Benign Prostatic Enlargement (BPH)

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) 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 always cause problems.

The prostate is made up of anatomical zones, BPH typically occurs in the central and transitional zones of the prostate, and prostate cancer typically occurs in the peripheral zones of the prostate.

What are the symptoms of benign prostatic hyperplasia?

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 may occur over a period of time is prostatic enlargement causing obstruction is not treated:

  • Bladder wall thickens, capacity of the bladder is reduced and becomes irritable
  • Frequent urination as the bladder walls begin to contract even with small amounts of urine
  • Bladder may become weak and loses the ability to empty; thereby retaining urine

The partial emptying of the bladder and narrowing of the prostatic 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
  • Needing to strain and push with abdominal muscles to start urination
  • 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

How is benign prostatic hyperplasia diagnosed?

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:

  • Urine test: 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 assess the size and condition of the prostate that can be felt under rectal wall. If your doctor feels something suspicious, such as a lump or bump, further tests will be carried out.
  • 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.

Further tests may be required to assess the prostate.

  • Flow test and bladder scan: 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. A bladder scan is then performed to assess how much urine is left in the bladder after urination.
  • Ultrasond: Ultrasound imaging is used to estimate the size of the prostate gland and also look for growth of the prostate gland into the bladder. This can be done over the abdomen or through the rectum.
  • 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.
  • Urodynamics study: This measures pressure in your bladder and in the surrounding region during bladder filling and urination. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with water. Another catheter with a pressure-measuring sensor is placed in your rectum. This procedure can differentiate between several conditions that can cause difficulties voiding, including bladder outlet obstruction caused by BPH, overactive bladder and underactive bladder. This test is recommended when the doctor is not sure if the urination symptoms are caused by BPH.

How is benign prostatic hyperplasia treated?

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.

Your 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 is another option for the treatment of BPH. There are now many options for treatment of BPH including the UROLIFT procedure and various operations aimed at reducing the size of the prostate gland using different energy sources. The best choice of the procedure will depend on the prostate size and configuration and whether you are taking medicines that affect blood clotting.

Options include:

  • TURP: Transurethral resection of the prostate gland
  • HOLEP: Holmium laser enucleation of the prostate gland
  • PVP: Greenlight laser vaporisation of the prostate gland

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