The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately 70% of the seminal volume. The secretions produce lubrication and nutrition for the sperm. The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize the acidic vaginal environment.
The prostatic urethra is a conduit for semen and prevents retrograde ejaculation (ie, ejaculation resulting in semen being forced backwards into the bladder) by closing off the bladder neck during sexual climax. Ejaculation involves a coordinated contraction of many different components, including the smooth muscles of the seminal vesicles, vasa deferentia, ejaculatory ducts, and the ischiocavernosus and bulbocavernosus muscles.
Related Questions:
[Guideline] Parsons JK, Dahm P, Köhler TS, Lerner LB, Wilt TJ. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2020. J Urol. 2020 Oct. 204 (4):799-804. [Medline]. [Full Text].
Nimeh T, Magnan B, Almallah YZ. Benign Prostatic Hyperplasia: Review of Modern Minimally Invasive Surgical Treatments. Semin Intervent Radiol. 2016 Sep. 33 (3):244-50. [Medline].
Kopp W. Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?. Nutr Metab Insights. 2018. 11:1178638818773072. [Medline]. [Full Text].
Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am. 2016 Aug. 43 (3):289-97. [Medline].
Seftel AD, Rosen RC, Rosenberg MT, Sadovsky R. Benign prostatic hyperplasia evaluation, treatment and association with sexual dysfunction: practice patterns according to physician specialty. Int J Clin Pract. 2008 Apr. 62(4):614-22. [Medline].
Carballido J, Fourcade R, Pagliarulo A, et al. Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial. Int J Clin Pract. 2011 Sep. 65(9):989-996. [Medline].
[Guideline] American Cancer Society recommendations for prostate cancer early detection. American Cancer Society. Available at https://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-acs-recommendations. November 17, 2020; Accessed: February 19, 2021.
D'Silva KA, Dahm P, Wong CL. Does this man with lower urinary tract symptoms have bladder outlet obstruction?: The Rational Clinical Examination: a systematic review. JAMA. 2014 Aug 6. 312 (5):535-42. [Medline].
McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline. No. 8, AHCPR Publication No. 94-0582. Rockville, Md: Agency for Healthcare Policy and Research,. Public Health Service, US Department of Health and Human Services, 1994.
Sebastianelli A, Gacci M. Current Status of the Relationship Between Metabolic Syndrome and Lower Urinary Tract Symptoms. Eur Urol Focus. 2018 Jan. 4 (1):25-27. [Medline].
Yoo S, Oh S, Park J, Cho SY, Cho MC, Jeong H, et al. The impacts of metabolic syndrome and lifestyle on the prevalence of benign prostatic hyperplasia requiring treatment: historical cohort study of 130 454 men. BJU Int. 2019 Jan. 123 (1):140-148. [Medline].
Zhou B, Wang P, Xu WJ, Li YM, Tong DL, Jiang J, et al. Correlations of glucose metabolism, insulin resistance and inflammatory factors with symptom score of patients with benign prostatic hyperplasia. Eur Rev Med Pharmacol Sci. 2018 Aug. 22 (16):5077-5081. [Medline]. [Full Text].
Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gómez JM, Castro R. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. 2008 Jul. 62(7):1076-86. [Medline].
Jung JH, Kim J, MacDonald R, Reddy B, Kim MH, Dahm P. Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2017 Nov 22. 11:CD012615. [Medline].
Hellstrom WJ, Sikka SC. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol. 2006 Oct. 176(4 Pt 1):1529-33. [Medline].
Pande S, Hazra A, Kundu AK. Evaluation of silodosin in comparison to tamsulosin in benign prostatic hyperplasia: a randomized controlled trial. Indian J Pharmacol. 2014 Nov-Dec. 46 (6):601-7. [Medline]. [Full Text].
Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A, Hemerson P, Rogers M, Stamper B. Intraoperative floppy iris syndrome associated with alpha1-adrenergic receptor antagonists. Ann Pharmacother. 2008 Apr. 42(4):558-63. [Medline].
Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20. 301(19):1991-6. [Medline]. [Full Text].
McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998 Feb 26. 338(9):557-63. [Medline].
Nickel JC, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011 Aug. 108(3):388-94. [Medline].
Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003 Jul 17. 349(3):215-24. [Medline].
