Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy is the enlargement of the prostate gland. The word "benign" means the cells are not cancerous. "Hyperplasia" means an increased number of cells. The prostate gland usually enlarges with age but doesn't usually cause problems. Symptoms are rarely seen before the age of 40, but over half of all men in their sixties and about 90%of men in their seventies and eighties show some symptoms of BPH.
The prostate gland encircles the urethra, so when the gland enlarges, it presses against the urethra, restricting urine flow through the tube and causing problems with urination. The following changes occur over a period of time:
- Bladder wall thickens and becomes irritable
- Frequent urination as the bladder walls begin to contract even with small amounts of urine
- The bladder becomes weak and loses the ability to empty; thereby retaining urine
The partial emptying of the bladder and narrowing of the urethra may lead to many problems such as:
- Urinating more often during the day
- Urge to urinate frequently during the night
- Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time
- The urine stream is slow to start
- Urine dribbling for some time after urination
- A sensation that the bladder isn't fully emptied after urination
- Lack of force to the urine flow
- The sensation of wanting to go again a few minutes after urinating
Diagnosis of Benign Prostatic Hyperplasia (BPH)
You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may do a physical examination to assess the condition of the prostate.
The tests vary from patient to patient, but the following are the most common:
- Urinalysis: A urine sample is taken to look for signs of blood and infection.
- Digital rectal examination (DRE): Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious, such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.
- Prostate-specific antigen (PSA) test: A blood sample is taken by your doctor to check for prostate-specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.
As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).
PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.
Urodynamics: Your doctor may ask you to urinate into a device that measures how fast the urine flows. A decrease in the flow can suggest BPH.
Intravenous pyelogram (IVP): IVP is an X-ray of the urinary tract. In this test, a dye is injected into a vein, and an X-ray is taken. The dye makes the urine visible on the X-ray and shows any obstruction or blockage in the urinary tract.
Cystoscopy: Your doctor inserts a small tube called a cystoscope(contains a lens and light system) through the urethral opening in the penis. It helps your doctor closely view the urethra and bladder, and determine the size, location, and extent of obstruction.
Treatment of Benign Prostatic Hyperplasia (BPH)
If you do not experience any symptoms of BPH, your doctor may decide to wait-and-watch for the progression of the condition with regular monitoring, usually once a year.
The doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person's general health condition, medical history, medications taken for other conditions and quality of life considerations.
Surgery for Benign Prostatic Hyperplasia (BPH)
Modern surgical procedures usually access the prostate through the urethra, so no incision is required. Different approaches to benign prostate surgery include:
- Transurethral resection of the prostate (TURP): Removal of part of the prostate causing obstruction with the help of surgical instruments passed through the urethra.
- Transurethral incision of the prostate (TUIP): Making incisions on the prostate with instruments introduced through the urethra to decrease the pressure on the urethra.
- Laser therapy: Using a laser to make cuts or destroy the obstructive part of the prostate.
- Transurethral needle ablation (TUNA): Destroying part of the prostate with a heated needle.
- Transurethral microwave therapy (TUMT): Using heat from microwave energy to destroy part of the prostate.
- UroLift: A new system which uses implants to shift and hold prostate tissue away from the urethra.
- Open prostatectomy: Making an incision on the skin to access and remove the prostate (rarely used and mostly recommended for very large prostates).
Risks and Complications of Benign Prostatic Hyperplasia (BPH) Surgery
As with most surgical procedures, surgery for benign enlargement of the prostate may be associated with certain risks, which include problems with erection, retrograde ejaculation (releasing semen backward into the bladder during ejaculation) and urinary incontinence (loss of bladder control).