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What is BPH?

It is common for the prostate gland to get enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

Is the enlargement of the prostate a cause for concern?

It depends, whether you have any symptoms related to the enlarged prostate or not.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't always cause problems. Even when it does, it usually may not cause problems until late in life. BPH (noncancerous enlargement of prostate) rarely causes symptoms before the age of 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

What are the symptoms of BPH?

The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as
  • Delay in starting of the urination
  • Stopping and starting while urinating
  • Weak urinary stream
  • Urgency and leaking or dribbling
  • More frequent urination, especially at night
  • Feeling of incomplete emptying of the bladder (Residual urine)
  • Recurrent urinary tract infection
  • Blood in urine 
  • Occasionally complete retention of urine requiring catheterization
What cause the symptoms of BPH

Many symptoms of BPH result from narrowing of the urinary passage (urethra) and gradual loss of bladder function, which results in incomplete emptying of the bladder. As the prostate enlarges, the gland presses against the urethra like a clamp on a garden hose. The bladder has to work harder to push the urine thought the narrow passage. To compensate, the bladder wall becomes thicker and irritable. An irritable bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder causes many of the problems associated with BPH.

Is there a relation between the size of prostate and the symptoms?

The size of the prostate does not always determine how severe the narrowing or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called Acute Urinary Retention, may be triggered by taking over-the-counter cold or allergy medicines.

When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

It is important to tell your doctor about urinary problems such as those described above. In eight out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can be ruled out only by a doctor's examination.

What are the potential consequences if you neglect the symptoms?

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence—the inability to control urination. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications

How is the Diagnosis made?

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Examination (DRE)

This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.

Prostate-Specific Antigen (PSA) Blood Test

To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. Once a year PSA test along with a digital rectal examination is recommened in men who are age 50 or older. It helps in detecting prostate cancer at an early and potentially curable stage.

Rectal Ultrasound and Prostate Biopsy (TRUS)

If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, an ultrasound probe is inserted in the rectum to guide a biopsy needle. The needle collects a few pieces of prostate tissue for examination with a microscope.

Urine Flow Study

Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Cystoscopy

In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

How is BPH treated?

Men who have BPH with symptoms usually need some kind of treatment at some time. Patients with mild symptoms may not need immediate treatment but should undergo regular checkups to watch for early problems. If the condition causes a major inconvenience to him or begins to pose a danger to the patient's health, treatment is recommended.

A wide variety of treatments are available for enlarged prostate. These include medications, surgery and minimally invasive surgical methods.

Oral Medications

These are the most common treatment for moderate symptoms.

The medications known as Alpha blockers are given to relax the muscle fibers in the bladder neck and prostate and make it easier to urinate.

Certain other medications called 5-AR inhibitors inhibit the production of the hormone DHT. The use of this class of drugs can either prevent progression of growth of the prostate or actually shrink the prostate in some men.

Surgical Treatment

Your doctor may recommend surgery if medications isn’t effective or you have severe symptoms. There are several types of surgical procedures for BPH, they all remove only the enlarged inner tissue that is pressing against the urethra, and the outer side of the prostate gland and the capsule are left intact.

Transurethral surgery In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an endoscopic instrument through the urethra. A procedure called transurethral resection of the prostate (TURP) is used for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument called a ‘Resectoscope’ is inserted through the penis. The surgeon uses the Resectoscope's wire loop to remove the obstructing tissue.

Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. One possible side effect of TURP is retrograde, or backward, ejaculation. In this condition, semen flows backward into the bladder during climax instead of out the urethra.

LASER Prostatectomy: In this method, the surgeon passes the Laser fiber through the urethra into the prostate using a cystoscope and then use laser energy to resect or vaporize the obstructing prostatic tissue. As with TURP, laser surgery requires anesthesia and a hospital stay. One advantage of laser surgery is that it is less likely to cause blood loss during the surgery. Various types of Laser energy sources used are:
  • Holmium Laser
  • Green light Laser
  • Thulium Laser

Open surgery is rarely done now a day for a very large prostate.


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