BPH

Benign Prostatic Hyperplasia


What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia also abbreviated as BPH, is a well-known benign enlargement of the prostate faced by men of advancing age. 


BPH causes the prostate gland to become enlarged and causes difficulty during urination.  BPH is common and is not related to Prostate Cancer.

Who Does Benign Prostatic Hyperplasia Affect?


BPH occurrence increases with increasing age. 


  • Around 30% at age 60 experience BPH 
  • Over 50% of men aged 70 experience BPH with about 30% finding the symptoms bothersome.
  • About 90% of men over the age of 85 will have BPH.


Other risk factors for BPH include:


  • A positive family history, 
  • obesity, 
  • cardiovascular conditions and 
  • pre-existing diabetes 


How Does BPH Occur?

BPH occurs as a result of both proliferation (hyperplasia) and increased growth (hypertrophy) of the epithelial and stromal layers of the prostate gland. This is typically in response to hormonal changes which results in enlargement of the gland. A more correct name should be Benign Prostatic Enlargement.


Causes Of BPH?

BPH is a benign enlargement of the prostate gland. The exact causes are not fully understood, however, it may be due to the natural growth process or due to hormonal changes that occur with age, specifically testosterone and dihydrotestosterone (DHT).


Symptoms of BPH

The symptoms caused by BPH are a result of the constriction of the urethra and the secondary response of the bladder, which results in:

 

  • Increased need to go to the bathroom at night-time (nocturia)
  • Increased frequency of urination
  • Increased urgency, and possibly urge incontinence when it becomes extreme
  • Weak stream of urine
  • Difficulty getting started (hesitancy)
  • An interrupted urinary stream (intermittency)
  • Dribbling after urination
  • The feeling of incomplete emptying


Severity Of Benign Prostatic Hyperplasia

The growth of benign prostatic tissues can be determined by your surgeon. However, prostate size is not always an indicator of symptoms severity.


How is Benign Prostatic Hyperplasia Diagnosed?


The diagnosis of BPH is made by the doctor by performing the following tests:

 

  • History of symptoms, and associated complications
  • Digital Rectal Examination
  • Blood Tests including PSA (Prostate-Specific Antigen) test
  • Urinary Flow Test
  • Cystoscopy 
  • Ultrasound
  • Urodynamics

How is Benign Prostatic Hyperplasia Treated?

Treatment options for BPH include both medications as well as surgical options, and the best course of therapy is determined by the doctor based on:

 

  • overall health, 
  • lab results,
  • progression of the enlargement, and
  • presence of complications due to enlarged prostate


Medications for BPH Treatment

Medicine works best in cases with mild to moderate symptoms and includes

 

  • Alpha blockers – They act by relaxing the neck of the bladder muscles and surrounding tissues, making it easier to urinate.
  • 5 Alpha-Reductase Inhibitors – This group of drugs results in size reduction of the prostate gland, again, making urination easier
  • Combination – A combination approach can also be given in certain cases. These work by relaxing bladder muscles and shrinking the prostate gland, respectively.
  • PDE5 inhibitors – They have been shown to be effective presumably due to the relaxation of the smooth muscle fibers of the bladder and prostate, especially useful in men with erectile dysfunction

Anticholinergics or beta3 agonist (Mirabegron) – They are not the first line for BPH. However, they relieve overactive bladder symptoms and are useful adjuncts, especially for men suffering severe urge or urge incontinence


Surgical BPH Treatments

 

  • UroLift - tiny implants are placed into the prostate that effectively holds the urethra open. There is no cutting, heating or removal of prostate tissue.
  • Laser Therapy - where amplified light energy is used to generate heat to destroy prostatic tissue. There are many different types of laser therapy for BPH, Dr Hadley uses a GreenLight Laser.
  • REZUM – Using water vapour (steam) which is injected into the prostate causing the enlarged parts of the prostate to die and be reabsorbed by the body.
  • Bladder Neck Incision (BNI) or Trans-urethral Incision Of The Prostate (TUIP)- this procedure is usually done in small prostates where the incision is made where the bladder and prostate join at the bladder neck. 
  • Trans-urethral Resection Of The Prostate (TURP) - A telescope is inserted via the urethra and the enlarged part of the prostate gland is removed
  • Simple Prostatectomy (Open/Robotic) - indicated especially if the above endoscopic option is not most suitable, especially for men with very large or massive prostate gland. Unlike prostatectomy for prostate cancer involving removing the entire prostate (radical prostatectomy), this procedure removes just the part of the prostate that's blocking the flow of urine (adenomas). 
  • Prostatic Artery embolization (PAE) – where the blood supply to the prostate is cut, a shrinkage in size is expected to allow easier passing of urine.

 


What If BPH Is Untreated 

If left untreated, the symptoms caused by BPH may continue to cause the patient mild or severe distress, depending upon the growth of the prostate gland.

Further distress can result from the frequently worrying about having to urinate and constant visits to the bathroom when at work or attending events and at night. Usually it is a lifestyle problem rather than a medical problem.


Sometimes medical complications such as frequent urine infections, an inability to pass urine at all (retention), bladder stone formation, blood in urine (haematuria), and kidney damage can occur.

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