Benign Prostatic Hyperplasia (Prostate Enlargement), causes, diagnosis & treatment

Benign prostate hyperplasia (BPH) means ‘prostate enlargement’. The prostate is a walnut-sized gland present between the urinary bladder and the penis. This condition is often found in older men. If not treated early, it can cause blockage of the urinary flow leading to severe complications of the bladder, kidney and urinary tract. Benign prostatic hyperplasia has various effective treatments ranging from medications, to minimally invasive therapies to surgery.

Symptoms:

The severity of BPH symptoms varies significantly from person to person. The symptoms gradually worsen over time.
 
Here are some common symptoms:
 

• Frequent urge to urinate
• Increased urination frequency during night (nocturia)
• intermittent stream of urine
• dabbling at the end of urination
• straining during urination
• inability to completely empty the bladder during urination
• difficulty to start urination

 
Less common signs and symptoms:
 

• Urinary tract infection
• Inability to urinate
• Blood in the urine

 
Some men, however, experience stability of recurrent symptoms overtime and their condition might improve.
 
Other possible causes:
 

• Prostate inflammation (prostatitis)
• Bladder or kidney stones
• Urethral stricture or narrowing of urethra
• Prostate or bladder cancer
• Scarring in the bladder neck
• Problems with bladder control (nerve)

Causes:

The tube that carries urine is called urethra which transports urine from the bladder, through the center of the prostate gland, to the penis. This gland keeps growing with age in most men. If the gland grows large enough, it can lead to significant blockage of urine flow. The cause of prostate enlargement is not clear. However, it is speculated that the imbalance of sex hormones in men with age can be a potential trigger.

Risk factors

Risk factors for prostate gland enlargement include:
 

• Aging. Prostate gland enlargement grows significantly with age.It does not affect men below 40 years. However, symptoms start appearing in one-third of men by the age of 60 and nearly 50% of men around 80 years and above experience moderate to severe symptoms
• Family history. A blood relative with a history of the prostate problem can pass it to the next generation
• Diabetes and heart disease. Studies indicate diabetes, heart diseases, and medicines to control blood pressure (beta blockers) can increase chance of BPH
• Lifestyle. Obesity can increase chances of BPH. Maintaining an active lifestyle with regular exercises can lower the risk.

Diagnosis

The diagnosis involves discussion of your medical history, current symptoms and health issues followed by a physical examination. Your doctor might suggest the following tests based on your symptom presentation:
 

• Digital rectal exam. Doctor inserts a gloved lubricated finger into the patient’s rectum by the doctor to check for enlarged prostate
• Urine test. It is checked to rule out the possibility of an infection
• Blood test. The results can indicate disorders of the kidney.
• Prostate-specific antigen (PSA) blood test. PSA is a substance found in prostate whose levels increase with prostate enlargement. However, the levels can also be elevated due to infection, surgery or prostate cancer.

 
Your doctor can recommend additional tests to confirm an enlarged prostate and to rule out other conditions. These tests include:
 

• Urinary flow test
• Post-void residual volume test
• 24-hour voiding diary

Treatment

Treatment for BPH can start with lifestyle modifications and herbal therapies. This is followed by additional treatments like medication, minimally invasive therapies or surgery to correct the problem.

Lifestyle changes

Lifestyle changes don’t prevent the prostate from getting larger, but it can relieve certain annoying symptoms.
 
Following lifestyle changes can be useful to reduce symptoms:
 

• Limiting beverages intake within an hour or two of bedtime.
• Not waiting too long to urinate. Urinating at regular times throughout the day can calm urinary frequency and urgency.
• Avoiding caffeine and alcohol intake, which are diuretics (increase urine output). These can also irritate the bladder, causing more frequent urination.
• Avoiding antihistamines and decongestants as they constrict the prostate, making urination harder.
• Staying active and eat healthily. Even light exercise can help reduce the urinary problems BPH causes. Keeping a healthy weight and BMI can minimize BPH-related issues.

Medications

Doctors commonly prescribe medication to treat mild to moderate symptoms of BPH. Medication options include:
 

• Alpha blockers
• 5-alpha reductase inhibitors
• Combination drug therapy

Minimally invasive surgery (MIS)

Minimally invasive surgeries can be suggested by your doctor and can be performed on an outpatient basis. Choosing the right surgery for you may depend on:
 

• your prostate size.
• your health.
• Your personal choice.

 
Types of surgeries include:
 

• Transurethral resection of the prostate (TURP)
• Transurethral incision of the prostate (TUIP)
• Transurethral microwave thermotherapy (TUMT)
• Laser ablation
• Transurethral needle ablation (TUNA)
• Urolift
• Open or robot-assisted prostatectomy
• GreenLight™ Laser Therapy

 
Post treatment, Fortis doctors will suggest the best follow up care for you which will depend on the type of treatment used.  We will decide together decide what is best for you.