Benign Prostatic Hyperplasia (BPH)

(Benign Prostatic Hypertrophy)
Definition
Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate. The prostate is a walnut-sized gland located at the neck of the bladder surrounding the urethra. It is part of the male reproductive system.
The Male Urogenital System


Causes
The exact cause of BPH is unknown. It may be related to changes in hormone levels as men age. These changes probably cause the prostate to grow. Eventually, the prostate becomes so enlarged that it puts pressure on the urethra. This causes the urethra to narrow or, in some cases, close completely.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The main risk factor for BPH is being over 50 years old. By age 60, 50% of all men will have some evidence of BPH in their prostates.
Symptoms
Narrowing of the urethra caused by enlargement of the prostate causes the symptoms of BPH. Symptoms usually increase in severity over time.
Symptoms include:
• Difficulty starting to urinate
• Weak urination stream
• Dribbling at end of urination
• Sensation of incomplete bladder emptying
• Urge to urinate frequently, especially at night
• Deep discomfort in lower abdomen
• Urge incontinence
Diagnosis
BPH diagnosis is based on:
• Your age
• Symptoms—often quantified using a validated survey know as the IPSS score sheet
• Digital rectal exam—the doctor inserts a gloved finger into the rectum to examine the area
Other tests may include:
• Urine flow study
• Cystometrogram (a functional study of the way your bladder fills and empties)
• X-ray of the urinary tract
• Cystoscopic examination
• Transrectal ultrasound
• Post-void residual volume test—measures whether you can empty your bladder completely
• Cystoscopy—this test allows a doctor to look inside the urethra and bladder
Testing for prostate specific antigen (PSA) is often used to screen for prostate cancer, a malignant condition. However BPH, which is far more common, may cause a lesser elevation in PSA levels, which may raise false concerns about the presence of cancer.
Treatment
In mild cases of BPH, no treatment is necessary. In many cases, men with BPH eventually request medical intervention.
Treatments include:
Medication
Medications include:
• Enzyme inhibitors ( 5-alpha reductase)
o Finasteride (proscar)—inhibits the production of the specific form of testosterone, which is responsible for prostate glandular growth (In some men, finasteride can shrink the prostate.)
o Dutasteride (avodart)—inhibits the production of the specific form of testosterone, which is responsible for prostate glandular growth. Like proscar, avodart can result in shrinking of the prostate.
• Alpha-blockers (flomax, uroxatral, cardura, terazosin)—reduce bladder obstruction and improve urine flow by relaxing the muscles of the prostate and bladder neck
Both of groups of medications have different side effect profiles:
Enzyme inhibitors may cause decreased sexual desire and problems with erection. The alpha-blockers may cause decreased blood pressure, dizziness, and stuffy nose. At times they are combined together.
Men with BPH should not take decongestant drugs containing alpha-agonists such as pseudoephedrine. These drugs can worsen the symptoms of BPH.
Minimally Invasive Interventions
These are used when drugs are ineffective, but the patient is not ready for surgery. Nonsurgical treatments include:
Transurethral Microwave Thermotherapy (TUMT)—uses microwaves to destroy excess prostate tissue
Transurethral Needle Ablation (TUNA)—uses low levels of radio frequency energy to burn away portions of the enlarged prostate
Transurethral Laser Therapy—uses highly focused laser energy to remove prostate tissue
Surgery
Surgical procedures include:
Transurethral Surgical Resection of the Prostate (TURP)—a scope is inserted through the penis to remove the enlarged portion of the prostate
Transurethral Incision of the Prostate (TUIP)—small cuts are made in the neck of the bladder to widen the urethra. The long-term effectiveness of TUIP is not yet clearly established.
Open Surgery—removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area. This is much more invasive then TURP or TUIP.
Prostatic Stents—tiny metal coils that are inserted into urethra to widen it and keep it open. They are usually used for men who do not wish to take medication or have surgery. They do not appear to be a good long-term option.
Alternative Treatments
Three different herbal products are used for BPH: saw palmetto, beta-sitosterol, and Pygeum (Prunus Africana). None of them is approved by the US Food and Drug Administration. Research regarding its effectiveness and safety is limited. Frequently, the results are conflicting, but this may be due to variability of the products and difficulty in conducting these types of studies.
Prevention
Because prostate enlargement occurs naturally with advancing age, there are no specific prevention guidelines.