Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a prevalent condition that affects a significant number of men, particularly those over the age of 50. As a noncancerous growth of the prostate gland, BPH can lead to various urinary symptoms that can have a substantial impact on an individual's quality of life. In this article, we will explore the causes, symptoms, and stages of BPH to provide a comprehensive understanding of this condition and the available treatment options.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland. The prostate, a small gland located below the bladder and surrounding the urethra, plays a vital role in the male reproductive system by producing seminal fluid. As men age, the prostate can gradually increase in size, potentially leading to urinary symptoms. BPH is the most common benign tumour found in men, affecting approximately one-third of those over the age of 50. While BPH is not cancerous, it can significantly impact the quality of life if left untreated. Understanding the stages and types of BPH is essential for proper diagnosis and management.

There are three main types of BPH, each with its own characteristics:

• Simple enlargement: In this type, the prostate gland grows in size but does not cause significant urinary symptoms. Men with simple enlargement may not require immediate treatment but should be monitored regularly.

• Obstructive BPH: This type of BPH is characterised by an enlarging prostate that causes urinary symptoms due to bladder outlet obstruction. Treatment is often necessary to alleviate symptoms and prevent complications.

• Non-obstructive BPH: In non-obstructive BPH, the prostate gland grows without causing significant urinary symptoms despite its increased size. While treatment may not be immediately necessary, regular monitoring is still important.

Understanding these types of BPH can help doctors develop personalised treatment plans that address each patient's specific needs and concerns.

These early signs of benign prostatic hyperplasia can be subtle and may gradually worsen over time, leading to more pronounced symptoms. These include:

• Difficulty peeing

• Weak urine flow

• Trouble starting to urinate

• Straining while urinating

• Stopping and starting urine flow

• Dribbling after urination

• Frequent urination

• Increased urgency to pee

• Waking up frequently to pee at night

Benign prostatic hyperplasia causes various urinary symptoms due to prostate enlargement. These include:

• Obstructive symptoms: Enlargement of the prostate can compress the urethra, leading to a weak or interrupted urine stream. Difficulty starting urination and a feeling of incomplete bladder emptying are common, and in severe cases, urinary retention may occur.

• Irritative symptoms: BPH can also increase bladder activity, resulting in frequent urination, a sudden strong urge to urinate, and nocturia, which involves waking up multiple times at night to urinate.

It is important to note that advanced BPH may lead to complications like urinary tract infections or bladder stones, which can cause painful urination or blood in the urine.

The progression of BPH can be divided into three main stages:

• Early stage: In this initial stage, the prostate begins to enlarge, but the growth is not significant enough to cause noticeable urinary symptoms. Many men may be unaware of their condition at this point.

• Moderate stage: As the prostate continues to grow, men may start to experience notable urinary symptoms, such as increased frequency, urgency, nocturia, and a weaker urine stream. At this stage, symptoms can often be managed through lifestyle changes and medication.

• Advanced stage: In the advanced stage, the prostate has enlarged to a point where it causes severe urinary symptoms that require medical intervention. If left untreated, complications such as urinary retention, infections, and even kidney damage can occur.

Benign prostatic hyperplasia arises from a combination of factors that lead to the enlargement of the prostate gland. These include:

• Hormonal changes: A key cause of BPH is hormonal changes that occur with ageing. As men grow older, levels of testosterone and its derivative, dihydrotestosterone (DHT), change. DHT is known to stimulate prostate cell growth, which contributes to the enlargement of the prostate gland.

• Genetic factors: Genetics also play a significant role in BPH. Men with a family history of prostate problems are more likely to develop BPH, indicating that genetic predisposition influences the risk of prostate enlargement.

• Age-related changes: BPH is uncommon in younger men but becomes increasingly prevalent after age 50. This age-related increase in prostate size is a natural part of ageing.

• Lifestyle and environmental factors: Aspects such as diet, physical activity, and overall health can influence prostate health, although their precise impact on BPH requires further research.

Several factors can increase the likelihood of developing BPH. These include:

• Age 60 or older

• Family history of BPH

• Familial hypercholesterolaemia

• Obesity

• Lack of physical activity

• Imbalances in hormones (testosterone and dihydrotestosterone)

• Diet high in red meat, dairy, and processed foods

Who's at Risk?

Certain groups have a higher risk of developing benign prostatic hyperplasia. These include:

• Men over age 60

• Men with a family history of BPH

• Men with familial hypercholesterolaemia

• Men who consume a diet high in red meat, dairy, and processed foods

Benign prostatic hyperplasia (BPH) can lead to various complications if left untreated. Some of the most common complications associated with BPH include:

• Urinary tract infections (UTIs): UTIs occur when bacteria enter the urinary system and multiply, causing infection. In men with BPH, the enlarged prostate can obstruct the flow of urine, allowing bacteria to grow more easily. If left untreated, UTIs can lead to kidney damage.

• Acute urinary retention (AUR): AUR is a sudden inability to pass any urine, which should be treated as a medical emergency. It can occur when the enlarged prostate completely blocks the urethra, preventing urine from flowing out of the bladder. If urine backs up into the kidneys, it can cause kidney damage.

• Bladder stones: When urine becomes concentrated due to incomplete emptying of the bladder, it can crystallise and form stones. These stones can cause infections and other complications, such as pain and difficulty urinating.

• Gross haematuria: Gross haematuria refers to visible blood in the urine, which can occur due to bleeding from the prostate. This may be a sign of a more serious underlying condition and should be evaluated by a doctor.

