Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland in men enlarges and is not cancerous. Benign prostatic hyperplasia, benign prostatic hypertrophy or benign prostatic obstruction are other names for this disease. 

As the prostate enlarges, the urethra is compressed and presses against it. This can cause thickening of the bladder wall, weakening the bladder and losing its ability to empty completely, leaving some urine in the bladder. Many of these problems related to benign prostate hyperplasia are brought on by urethral narrowing and urine retention (inability to completely empty the bladder).

A urology doctor chooses a method of treatment for benign prostatic hyperplasia based on the severity of symptoms, how much the symptoms affect a man's daily life, and a man's preferences. (1)

Definition and Overview

Benign Prostate Hyperplasia (BPH), also known as benign prostatic enlargement, is the medical term to describe an enlarged prostate, a condition that can affect urination. Benign Prostate Hyperplasia (BPH) is common in men over the age of 50. Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer, but it is not cancer and usually does not pose a serious threat to health. Men who experience an enlarged prostate do not have a greater risk of prostate cancer than men without an enlarged prostate.(2)

A healthcare provider diagnoses benign prostatic hyperplasia based on personal and family medical history, physical examination, and medical tests. Doctors who specialize in urinary problems and the male reproductive system (urologists) usually diagnose benign prostatic hyperplasia based on symptoms and a digital rectal exam. They use medical tests and certain procedures to help diagnose lower urinary tract problems related to benign prostatic hyperplasia and recommend treatment. These tests include:

• Urinalysis

The patient takes a urine sample in a special container in a medical facility. During a practice visit, a healthcare professional sends the sample to a lab for analysis. The doctor examines the lab result of the urine sample.

• A prostate-specific antigen (PSA) blood test

A healthcare provider takes a blood sample for a PSA test and sends it to a lab for examination. PSA is a protein produced by prostate cells. Blood PSA levels in men with prostate cancer may be higher. However, prostate cancer is not always indicated by a high PSA level. In some cases, benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations cause the PSA level to rise.

• Urodynamic tests

In urodynamic tests, different techniques are used to assess how well the bladder and urethra hold and release urine.

• Cystoscopy

 Cystoscopy is a procedure that uses a tube-like instrument called a cystoscope to view the inside of the urethra and bladder. Through the incision at the tip of the penis, a urologist inserts the cystoscope into the lower urinary system.

• Transrectal ultrasound

Transrectal ultrasound creates an image of the organ's structure by projecting safe, painless sound waves from the organs.

• Biopsy

A biopsy is a procedure that involves removing a small piece of prostate tissue for examination with a microscope. (3)

Procedures

The doctor chooses a benign prostatic hyperplasia treatment procedure according to the severity of the symptoms of the patient, how much it affects his daily life and his preferences. These procedures include the following.

• Medications

An urologist may recommend drugs that decrease or stop the prostate from growing, or that lessen the symptoms of benign prostatic hyperplasia.

• Minimally Invasive Procedures

If medicine doesn't work to treat the symptoms of benign prostatic hyperplasia, there are several minimally invasive procedures that can help. Benign prostatic hyperplasia can cause congestion and urine retention, however minimally invasive procedures can help relieve these symptoms by widening the urethra or destroying enlarged prostate tissue. Depending on the procedure, local, regional, or general anesthesia may be needed. The most common minimally invasive procedures include:

• Transurethral needle ablation
• Transurethral microwave thermotherapy
• High-intensity focused ultrasound
• Transurethral electrovaporization
• Water-induced thermotherapy
• Prostatic stent insertion
• Surgery

A urologist might advise removing the enlarged prostate tissue or creating incisions in the prostate to expand the urethra as long-term treatments for benign prostatic hyperplasia. Surgeries to remove enlarged prostate tissue includes 

• Transurethral resection of the prostate (TURP)
• Laser surgery
• Open prostatectomy
• Transurethral incision of the prostate (TUIP) (4)

Candidates

Prostate enlargement can irritate or block the bladder. The need to urinate frequently is a common symptom of BPH. Men with the following symptoms are good candidates for BPH treatment and surgery.

• Incomplete emptying: a feeling that the bladder is full, even after urinating.
• Frequency: the need to urinate frequently, about once every one to two hours.
• Intermittent: the need to stop and start several times while urinating.
• Urgency: feeling the urgent need to urinate as if you couldn't wait.
• Weak flow: a weak stream of urine.
• Strain: difficulty starting to urinate or the need to push or strain to pass urine.
• Nocturia: needing to wake up more than twice a night to urinate (5)

Risks and Side Effects

Medications used for treatment may have some side effects such as

• hives,
• rash,
• itching,
• shortness of breath,
• rapid, pounding, or irregular heartbeat, and more.

Risks after minimally invasive procedures may include

• painful urination,
• difficulty urinating,
• an urgent or frequent need to urinate,
• urinary incontinence,
• blood in the urine for several days after the procedure,
• sexual dysfunction.

Risks and side effects after surgery may include

• problems urinating
• urinary incontinence
• bleeding and blood clots
• infection
• scar tissue
• sexual dysfunction
• recurring problems such as urinary retention and UTIs (6)

Post-Procedure and Follow-up

Most men's BPH symptoms become better with treatment. Following different treatments, it's possible to get an infection, bleeding, urine incontinence, or erectile dysfunction. Scar tissue may develop in some situations. After surgery, it could take some time for sexual function to recover.

Recovery

After the procedures, it is normally acceptable to resume routine daily activities, and one to two months later, it is safe to begin strenuous activities. 

Results

Most men start to feel better and have a better urine flow 4 to 6 weeks after their BPH treatments. When you feel that there is an emergency, medical assistance should be sought immediately. (7)