Andriole GL, Bostwick DG, Brawley OW, Gomella LG, Marberger M, Montorsi F, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010 Apr 1. 362(13):1192-202. [Medline].
Azoulay L, Eberg M, Benayoun S, Pollak M. 5α-Reductase Inhibitors and the Risk of Cancer-Related Mortality in Men With Prostate Cancer. JAMA Oncol. 2015 Jun 1. 1 (3):314-20. [Medline].
Dimitropoulos K, Gravas S. Fixed-dose combination therapy with dutasteride and tamsulosin in the management of benign prostatic hyperplasia. Ther Adv Urol. 2016 Feb. 8 (1):19-28. [Medline]. [Full Text].
Madersbacher S, Marszalek M, Lackner J, Berger P, Schatzl G. The long-term outcome of medical therapy for BPH. Eur Urol. 2007 Jun. 51(6):1522-33. [Medline].
McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18. 349(25):2387-98. [Medline].
Montorsi F, Roehrborn C, Garcia-Penit J, et al. The effects of dutasteride or tamsulosin alone and in combination on storage and voiding symptoms in men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH): 4-year data from the Combination of Avodart and Tamsulosin (CombAT) study. BJU Int. 2011 May. 107(9):1426-31. [Medline].
Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008 Feb. 179(2):616-21; discussion 621. [Medline].
Montorsi F, Roehrborn C, Garcia-Penit J, Borre M, Roeleveld TA, Alimi JC, et al. The effects of dutasteride or tamsulosin alone and in combination on storage and voiding symptoms in men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH): 4-year data from the Combination of Avodart and Tamsulosin (CombAT) study. BJU Int. 2011 Feb 23. [Medline].
Dong Y, Hao L, Shi Z, Wang G, Zhang Z, Han C. Efficacy and safety of tadalafil monotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a meta-analysis. Urol Int. 2013. 91 (1):10-8. [Medline].
Zhang Z, Li H, Zhang X, Dai Y, Park HJ, Jiann BP, et al. Efficacy and safety of tadalafil 5 mg once-daily in Asian men with both lower urinary tract symptoms associated with benign prostatic hyperplasia and erectile dysfunction: A phase 3, randomized, double-blind, parallel, placebo- and tamsulosin-controlled study. Int J Urol. 2018 Oct 25. [Medline].
Sildenafil [package insert]. New York, NY: Pfizer Inc. 12/2017. Available at [Full Text].
Vardenafil [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc/GlaxoSmithKline. April 2014. Available at [Full Text].
Tadalafil [package insert]. Indianapolis, IN: Lilly USA LLC. October 2011. Available at [Full Text].
Sharma M, Chadha R, Dhingra N. Phytotherapeutic Agents for Benign Prostatic Hyperplasia: An Overview. Mini Rev Med Chem. 2017. 17 (14):1346-1363. [Medline].
Barry MJ, Meleth S, Lee JY, et al. Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms: A Randomized Trial. JAMA. 2011 Sep 28. 306(12):1344-1351. [Medline].
Damiano R, Cai T, Fornara P, Franzese CA, Leonardi R, Mirone V. The role of Cucurbita pepo in the management of patients affected by lower urinary tract symptoms due to benign prostatic hyperplasia: A narrative review. Arch Ital Urol Androl. 2016 Jul 4. 88 (2):136-43. [Medline]. [Full Text].
Malek RS, Kuntzman RS, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol. 2005 Oct. 174(4 Pt 1):1344-8. [Medline].
Kuntz RM. Laser treatment of benign prostatic hyperplasia. World J Urol. 2007 Jun. 25(3):241-7. [Medline].
Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: a size-independent new "gold standard". Urology. 2005 Nov. 66(5 Suppl):108-13. [Medline].
Gupta N, Rogers T, Holland B, Helo S, Dynda D, McVary KT. Three-Year Treatment Outcomes of Water Vapor Thermal Therapy Compared to Doxazosin, Finasteride and Combination Drug Therapy in Men with Benign Prostatic Hyperplasia: Cohort Data from the MTOPS Trial. J Urol. 2018 Aug. 200 (2):405-413. [Medline].
Crane M. FDA OKs New Device to Treat BPH. Medscape Medical News. Available at https://www.medscape.com/viewarticle/810981. September 13, 2013; Accessed: February 19, 2021.
