when starting to
urinate, and slow or dribbling flow of urine. Irritative symptoms include urgent or frequent
urination during the day and night. (Prahran et. al 2016).

Internationally, BPH is the most common diagnosis made by urologists for men in age group
of 45-74. It is also the most common disorder of the prostate. Prostate grows larger in men as
they grow old and 45% of men above 46 years of age are more likely to suffer from BPH if their
longevity allows them another 30 years. 50% of men in their 50s and 80% of men in their 80s
show symptoms of BPH. Over 8.4 million men above 50 years of age in the US require treatment
for enlarged prostate. 3 million age 50 to 59, 2.6 million age 60 to 69, 2.8 million age 70 to
79. There are 19 million people with symptomatic BPH. Of these 14 million remain undiagnosed
and 2 million are diagnosed but not treated. Rate of incidence of BPH 3 cases /1000 men in age
group of 45-49 years to 38 cases/1000 men by 75-79 years. Rate of prevalence of BPH 2.7% in
men between ages 45 49 and 24% for men around 80 years. In 8 cases out of 10, presence of
BPH is diagnosed by symptoms related to urination problems like increased frequency, dribbling,
weak urine stream, and urgency to urinate.
Anatomy and Physiology

The prostate gland is part of a man's reproductive and urinary systems. The prostate is
oval shaped with a rounded tip. It is approximately 4 cm wide and 3 cm thick. The actual size of
the prostate varies from man to man. It can range from the size of a walnut to a small apple.
The prostate surrounds the base (or neck) of the bladder. It has 2 lobes that surround the
urethra. The urethra carries urine from the bladder, through the prostate, and out the penis.

Structure

The prostate gland is covered in a layer of connective tissue called the prostatic capsule.
The prostate gland is made up of different types of cells:

gland cells that produce the fluid portion of semen

muscle cells that control urine flow and ejaculation
fibrous cells that provide the supportive structure of the gland
Some structures around the prostate are:

seminal vesicles These glands produce semen and are found on both sides of the
prostate.
vas deferens These tubes carry sperm from the testicles to the seminal vesicles.
nerve bundles These nerves control bladder and erectile function and are found on both
sides of the prostate.
muscles These muscles control urination.

Zones of the prostate

The prostate gland is divided into 3 zones:

peripheral
transition
central

Peripheral zone

The peripheral zone is the area of the prostate that is closest to the rectum. It can easily be felt by
the doctor during a digital rectal examination (DRE). It is the largest zone of the prostate gland.
The majority of prostate tumours (approximately 75%) are found in the peripheral zone.

Transition zone

The transition zone is the middle area of the prostate, between the peripheral and central zones. It
surrounds the urethra as it passes through the prostate. This zone makes up about 20% of the
prostate gland until the age of 40.
As men age, the transition zone begins to enlarge, until it becomes the largest area of the
prostate. This is called benign prostatic hyperplasia (BPH). When the transition zone enlarges, it
pushes the peripheral zone of the prostate toward the rectum.

Central zone

The central zone is in front of the transition zone. It is the part of the prostate that is farthest from
the rectum. Because of this, prostate tumours in this zone cannot be felt by the doctor during a
DRE.

Function

The main function of the prostate is to produce the fluid portion of semen. The gland cells within
the prostate produce a thin fluid rich in proteins and minerals that maintain and nourish sperm.
This fluid is made continuously. The excess passes from the body in the urine. When a man is
sexually aroused, the prostate produces larger amounts of this fluid. It then mixes with sperm and
is ejaculated as semen.
The prostate also plays a part in controlling the flow of urine. The urethra runs from the bladder,
through the prostate, and out through the penis. The muscle fibres of the prostate are wrapped
around the urethra and are under involuntary nervous system control. These fibres contract to
slow and stop the flow of urine.