ConditionandTreatments

Overview

Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a condition where the prostate gland increases in size. This enlargement can lead to various urinary symptoms due to its impact on the urethra, which passes through the prostate. BPH is a common condition among aging men and is not related to prostate cancer. It can affect the quality of life but is manageable with appropriate treatment.

Symptoms and Causes

What are the warning signs of benign prostatic hyperplasia (BPH)?

When the prostate enlarges due to BPH, it can press against the urethra, leading to various symptoms. Early signs of BPH may include:

• Slow or Dribbling Urine Flow: Difficulty initiating urination or experiencing a dribbling stream.
• Difficulty Starting Urination: Trouble beginning to urinate.
• Urinary Incontinence: Unintentional leakage of urine.
• Urgency: A sudden, strong urge to urinate that may be hard to control.
• Frequent Nighttime Urination: The need to wake up frequently during the night to urinate.
• Incomplete Bladder Emptying: Feeling as though the bladder isn't fully emptied after urination.
• Painful Urination or Post-Ejaculation: Discomfort or pain during urination or after ejaculation.
• Changes in Urine Color: Alterations in the color of your urine.
• Altered Urine Odor: A change in the smell of your urine.

Causes

The prostate gland, situated below the bladder, surrounds the urethra—the tube through which urine exits the body. As the prostate enlarges, it can obstruct the flow of urine. Typically, the prostate continues to grow throughout a person's life. This continuous growth can eventually lead to symptoms or block the flow of urine. The exact reason for prostate enlargement is not well understood, but it may be related to hormonal changes that occur with aging.

Types

BPH does not have distinct types but can be classified based on its impact and severity:

• Mild BPH: Minimal symptoms that do not significantly affect daily life.
• Moderate BPH: Symptoms that impact daily activities and may require medical intervention.
• Severe BPH: Pronounced symptoms that severely impact quality of life and may lead to complications if untreated.

Diagnosis

Diagnosing BPH involves a thorough evaluation by a healthcare provider, which may include:

• Medical History: Discussion of symptoms, medical history, and any other relevant conditions.
• Physical Examination: A digital rectal exam (DRE) to assess the size and texture of the prostate.
• Urinary Tests: Evaluation of urine flow rate and the amount of residual urine in the bladder.
• Prostate-Specific Antigen (PSA) Test: Blood test to rule out prostate cancer and evaluate PSA levels.
• Imaging Tests: Ultrasound or MRI may be used to assess prostate size and urinary tract structure.

Treatment

Nonsurgical Options

• Lifestyle Changes: Reducing fluid intake before bedtime, avoiding caffeine and alcohol, and practicing pelvic floor exercises may help alleviate symptoms.
• Medications:
  • Alpha Blockers: Relax the muscles of the prostate and bladder neck to improve urine flow.
  • 5-Alpha-Reductase Inhibitors: Reduce the size of the prostate by blocking hormones that contribute to enlargement.
  • Combination Therapy: A combination of medications may be used for better symptom control.
• Herbal Remedies: Some individuals use natural supplements such as saw palmetto, though their effectiveness is debated.

Surgical Treatment

For many patients with prostate enlargement, surgery is recommended as a long-term solution. Surgical procedures focus on removing only the enlarged tissue that is compressing the urethra. This approach usually resolves the obstruction and incomplete bladder emptying caused by the enlarged prostate. Various surgical techniques include:

• Transurethral Resection of the Prostate (TURP): This minimally invasive procedure requires no external incisions. Under regional anesthesia, a resectoscope is inserted through the penis to reach the prostate. A wire loop on the resectoscope removes the obstructive tissue piece by piece.
• Other Endoscopic Procedures: Procedures such as Transurethral Incision of the Prostate (TUIP) and Transurethral Electrovaporization of the Prostate (TUEVP) are used for smaller prostates. TUEVP is similar to laser surgery in its approach.
• Laser Surgery: Holmium Laser Enucleation of the Prostate (HoLEP) involves using a laser to remove the prostate gland through an endoscopic method, similar to traditional surgery but with potentially fewer complications. At Yatharth Hospital, we utilize advanced Holmium Laser (HoLEP) technology, including the VersaPulse® device, to perform precise surgeries with minimal incisions and reduced bleeding.
• Open Surgery: In cases where transurethral procedures are not suitable—such as significantly enlarged prostates or when the bladder has been damaged—open surgery may be necessary. This method involves making an incision and is typically reserved for more complex cases.

FAQ

• What causes BPH?

  BPH is primarily associated with aging and hormonal changes. The exact cause is not fully understood, but it involves a combination of genetic, hormonal, and environmental factors.

• Is BPH the same as prostate cancer?

  No, BPH is a non-cancerous enlargement of the prostate. Prostate cancer is a separate condition that involves malignant growth in the prostate gland.

• Can BPH lead to complications?

  If left untreated, BPH can lead to complications such as urinary tract infections, bladder stones, and acute urinary retention.

• How is BPH managed?

  Management of BPH depends on the severity of symptoms and may include lifestyle changes, medications, or surgical interventions.

• Are there any long-term effects of BPH treatments?

  Most treatments for BPH are effective and well-tolerated. However, potential side effects and complications vary based on the type of treatment and individual patient factors. Discuss these with your healthcare provider to understand the best approach for your situation.