Benign prostatic hyperplasia (BPH) refers to non-cancerous enlargement of the prostate with age. As the prostate enlarges the urethra gets 'squeezed' and narrows. This results in blockage of the passage of urine from the bladder and greater pressure is required to pass urine. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH. The narrowing can become so tight that no urine passes at all. BPH can also cause urinary incontinence, recurrent urinary tract infection, bladder stone formation, and occasionally kidney failure.
BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.
The cause of benign prostatic hyperplasia is unknown. It is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which is converted to dihydrotestosterone (DHT) and estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause hyperplasia. How and why levels of DHT increase remains a subject of research. Increasing data seems to point to an imbalance of factors promoting cell division and cell death.
Common symptoms of benign prostatic hyperplasia include the following:
- Pushing or straining to begin urination
- Hesitant, interrupted, or weak urine stream
- Dribbling after voiding
- Feeling that the bladder has not emptied completely after urination
- Frequent urination
- Urgency (sudden urgent need to urinate)
- Nocturia (needing to wake up to pass urine at night)
- Incontinence or leakage of urine
- Blood in the urine
International Prostate Symptoms Score
Answer these questions to see if you have BPH
Add the scores together (minimum is 0 and maximum is 35)
Interpretation of IPSS values
Mild BPH: Score of 0 – 7
Moderately severe BPH: Score 8 – 18
Severe BPH : Score more than 18
In severe cases of BPH, acute urinary retention (sudden complete inability to urinate) can result from holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.
BPH does not lead to prostate cancer. The two are not linked. However, because the early symptoms are the same for both conditions, it is important to see a doctor to evaluate these symptoms.
A physical examination, patient history, and evaluation of symptoms provide the basis for a diagnosis of benign prostatic hyperplasia. The physical examination includes a digital rectal examination (DRE) whereby the doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam reveals the size, shape, consistency of the prostate. In benign enlargement, the prostate is smooth, symmetrical and rubbery.
The PSA blood test is done to differentiate between BPH and prostate cancer. (see prostate cancer)
Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing. A reduced flow may mean you have BPH.
Cystoscopy : This is a clinic procedure whereby a flexible tube containing a miniature scope is inserted into the bladder through the urethra. This painless procedure is done after a lubricating solution numbs the inside of the penis. This procedure allows the doctor to examine the inside of the bladder, urethra and prostate and to determine the size of the gland and identify the location and degree of the obstruction.
Bladder Ultrasound : This clinic procedure is used to study the volume of bladder before and after urination. An ultrasound probe is placed on the lower abdomen just above the bladder. High frequency sound waves passing through the abdominal wall and reflecting back from the bladder wall allows accurate study of the bladder volume and content. This is a painless procedure and takes about 10 minutes.
Prostate Ultrasound : This clinic procedure is used to study the shape and volume of prostate and to diagnose prostatic disorders like prostatic cyst, abscess, calcification, enlargement and cancer. Ultrasound of the prostate is most often performed with the patient lying on his left side with his knees and hips bent up slightly. The elongated ultrasound probe is inserted up the anus into the rectum. High frequency sound waves bounces back from the prostate and forms detailed images. This procedure takes about 10 to 15 minutes and causes some discomfort but no pain.
Ultrasound kidney : This clinic procedure is used to study the size and shape of the kidneys and to diagnose kidney stones, tumours, cyst and obstruction. This procedure is painless and takes about 15 minutes.
Several treatments are available. Choice of treatment options will depend on age of patient, severity of BPH and general wellbeing of patient.
Watchful waiting. If your symptoms don't bother you too much, you may choose to live with them rather than take pills every day or have surgery. Have regular checkups and be ready to start treatment as soon as you need it.
Medication. Two broad categories of medications are available. The alpha-blockers work by relaxing the prostate to keep it from blocking the bladder opening. Symptoms are relieved rapidly within a few days. It may cause some amount of giddiness especially if one gets up suddenly from a lying to a standing position. Symptoms usually reappear when the medication is stopped. The 5-alpha reductase inhibitors are used to shrink the prostate. It takes three to six months to shrink the prostate by about 20 to 30% in size. Symptom relief is slower and sexual function may be affected in up to 10% of patients.
Minimally invasive BPH treatments use state-of-the-art tools and techniques to reduce or eliminate symptoms. The gold standard surgery for BPH is a TURP or transurethral resection of prostate. In TURP, the surgeon inserts a thin telescopic tube up the urethra and cuts away pieces of the prostate with a wire loop. This is done under direct vision through a cystoscope and video system. By coring out the central enlarged and obstructing portion, a wide channel is obtained which will improve the urine flow and reduce symptoms dramatically. This procedure is painless under general or regional anesthesia. After the surgery, a rubbery catheter is placed within the bladder for a day or two. Saline solution is used to irrigate the bladder to wash away any blood stain and blood clots. The rubber catheter is removed on the third day and the patient is ready for discharge when he can pass urine comfortably.
TUNA or TransUrethral Needle Ablation of prostate. A thin telescoping device is inserted through the urethra to deliver controlled heat to areas of the prostate. The tensed smooth muscles within the prostate undergoes cell death and the prostate relaxes, resulting in symptom relief. This procedure can be done under local anesthesia with sedation.
Greenlight LASER. The surgeon inserts a thin telescopic tube up the urethra and uses the greenlight laser to burn and create a wide central channel within the prostate. Urine flow improves and symptoms are relieved. This is a bloodless procedure. Hospital stay is short, about a day or two. General or regional anesthesia is required.
