Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is the most common medical condition experienced by men as they age as a result of the hormonal changes they undergo while ageing. This usually affects half of men aged 60 and above, and about 80-90% of men above the age of 80, and can result in a series of medical conditions affecting the bladder and the kidneys.
What is Benign Prostatic Hyperplasia?
Benign Prostatic Hyperplasia (BPH), also known as prostate gland enlargement, is the enlargement of the prostate. As its name suggests, BPH is non-malignant or, in other words, non-cancerous.
The prostate is a walnut-sized gland in men (when young) that surrounds the urethra, a tube that carries urine and sperm out of the body. It is also responsible for producing fluids for semen. BPH can block the flow of urine, and also cause a series of urinary, bladder and kidney problems.
What are the symptoms of Benign Prostatic Hyperplasia?
The most common symptom often involves voiding difficulties such as frequent urination or an inability to urinate.
It is important to notice the symptoms of BPH in order to get it treated as soon as possible. Some of these symptoms include:
- Nocturia (Waking up in the middle of the night to urinate)
- Slower urine stream
- Inability to completely empty the bladder
- Increased frequency or need to urinate
- Blood in urine
- Pain when urinating
Although BPH is not cancerous in nature, early treatment is important to avoid other complications such as urinary tract infections, kidney damage or bladder stones.
What causes Benign Prostatic Hyperplasia?
There is no definite cause of benign prostatic hyperplasia. However, several risk factors may play a part in benign prostatic hyperplasia:
- Age — Ageing leads to changes in the cellular processes and hormonal imbalances in the prostate gland, which may cause the prostate to enlarge.
- Genetics — Studies have shown that genetic predisposition may play a part in benign prostatic hyperplasia.
- Hormonal changes — Changes in hormone levels are thought to play a role in causing benign prostatic hyperplasia. In older men, dihydrotestosterone (DHT), a hormone responsible for prostate development, remains high, while testosterone levels decrease. This can lead to an increase in the size of the prostate.
When should I visit the doctor?
You should consult a urologist if you are experiencing any of the aforementioned symptoms. Remember, early diagnosis leads to early treatment. If you experience painful urination or observe blood in your urine, you should seek immediate medical attention.
What can I expect during my first consultation?
Firstly, your urologist may take a detailed medical and social history from you. Questions may include any medications you are taking, the symptoms you experience, or if you have had any past illnesses.
A physical exam will be conducted to check for any discharge from the urethra and enlarged or tender lymph nodes in the groin area or a swollen or tender scrotum. Your urologist may also perform a rectal exam to feel for any prostate abnormalities. After which, other diagnostic tests will be run.
Are Benign Prostatic Hyperplasia and Benign Prostate Enlargement the same?
To some extent, BPH happens in all men as a result of ageing. In about half of these men, BPE may occur, which is an enlargement of the prostate that can obstruct urine (benign prostatic obstruction).
How is Benign Prostatic Hyperplasia diagnosed?
Benign prostatic hyperplasia can be diagnosed through a series of tests such as:
Digital rectal examination
A digital rectal examination will help the doctor evaluate the size and shape of the prostate – if it is healthy or if there is any abnormal growth.
Fasting serum glucose, renal function and urine dipstick tests
These tests can help doctors rule out any other medical conditions such as diabetes or renal impairment.
Serum prostate-specific antigen test (PSA)
Elevated serum prostate-specific antigen (PSA) could be a sign of prostatic hyperplasia, prostate cancer or inflammation and further tests (e.g. prostate health index, MRI or prostate biopsy) would be needed to determine if the prostate is benign or malignant.
This helps the urologist better understand the flow rate and check for obstruction.
Radiological investigations such as ultrasonography to check for structural abnormalities in the affected area, such as the bladder wall thickness, prostate size and shape.
Can Benign Prostatic Hyperplasia be cured?
Benign prostatic hyperplasia cannot be cured completely, but there are many treatment options that focus on helping to relieve the symptoms and improving the quality of life for men.
How is Benign Prostatic Hyperplasia treated?
There are a wide array of treatment options for benign prostatic hyperplasia, such as:
In some cases where patients have mild benign prostatic hyperplasia, your urologist may choose to monitor the condition. Regular exercise and a healthy diet are recommended to help manage any symptoms. Regular checkups are also scheduled to ensure that the condition is well-controlled.
Your urologist may prescribe medications to help with the symptoms of benign prostatic hyperplasia. The two most common medications are alpha-blockers and 5-alpha-reductase inhibitors. For example, 5-alpha-reductase inhibitors help to increase urine flow and shrink the prostate by blocking and lowering the DHT levels.
Minimally invasive procedures
Doctors may carry out surgery to help manage your condition and symptoms. All these procedures are usually done outpatient and are administered under local or general anaesthesia. For example:
- A prostatic urethral lift (PUL) is a surgical procedure that involves the insertion of tiny implants in the prostate. These implants lift and compress the prostate, preventing the obstruction of the urethra.
- Transurethral microwave therapy (TUMT) uses microwaves to destroy prostate tissues, reducing prostate size.
- Water Vapour Thermal Therapy uses water vapour to destroy prostate cells squeezing the urethra.
Doctors may insert a catheter into the bladder in the acute setting to help with the draining of urine, especially for men with bladder problems and enlarged prostate who are unable to pee.
For more severe cases, more invasive surgeries may be required. For example, a transurethral resection of the prostate involves widening the urethra by resecting the obstructive prostatic lobes and reducing the pressure of the prostate on the urethra. To perform this surgery, the urologist may use a heated loop through a rigid cystoscope (called a resectoscope) or laser. Rarely, prostatectomy is performed, where the surgeon removes the entire prostate gland through the bladder.
What’s the difference between Prostatitis and BPH?
Prostatitis is the inflammation of the prostate tissue, while BPH is prostate enlargement due to excessive proliferation of prostate cells.
If you experience intermittent pain while urinating, fever, and erectile dysfunction, prostatitis is more likely than BPH.
However, the only way to definitively diagnose your condition is to undergo a physical examination and various diagnostic tests recommended by your urologist.
Having benign prostatic hyperplasia sounds scary, but early diagnosis will allow your doctor to start treatment earlier to restore your quality of life. Remember to seek professional help if you suspect you may have benign prostatic hyperplasia.