Benign prostatic hyperplasia

 

Benign prostatic hyperplasia (BPH) is an overgrowth of the prostate gland, a gland located between the penis and the bladder. The prostate gland surrounds the urethra and produces a fluid that forms a part of the semen. BPH is not cancer.

 

 

The cause of BPH is not clearly known. The risk factors include:

1. Age -- BPH usually occurs in men above the age of 50 years. Its incidence increases with age. Almost 88% of men develop BPH by the 80 years of age.

2. Testicular function -- the presence of testicular function increases the risk of BPH. It does not occur in men who have been castrated (testicles are removed) for some reason.

 

 

The enlarged prostate compresses the urethra and makes the passage of urine through it difficult. The symptoms include:

1. Frequent need to urinate

2. Inability to void completely

3. Leakage of urine

4. Inability to hold the urine

5. Need to wake up at night to urinate

6. Incomplete emptying of the bladder

The size of the prostate gland is not related to the severity of symptoms. However, increased inflammation may increase the severity of BPH.

Severe BPH symptoms include:

1. Blood in the urine

2. Stones in the bladder

3. Inability to empty the bladder

4. Urinary tract infection

 

 

The investigations for BPH include the following:

1. History of the symptoms and how long you have had them.

2. Digital rectal exam to check the size of the prostate gland. The doctor will insert a gloved finger into the rectum and feels the prostate gland.

3. Urine tests and urine culture to check for infections

4. Blood test to check prostate specific antigen (PSA) levels. The PSA is a protein made by the prostate glands. Elevated levels of PSA may indicate prostate cancer.

Other tests for severe BPH may include:

1. Uroflowmetry to measure the flow rate and the force with which urine is passed. It is also called uroflow test.

2. Post-void residual (PVR) test to measure the volume of urine left in the bladder after passing urine.

3. Urethrocystoscopy to look for abnormalities inside the bladder

5. Ultrasound of the prostate gland may be done before doing an invasive procedure such as a surgery to correct BPH.

 

 

BPH is treated through both invasive and non-invasive procedures. The treatment mainly aims at:

1. Reducing the size of the prostate gland

2. Correcting the smooth muscle tone of the prostate gland

The doctor may prescribe the following medicines for BPH:

1. Antiandrogens: These drugs block the effect of the male sex hormone testosterone and dihydrotestosterone.

2. a-Adrenergic receptor antagonists: These medicines relax the muscle of the prostate. They act quickly and improve the symptoms in 1 to 2 weeks. These do not affect the size of the prostate gland. Examples include tamsulosin.

3. 5a-Reductase inhibitors: These medicines block the conversion of testosterone to dihydrotestosterone (DHT) and help in reducing the size of the prostate gland. However, the effect may not be seen very soon and it may take up to 6 months. These are usually prescribed when there is a large increase in the size of the prostate gland. Examples include finasteride and dutasteride.

Surgery may be required if the patient is not able to pass urine. The doctor may perform transurethral resection of the prostate (TURP). This process involves removing the tissue of the prostate gland that is obstructing the urine flow.

Other invasive procedures to remove the obstructing prostate tissue may include the use of:

1. Hyperthermia

2. Microwave thermotherapy

3. Laser-based tissue coagulation

 

 

If BPH is not treated it may lead to complications such as:

1. Inability to pass urine

2. Bladder dysfunction

3. Kidney disease that may require dialysis

In extreme cases, BPH can lead to death.

Using antiandrogens for treatment may have side effects. These include:

1. Increase in breast size

2. Weakening of bones

3. Loss of libido

4. Problems with erection

5. Problems with metabolism of glucose

Conditions that may be associated with BPH include:

1. Obesity

2. Diabetes

3. Heart diseases

 

 

The symptoms of BPH may get better with treatment. However, the medications may cause some side-effects. It is not possible to prevent BPH.

 

 

Beardsley EK, Frydenberg M, Risbridger GP. Endocrinology of benign prostatic hyperplasia and prostate cancer. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143.

Roehrborn CG. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 103.