BENIGN PROSTATIC HYPERPLASIA (BPH)

Benign Prostatic Hyperplasia (BPH) can also be called Prostate Gland Enlargement. This condition is a common condition as men get older. The prostate gland is located beneath the bladder. That is, the tube that transports urine from the bladder out of the penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older. Diagnosis and treatment of BPH and other diseases of the urinary system is done by a urologist.

Risk factors of BPH

There are some factors that can put us at risk of developing Benign Prostatic Hypertrophy. These are:

  1. Aging: Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60 and about half do so by age 80.
  2. Past history: Having a family history of BPH put the individual at risk of developing BPH.
  3. Diabetes and heart disease: Studies show that diabetes, as well as heart disease and use of beta blockers medications, might increase the risk of BPH.
  4. Lifestyle:  Obesity increases the risk of BPH, while exercise can lower your risk.

Signs and Symptoms of BPH

Common signs and symptoms of BPH include:

  1. Frequency or urgency in urination
  2. Increased frequency of urination at night (nocturia)
  3. Difficulty starting urination
  4. Weak urine stream or a stream that stops and starts
  5. Dribbling at the end of urination
  6. Inability to completely empty the bladder
  7. Urinary incontinence: the accidental loss of urine
  8. Pain after ejaculation or during urination
  9. Urine that has an unusual color or smell.

Diagnosis of BPH

Diagnostic tests of BPH may include:

  1. Urinalysis: this involves testing a urine sample by placing a strip of chemically treated paper, called a dipstick into the urine. Patches on the dipstick change color to indicate signs of infection in urine.
  2. Prostate-Specific Antigen (PSA) blood test: Prostate cells create protein called PSA. Blood is drawn from the individual for a PSA test and the test has the ability to discriminate between benign prostatic hyperplasia and cancer, and the best course of action to take if the PSA level is high.
  3. Urodynamic test: this includes a variety of procedures that look at how well the bladder and urethra store and release urine.
  4. Cystoscopy: this is a procedure that uses an instrument called cystoscope to look inside the urethra and bladder. A cystoscope may also be used to look for blockage or stones in the urinary tract.
  5. Transrectal ultrasound: this uses a device called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The ultrasound image shows the size of the prostate and shows any abnormalities such as tumors.
  6. Biopsy: this is a procedure that involves taking a small piece of prostate tissue for examination with a microscope.

Management of BPH

Treatment of BPH may include:

  1. Lifestyle changes: this includes reducing or avoiding the intake of caffeinated beverages and alcohol; training the bladder to hold more urine for longer periods; avoiding or monitoring the use of medications such as decongestants, antidepressants, antihistamines; exercising pelvic floor muscles and preventing or treating constipations.
  2. Medications: drugs that stops the growth or shrink the prostate or reduce symptoms associated with BPH include: Alpha blockers e.g., Terazosin (Hytrin), Doxazosin (Cardura); Phosphodiesterase-5 inhibitors e.g., Tadalafil (Cialis); 5-alpha reductase inhibitors e.g., Finasteride (Proscar), Dutasteride (Avodart); Combination medication e.g., Finasteride and doxazosin, Dutasteride and Tamsulosin (Jalyn) (a combination of both medications that’s available in a single tablet).
  3. Minimally Invasive Procedures: these procedures provide relief to BPH symptoms when medications prove ineffective. These procedures include: Transurethral needle ablation: this procedure uses heat generated by radio frequency energy to destroy selected portions of prostate tissue. Transurethral microwave thermotherapy: this procedure uses microwaves to destroy enlarged prostate tissue. High-intensity focused ultrasound: a special ultrasound probe is inserted into the rectum, near the prostate and this ultrasound waves from the probe heat destroy enlarged prostate tissue. Transurethral electrovaporization: a resectoscope is inserted through the urethra to reach the prostate. An electrode attached to this instrumen6t moves across the surface of the prostate and transmits an electric current that vaporizes prostate tissue. Water-induced thermotherapy: this procedure uses heated water to destroy prostate tissue. Prostatic stent insertion: this procedure involves inserting a prostatic stent through the urethra to the area narrowed by the enlarged prostate. Once the stent is in place, it expands like a spring and pushes back the prostate tissue.
  4. Surgery: For long-term treatment of BPH, a urologist may recommend removing enlarged prostate tissue or making cuts in the prostate to widen the urethra. Surgery to remove enlarged prostate tissue includes Transurethral resection of the prostate (TURP), Laser surgery, Open Prostatectomy and Transurethral incision of the prostate (TUIP).

Complications of BPH

  1. Infection e.g., Urinary Tract Infection
  2. Bladder stones
  3. Reduced kidney function
  4. Kidney failure
  5. Bladder damage.

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