• Kidney damage: If urine backs up into the kidneys due to BPH, it can cause hydronephrosis (swelling of the kidneys) and a decline in kidney function. This can lead to serious health problems if not addressed promptly.

Certain lifestyle factors may help reduce the risk of developing BPH. These include:

• Physical activity: Engaging in regular physical activity may help lower the risk of developing BPH, although the exact mechanisms are not fully understood. Exercise can help maintain a healthy weight, improve circulation, and reduce inflammation, all of which may contribute to prostate health.

• Avoid certain medications: Inform your doctor about any medications you are taking, such as decongestants, antihistamines, tranquillizers, antidepressants, and diuretics, as they can worsen BPH symptoms.

• Regular check-ups: Scheduling regular check-ups and prostate exams with a doctor can help detect BPH early and manage its effects on quality of life. Early detection allows for prompt treatment and can prevent complications from developing.

Diagnosing BPH involves a combination of medical history, physical examination, and diagnostic tests to assess the extent of prostate enlargement and its impact on urinary function. These include:

• Medical history: The initial step in diagnosing BPH involves discussing symptoms and medical history with a healthcare provider. This includes reviewing urinary symptoms such as increased frequency, urgency, and difficulty urinating. The doctor will also enquire about any other health conditions, medications, and family history of prostate issues.

• Physical examination: A physical examination is crucial for diagnosing BPH. This typically includes a digital rectal examination (DRE), where the doctor examines the prostate through the rectum to assess its size, shape, and consistency. The DRE helps determine if the prostate is enlarged and whether the enlargement is consistent with BPH.

• Prostate-specific antigen (PSA) test: This test measures the level of PSA, a protein produced by the prostate, in the blood. Elevated PSA levels can suggest BPH, but they can also indicate other prostate conditions, including prostate cancer.

• Urinalysis: A urinalysis involves analysing a urine sample to check for signs of infection, blood, or other abnormalities. This helps rule out other causes of urinary symptoms and assess the impact of BPH on urinary tract function.

• Imaging studies: Imaging studies, such as an ultrasound of the prostate, may be used to visualise the size and shape of the prostate gland. This can provide more detailed information about the extent of enlargement and help guide treatment decisions.

• Urodynamic tests: In some cases, urodynamic tests may be performed to assess how well the bladder and urethra are functioning. These tests measure bladder pressure and flow rates to determine the extent of urinary obstruction and bladder function.

The management of benign prostatic hyperplasia involves several treatment lines, depending on the severity of symptoms and the patient's overall health. These include:

• Medications: Medications such as alpha-blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors and beta-3 agonists may be prescribed to address symptoms of BPH.

• Laser therapies: Holmium laser enucleation of the prostate (HOLEP) and photoselective vaporisation of the prostate (PVP) are minimally invasive procedures that remove excess prostate tissue.

• Ablation therapy: This involves using heat or cold to destroy excess prostate tissue.

• Minimally invasive surgery: Techniques like transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) are used to reduce prostate size.

• Transurethral resection of the prostate (TURP): This surgical procedure removes the inner portion of the prostate gland, alleviating urinary symptoms.

Choosing the appropriate management option depends on the severity of symptoms, the size of the prostate, and the patient's overall health and preferences.

Medication for Benign Prostatic Hyperplasia

Several medications are used to manage the symptoms of benign prostatic hyperplasia. Alpha blockers, such as alfuzosin, doxazosin, tamsulosin, silodosin, and terazosin, work by relaxing the smooth muscle of the bladder neck and prostate, improving urinary flow. These medications are often the first-line treatment for mild to moderate BPH symptoms. 5-alpha reductase inhibitors, like finasteride and dutasteride, are used to shrink the prostate by preventing the conversion of testosterone to dihydrotestosterone, a hormone that promotes prostate growth. These medications are particularly effective in men with larger prostates. Phosphodiesterase-5 inhibitors, such as tadalafil, can also be used to manage lower urinary tract symptoms associated with BPH. These medications improve blood flow and relax the smooth muscles of the prostate and bladder.

If you experience symptoms suggestive of benign prostatic hyperplasia, it is essential to consult a doctor for proper evaluation and management. Common symptoms include frequent urination, difficulty starting or stopping urine flow, weak stream, and the need to urinate again soon after finishing. These symptoms can significantly impact daily life, causing discomfort and inconvenience. If left untreated, BPH can lead to complications such as urinary retention, recurrent urinary tract infections, and hematuria (blood in the urine). Your doctor will perform a thorough assessment, including a physical examination, urinalysis, and possibly imaging tests, to diagnose BPH and determine the most appropriate treatment plan for your individual needs.

• Benign prostatic hyperplasia is a common condition in older men, causing enlargement of the prostate gland and urinary symptoms.

• Symptoms of benign prostatic hyperplasia include frequent urination, weak urine stream, urgency, and nocturia.

• Treatment options for benign prostatic hyperplasia include medication, such as alpha-blockers and 5-alpha reductase inhibitors, as well as surgical and minimally invasive procedures.

• Consulting a doctor is essential if symptoms become bothersome or interfere with daily life to prevent complications and improve quality of life.

• Lifestyle changes, such as limiting fluid intake before bedtime, avoiding caffeine and alcohol, and practicing pelvic floor exercises, may help manage symptoms of benign prostatic hyperplasia.