Benign Prostatic Hyperplasia

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy is the enlargement of the prostate gland. The word "benign" means the cells are not cancerous. "Hyperplasia" means an increased number of cells. With age, hormonal changes occur and it is normal for the prostate gland to enlarge without causing irritative symptoms. All men will experience BPH to some extent during their life. However, symptoms of BPH are rarely seen prior to the age of 40. Over half of all men in their sixties, and around 90% of men in their seventies and eighties will experience some kind of symptoms.

In around 50% of men, BPH may result in benign prostatic enlargement (BPE).

What is the Prostate? 

The prostate is a gland located in the lower urinary tract beneath the bladder, which surrounds the urethra in men. The prostate produces the fluid component of semen which aids in its transport. It consists of smooth muscle which helps to propel semen out during ejaculation. 

A healthy prostate is the size of a large walnut and has a volume of 15-25 milliliters, however as aging occurs, the prostate slowly increases in size. 

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Symptoms

When the prostate is enlarged, it presses against the urethra and restricts the flow of urine. This causes issues with urination. The following symptoms may occur over a period of time:

  • The bladder wall thickens and becomes irritable.
  • Urinary frequency occurs as the bladder walls begin to contract, even with small amounts of urine.
  • The bladder becomes weak and loses the ability to empty completely, subsequently retaining urine.

The partial emptying of the bladder and narrowing of the urethra may lead to other problems such as:

  • Increased urinary frequency during the day.
  • Increased urinary frequency at night (Nocturia). 
  • Urinary urgency (the urge to urinate is strong and sudden). This may lead to urinary incontinence. 
  • The flow of urine is slow to start (hesitation). 
  • Urinary dribbling after urination. 
  • A sensation that the bladder has not emptied completely after urination.
  • Lack of force to the flow of urine.
  • The sensation of wanting to urinate again shortly after going to the toilet. 

Investigations

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may complete a physical examination to assess the condition of your prostate.

Investigations will vary patient to patient, however the following are examples of what you may expect:

  • Urinalysis: a urine sample is collected to look for signs of blood or infection.
  • Digital rectal examination (DRE): your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious, such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.
  • TRUSS assessment: The TRUSS assessment involves the use of an ultrasound to take measurements of the prostate gland and visualize the surrounding structures at the same time. The best way to view to prostate gland using ultrasound is via the rectal passage. 
  • Prostate specific antigen (PSA) test: A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.
  • Urodynamics: your doctor may ask you to urinate into a device that measures the flow of urine. A decrease in the flow can suggest BPH.
  • Intravenous Pyelogram (IVP): IVP is an X-ray of the urinary tract. In this test, a dye is injected into a vein, and the X-ray is taken. The dye makes the urine visible on the X-ray and shows any obstruction or blockage in the urinary tract.
  • Flexible Cystoscopy: your doctor inserts a small scope called a cystoscope (contains a lens and light system) through the urethra. It helps your doctor closely view the urethra and bladder, and determine the size, location and extent of obstruction.

Drug Therapy

The doctor may advise on a particular drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person's general health condition, medical history, current regular medications and quality of life considerations.

Surgery

Surgery is another option for the treatment of BPH. The most common type of surgery is Transurethral Resection of the Prostate (TURP), which is effective for relieving symptoms.

Conservative treatment

If you do not experience any symptoms of BPH, your doctor may decide to wait-and-watch for the progression of the condition with regular monitoring, usually once a year.

PSA

As the prostate gland grows with age, the PSA is likely to rise. A high PSA may indicate a type of prostate disease. The level can also be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland.

The PSA measurement is a useful tool for diagnosing and monitoring prostate diseases, however further tests may be required to confirm which condition is present.