Benign Prostatic Hyperplasia

What is BPH?
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland.

What Happens In BPH?
BPH causes urinary symptoms either by functional obstruction due to increased muscle tone at the bladder neck or by mechanical obstruction secondary to the compression of the urethral outlet by an enlarged prostate gland.

What Are The Symptoms Of BPH?

  • A weak urinary stream.
  • A sense of incomplete bladder emptying.
  • Difficulty in starting urination.
  • Frequent urination.
  • Urgency (the person has difficulty postponing urination).
  • Waking up frequently at night to urinate.
  • Interruption of the stream (‘stopping’ and ‘starting’ effect).
  • However, as prostate enlargement progresses, the urethra is squeezed on more tightly and the bladder cannot empty completely. In a small percentage of men, blockage from BPH may lead to repeated infections, sudden inability to urinate and stone formation.

How Is BPH Diagnosed?
Your doctor will first take your medical history and listen to the complaints you are having with urination. The doctor then continues with a physical examination of the prostate which lies in front of the rectum (As shown in Diagram A). The doctor can feel it by inserting a gloved finger into the rectum (As shown in Diagram B). This examination allows the physician to estimate whether the prostate is enlarged, has lumps, or other areas of abnormal texture.

When To See A Specialist
If your doctor has told you that you have BPH and the symptoms are bothersome, he or she may refer you to a urologist, a doctor who specializes in diseases of the urinary tract and the male reproductive system. The urologist will review the severity of your symptoms and perform specific tests.If you have uncomplicated BPH and are not bothered by your symptoms, you and your doctor may choose a program of “watchful waiting” – involving yearly or more frequent checkups. BPH requires treatment only if symptoms are bothersome or when urinary function is severely affected. These include surgical and non-surgical treatments:-

Surgical treatments For BPH
Surgery is currently most effective method of treatment when BPH symptoms are bothersome and blockage to the bladder is significantly severe. The most common surgical procedure is the transurethral resection of the prostate (TURP) in which the prostate’s innermost core is removed. TURP is performed through the urethra, so no skin incision is necessary.Most men do get retrograde ejaculation (ejaculation of semen backward into the bladder instead of through the urethra to the outside), which means that they most likely can no longer father children. Partial loss of control of urination (incontinence) is a rare complication of surgery for BPH in less that 1% of patients.

It is important to be aware that treatment for BPH does not eliminate prostate cancer. Prostate cancer begins in the outer layer of the prostate, which is not the portion removed during surgery for BPH. Yearly examinations are as important for men who have had surgery for BPH as for men who have not.

Nonsurgical Treatment For BPH
Non-surgery treatments for BPH are indicated for patients with bothersome symptoms but with no significant blockage of the bladder. Non-surgery treatments are generally not as effective as surgery. However, the risks of treatment are less.

5 alpha reductase inhibitors such as finasteride are types of medication that reduce the level of a male hormone called dihydrotestosterone (DHT) which contributes to prostate growth. They can also reduce the size of the enlarged prostate and relieve the symptom of BPH. Though the long-term benefits of finasteride are still unknown, clinical trials have shown that when patients’ symptoms improve with finasteride, that improvement continues for at least four years. Alpha blockers are medications that can relax the bladder neck muscle and may relieve part of the blockage. Similarly, long-term result is unknown at present. Patients whose symptoms improve with alpha blockers are likely to continue that improvement for at least two years.

Will BPH Affect My Life And My Lifestyle?
The good news is that you need not suffer from bothersome BPH symptoms. Such symptoms are not a necessarily part of getting older. They can be treated, and the number of treatment choices are increasing every year. If you are bothered by urinary symptoms, see your doctor for a prostate checkup.