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BENIGN PROSTATE HYPERPLASIA (BPH)

Benign prostatic hyperplasia (BPH) is a common disease of the prostate gland which includes an increase in the size of and changes in texture. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate grows, it can obstruct partly the urethra. This often causes problems with urination.
Benign prostatic hyperplasia is not cancer.

WHO GETS BPH?
BPH occurs in almost all men as they age. About half of men over 75 have some symptoms.

WHAT IS THE AETIOLOGY OF BPH?
Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in the balance of hormones and changes in cell growth.

WHAT ARE THE SYMPTOMS OF BPH?
Possible symptoms are:

  • Difficulty urinating.
  • Delay in starting urination.
  • Frequent urination.
  • Nocturia.
  • Sudden and strong urge to urinate.
  • Weak flow of urine.
  • A feeling that your bladder is not completely empty after urination.
  • In a small number of cases, BPH can cause urinary retention (complete inability to urinate).

WHAT ARE THE POSSIBLE COMPLICATIONS OF BPH;
If a patient is delayed to visit the urologist and has symptoms then BPH can lead to:

  • Gritty bladder.
  • Recurrent Urinary Tract Infections.
  • Incomplete urinary retention (retention and urinary incontinence).
  • Diverticula in the bladder.
  • Impaired renal function.
  • Haematuria.

Presence of these complications in BPH creates mostly need for surgery.

HOW IS BPH DIAGNOSED?
Your doctor can diagnose BPH by asking questions about your symptoms and doing a physical examination.
The examination will include digital rectal examination, which lets your doctor feel the size of your prostate. In some cases, a PSA is done to help exclude prostate cancer. Prostate cancer and benign prostate hyperplasia are not the same, but may have some of the same symptoms.
Neurological examination should also be done to determine if the symptoms are associated with any neurological problems in the bladder.
A questionnaire can be used to evaluate how annoying are your symptoms.
Other tests that may need to be done are:

  • Urinalysis and culture to exclude UTI.
  • PSA for prostate cancer exclusion.
  • Creatinine blood for testing kidney function.
  • Uroflowmetry , a method for objectification your symptoms and monitoring the change in symptoms after treatment.
  • Ultrasound of the kidneys , bladder and prostate
  • Cystoscopy in order for the doctor to look inside the urethra and bladder.
  • Intravenous pyelography (IVP) which uses X-rays to show the function of the kidneys and the flow of urine from the kidneys to the bladder.

WHEN MUST I VISIT A UROLOGIST?
Emergency Urology assessment is required when:

  • You are completely unable to urinate.
  • The urination is painful and you have fever, chills, or body aches.
  • There is blood or pus in your urine or semen.

Scheduled appointments needed if:

  • A burning sensation when urinating.
  • Painful ejaculation.
  • Problems with your urination during the day or night.

HOW TO CHOOSE A TREATMENT?
Benign prostatic hyperplasia (BPH) can not be treated conservatively, so treatment focuses on reducing your symptoms.
Treatment depends on how severe your symptoms are, how bothering they are, and if you have complications.
The symptoms that are mild (score 0-7) are best addressed by behavioral changes and frequent monitoring by your urologist. This means that you can make small changes to your lifestyle to control your symptoms while frequent medical examination confirming that the symptoms do not worsen.
Treatment of moderate to severe symptoms depends on how much you are troubled by them. If symptoms do not affect the quality of your life greatly, you can select behavioral therapy or drug therapy. If the symptoms are bothersome or if you want an immediate and radical treatment, you may be offered surgery or less invasive treatments.

WHAT ARE THE BEHAVIOURAL TREATMENTS;
There are some things you can do, that can help to reduce how much BPH affects your quality of life.

  • Do not postpone your urination.
  • Urinate every time before leaving home.
  • Do not rush when urinating. Give time to fully complete the flow of urine.
  • Try to relax while using the toilet.
  • Distribute the intake of fluids during the day in many small amounts.
  • Limit fluid intake in the evening before bedtime especially if you wake up at night to urinate.
  • If possible, avoid medications that worsen your symptoms (eg, decongestants).
  • Do not drink large amounts of liquids in one sum.
  • Avoid coffee.
  • Avoid alcohol.

WHAT IS THE DRUG THERAPY?
These drugs are sometimes used to help relieve annoying, moderate to severe urinary problems caused by benign prostatic hyperplasia (BPH). If you stop using the drug, the symptoms will return. The drugs carry some side effects for which your doctor will advise you.
The possible options are:

  • Alpha-blockers such as tamsulosin, alfuzosin, silodosin, relieve symptoms within a few days, but do not stop the process of BPH.
  • Inhibitors of 5-alpha reductase such as finasteride (Proscar) and dutasteride, can reduce the size of the prostate, but this can take 6 months or more to show any effect on the symptoms.
  • A combination of an alpha-blocker with an inhibitor of 5-alpha reductase can help you more than each drug alone.
  • Inhibitors of Phosphodiesterase 5-(PDE-5 ) as tadalafil (Cialis), a medicine that is successfully used in erectile dysfunction, can reduce the symptoms of BPH, regardless of whether or not you have erection problems.
  • Herbal extracts appear to have a positive effect on symptoms and does not appear to be associated with specific side effects.

WHAT ARE THE SURGICAL OPTIONS?
Typically a surgery that does not require skin incision is used. Surgical instruments are passed through the urethra. This is described as transurethral prostate surgery.
The transurethral resection of the prostate (TURP) is a surgery for BPH, which has been studied the most. All other surgeries today are compared to TURP. In TURP, part of the prostate adenoma is removed.

Newer developments for TURP is the bipolar TURP (TURIS). One method currently used worldwide with many advantages.
H plasma-sublimation prostate TURIS has the following advantages:

  • Much smaller bleeding rates .
  • Reduced surgical time.
  • Ability to manage patients with large prostate without the need for open surgery.
  • Quick removal of the catheter , from the very next day.
  • Speedy recovery and leaving the clinic again the next day.
  • Quick return to daily activities.
  • Possibility of intervention in high-risk patients on anticoagulants.
  • Compatible with pacemakers because the bipolar current.
  • Absence of dangerous water intoxication syndrome (TUR Syndrome).

Some of the other surgeries designed compared to TURP include:

  • Transurethral incision of the prostate (TUIP).
  • Laser treatments , in which a laser is used to make incisions or remove a portion of the prostate.
  • Transurethral microwave therapy (TUMT) , wherein the microwave energy is used to destroy a portion of the prostate by heating.
  • Transurethral ablation needle (TUNA) , wherein a heated needle is used to destroy a portion of the prostate.

In most cases, these therapies have been studied for a few years, and their efficacy is not yet known.

  • The oldest surgical method for treating BPH is open prostatectomy , in which an incision is made through the skin to remove the prostate. Doctors use this method less often now, but still preferred if the prostate is very large.
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