BENIGN PROSTATIC HYPERPLASIA
Introduction on Benign Prostatic Hyperplasia
BPH or Benign Prostatic Hyperplasia also known as Benign Prostatic Hypertrophy is a medical condition that affects men and people assigned male at birth (AMAB) and is characterized by proliferation of cells of the prostate gland, making it to become enlarged. The prostate is a small gland, located just below the bladder and it is involved in manufacturing some of the components of semen.
BPH is a common urological condition.
Key Facts & Statistics
Key facts and statistics that surround BPH
- This is a common condition. In fact, it is the most common prostate problem in people assigned male at birth. It is speculated that almost all individuals with a prostate will develop an enlargement in their prostates as they grow older.
- By the age of 60 years, almost half of the population with a prostate will show some signs of BPH.
- About 50% of individuals with BPH will develop symptoms that need medical attention.
Risk Factors
What are the risk factors for BPH?
Sex. BPH is the most common prostate problem in persons assigned male at birth (AMAB).
NOTE:
- BPH and cancer of the prostate have similar symptoms.
- A diagnosis of BPH does not mean that there is an increased risk of developing prostate cancer.
Causes
What are the causes of BPH?
The cause of BPH is not yet clear.
One of the theories developed revolves around the hormone testosterone. It suggests that, as an individual becomes older, testosterone becomes lower in their body. During the same period, estrogen levels are raised. These hormonal changes may cause the prostate gland to grow bigger.
However, people who take supplemental testosterone may develop or even worsen BPH.
Older men also have been found to have higher levels of dihydrotestosterone (DHT), which is a more potent form of testosterone. It increases the size of the prostate glan
Signs & Symptoms
What are the signs and symptoms of BPH?
The prostate surrounds the urethra, which allows urine to be passed out. BPH causes the prostate to grow, leading to blockage of the urethra.
As a result, early symptoms of BPH can include:
- Urine incontinence (leaking)
- Painful ejaculation.
- Urine that smells.
- Trouble beginning to urinate.
- Change in color of urine.
- Inability to completely empty the bladder.
- Sudden need to urinate.
- Slowness or dribbling during urination.
The size of the prostate does not always determine how serious the symptoms are. Some individuals who have slightly enlarged prostates can have major symptoms, while others who have much more enlarged prostates can have minor symptoms.
Urinary symptoms can be caused by other possible causes
Several medical conditions can lead to symptoms that are similar to those of an enlarged prostate. These are:
- An inflamed prostate.
- Bladder or kidney stones.
- Cancer of the bladder or prostate.
- Scarring in the bladder neck (due to past surgery).
- Narrowing of the urethra.
Diagnostic Procedures & Tests
How is BPH diagnosed?
Urologists are specialist doctors that deal with BPH and related disorders of the urinary system.
Diagnosis involves procedures such as patient-history taking (presenting signs and symptoms are noted down) and performing a clinical examination (which involves digital rectal examination).
In a digital rectal exam, a gloved and lubricated finger is inserted carefully into the patient’s rectum in order to:
- Feel the edges and surfaces of the prostate.
- Estimate the size of the prostate.
- Detect any hard areas (which could be cancer).
Apart from a digital rectal exam being performed, the urologist can also order for other tests:
- A cytoscopy test. This helps look into the bladder.
- A urine flow test. This measures the speed of urine flow.
- A study to check the amount of urine that remains in the bladder after urinating.
- A survey to evaluate the severity of the symptoms.
Treatment and Management
Does BPH have a cure?
Currently, it is unfortunate that there lacks a cure for BPH. Several treatment options are available to help in alleviating of symptoms.
How is BPH treated?
Mild symptoms rarely require treatment. A “watchful waiting” approach can be utilized- regular appointments are scheduled to make sure that BPH does not get any worse.
Current treatment options are:
- Medications.
- Surgery.
- Minimally invasive treatments.
Medications
Most medications that are prescribed are meant to relax the muscle in the prostate, thereby lowering tension on the urethra.
Examples are:
- Tamsulosin.
- Terazosin.
- Doxazosin.
- Alfuzosin.
- Silodosin.
Some medications reduce the production of dihydrotestosterone, thereby slowing down the growth of the prostate gland. They are a useful option for people with larger prostates. They include:
- Dutasteride.
- Finasteride.
Combinations of drugs are also applicable- for example dutasteride and tamsulosin.
It can take 1-8 weeks after starting medications for symptoms to improve.
Surgery
There are several surgical procedures that can be performed to remove prostate tissue that blocks the urethra. These are:
- Transurethral resection of the prostate (TURP).
- Transurethral incission of the prostate (TUIP).
- Transurethral electrovaporization.
- GreenLight laser treatment/ photoselective vaporization of the prostate/ prostate photovaporization.
- Aquablation.
Minimally invasive treatments
These include:
- Rezum therapy
- Prostatic urethral lift.
Herbal medicines
Prunus africana leaves can be used to treat BPH.
Complications
What are the complications of untreated BPH?
Untreated BPH can lead to further urethral blockages and worsening of symptoms. It may also cause:
- Hematuria (blood in urine)
- Bladder stones.
- Urinary tract infection (UTI).
- Kidney damage. This can occur when urine flows from the bladder back to the kidney. Urine back-flow increases pressure on the kidney.
Prevention
How can we prevent the risk of developing BPH?
Lowering this risk can be achieved by;
- Embracing a lifestyle that improves prostate and heart health
- Performing physical exercises for at least half hour per day.
- Maintaining normal blood pressure, blood sugar and cholesterol ranges.
- Herbal supplements. Pumpkin seed oil can aid in shrinking of the prostate.