Yu H, Isaacson AJ, Burke CT. Review of Current Literature for Prostatic Artery Embolization. Semin Intervent Radiol. 2016 Sep. 33 (3):231-5. [Medline].
Mirakhur A, McWilliams JP. Prostate Artery Embolization for Benign Prostatic Hyperplasia: Current Status. Can Assoc Radiol J. 2017 Feb. 68 (1):84-89. [Medline].
Shim SR, Kanhai K, Ko YM, Kim JH. Efficacy and safety of prostatic arterial embolization: Systematic review with meta-analysis and meta-regression. J Urol. 2016 Aug 31. [Medline].
Sotelo R, Spaliviero M, Garcia-Segui A, et al. Laparoscopic retropubic simple prostatectomy. J Urol. 2005 Mar. 173(3):757-60. [Medline].
Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Goodman P, Penson DF. Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. 2008 Apr 15. 167(8):925-34. [Medline].
Arai Y, Fukuzawa S, Terai A, Yoshida O. Transurethral microwave thermotherapy for benign prostatic hyperplasia: relation between clinical response and prostate histology. Prostate. 1996 Feb. 28(2):84-8. [Medline].
Barry MJ, Cockett AT, Holtgrewe HL, et al. Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J Urol. 1993 Aug. 150(2 Pt 1):351-8. [Medline].
Roehrborn CG. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. 2006 Apr. 97(4):734-41. [Medline].
Vallancien G, Emberton M, Alcaraz A, Matzkin H, van Moorselaar RJ, Hartung R. Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice. BJU Int. 2008 Apr. 101(7):847-52. [Medline].
Mulhall JP, Guhring P, Parker M, Hopps C. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med. 2006 Jul. 3(4):662-7. [Medline].
Ben-Zvi T, Hueber PA, Liberman D, Valdivieso R, Zorn KC. GreenLight XPS 180W vs HPS 120W Laser Therapy for Benign Prostate Hyperplasia: A Prospective Comparative Analysis After 200 Cases in a Single-center Study. Urology. 2013 Apr. 81(4):853-8. [Medline].
Bird ST, Delaney JA, Brophy JM, Etminan M, Skeldon SC, Hartzema AG. Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. BMJ. 2013 Nov 5. 347:f6320. [Medline]. [Full Text].
-
Benign prostatic hyperplasia. Normal prostate anatomy is shown. The prostate is located at the apex of the bladder and surrounds the proximal urethra.
-
Benign prostatic hyperplasia (BPH) diagnosis and treatment algorithm.
-
Benign prostatic hyperplasia. Basic management of lower urinary tract symptoms (LUTS) in men.
Tables
Levi A Deters, MD Attending Physician, Spokane Urology
Disclosure: Nothing to disclose.
Raymond A Costabile, MD Jay Y Gillenwater Professor of Urology and Vice Chairman, Senior Associate Dean for Clinical Strategy, University of Virginia Health System
Raymond A Costabile, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Andrology, American Urological Association, Phi Beta Kappa
Disclosure: Nothing to disclose.
Raymond J Leveillee, MD, FRCS(Glasg) Professor of Clinical Urology, Radiology and Biomedical Engineering, Department of Urology, University of Miami Miller School of Medicine; Chief, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, Department of Urology, Jackson Memorial Hospital
Raymond J Leveillee, MD, FRCS(Glasg) is a member of the following medical societies: American Urological Association, Endourological Society, Sigma Xi, The Scientific Research Honor Society, Society of Laparoendoscopic Surgeons
Disclosure: Received honoraria from ACMI/Gyrus for speaking and teaching; Received honoraria from Boston Scientific for speaking and teaching; Received honoraria from Applied Medical for speaking and teaching; Received honoraria from Intuitive Surgical for speaking and teaching; Received grant/research funds from Intio for other.
Charles R Moore, MD Endourology Fellow, Department of Urology, University of Miami School of Medicine
Charles R Moore, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association
Disclosure: Nothing to disclose.
Vipul R Patel, MD Consulting Surgeon, Global Robotics Institute, Florida Hospital Celebration Health
Vipul R Patel, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Endourological Society, Ohio State Medical Association, Society of Laparoendoscopic Surgeons
Disclosure: Received honoraria from Intuitive Surgical for speaking and teaching; Received honoraria from Pfizer for speaking and teaching.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo.
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Vincent G Bird, MD, to the development and writing of the source article.