Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is non-cancerous prostate enlargement that can obstruct urine flow. It affects about 70% of men in their 60s and 80% by their 70s, per the AUA BPH guideline.
Symptoms
Weak stream, urinary frequency and urgency, waking at night to urinate, a sense of incomplete emptying, and straining to start -- measured and tracked using the IPSS symptom score.
Causes and risk
Age and the ongoing effect of testosterone (converted to DHT) on the prostate over decades are the primary drivers; there's no clear way to prevent it.
How it is evaluated
Initial workup is history, exam, symptom score, and urinalysis. The AUA guideline frames PSA as an offer-after-discussion test, not a routine one for everyone; post-void residual and uroflowmetry are used selectively.
Treatment
Alpha-blockers relieve symptoms quickly by relaxing prostate and bladder-neck muscle; 5-alpha-reductase inhibitors shrink the prostate over months and work best for larger glands. Combination therapy outperforms either alone for men with more significant enlargement. Surgical and minimally invasive options are available when medication isn't enough.
When to seek care
Complete inability to urinate (acute urinary retention) is a urologic emergency requiring prompt bladder drainage -- since a telehealth visit cannot catheterize you, this needs an in-person or emergency evaluation right away.