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Benign Prostatic Hyperplasia (BPH)

An enlarged prostate gland may cause discomfort when urinating as it blocks the flow of urine. Besides, BPH may also cause some problems to organs such as bladder urinary tract or kidneys. 

Benign Prostatic Hyperplasia (BPH) is also known as prostate gland enlargement, and it occurs with men when they get older. An enlarged prostate gland may cause discomfort when urinating as it blocks the flow of urine. Besides, BPH may also cause some problems to organs such as bladder urinary tract or kidneys. 

BPH can be treated with various effective treatments such as medications, minimally invasive therapies or surgery. If you have BPH, you will need to discuss treatment options with your doctor that is suitable for your case and health conditions. Your doctor will elaborate about your symptoms, the size of your prostate as well as other health conditions following the procedures you choose that you may have and your preferences.

 

What are the symptoms?

The symptoms and severity of BPH can vary; however, symptoms can gradually worsen over time. The signs and symptoms of BPH are as follows:

  • Often need to urine
  • Having nocturia or want to urine at night more often
  • Starting urination with difficulty (Hesitancy)
  • Having a weak urine stream. Sometimes it stops and starts.
  • Having dripping urine as you finish the urination
  • Feeling that bladder is not completely emptied

Other signs and symptoms of BPH but less common are as follows:

  • Having an infection in the urinary tract
  • Burning or painful urination
  • Having blood in the urine


The severity of the symptoms can vary; however, the size of the prostate does not signify the severity of the symptoms. This means, some men with slightly enlarged prostates can have severe symptoms, while men with very large prostates have less severe symptoms. In some men, symptoms can be stabilized and might improve over time, while it takes a longer time for some men to get the condition improved.

 

BPH may be caused by other factors

Other factors can cause urinary symptoms, such as:

  • Having an infection in the urinary tract
  • Having prostatitis or inflammation of the prostate
  • Having urethral stricture or narrowing of the urethra
  • Having scars in the bladder neck because of previous surgery
  • Having bladder or kidney stones
  • Having problems with nerves that control the bladder
  • Having prostate cancer or bladder cancer

 

When to see a doctor?

You are advised to discuss your urinary problems when having them with your doctor. Although you can still bear with some symptoms, your doctor still needs to identify causes and rule out any underlying causes. If the problems are not gotten rid of, obstruction of the urinary tract may get worse. If you cannot urinate, you are advised to consult your doctor immediately.

 

What are the causes of BPH?

When the prostate is enlarged, your urine flow will be blocked. As a result, you will find it difficult to urinate or you lost the ability to urine. Most men experience gradually enlargement of the prostate throughout their life, and it is big enough for most of them to create urinary symptoms, such as blocking the urine flow.

However, it remains unclear what the exact causes of the prostate enlargement are. In some cases, the changes in the balance of sex hormones when men grow older.

 

What are the risk factors of BPH?

There are several risk factors for prostate gland enlargement, including:

  • Age: Signs and symptoms of BPH can be easily detected when men are older than 40. Moderate to serious symptoms can be detected among one-third of men by the age of 60. Moreover, all men who live long enough will develop enlarged prostates and may suffer serious symptoms by the age of 80.
  • Using some herbal medicine that gives male sex hormone or being on testosterone replacing therapy that may cause prostate to enlarge.
  • Having diabetes and heart disease: According to studies, those with heart disease and diabetes have a chance to have BPH as they use beta-blockers.
  • Prostate infection (Prostatitis) may cause prostatic swelling and result in symptoms like BPH.

 

What is the diagnosis that is used with BPH?

You will be asked with a series of detailed questions about your symptoms when seeing your doctor. The doctor will also run some physical tests initially, such as:

  • Digital Rectal Exam (DRE): With this exam, the doctor normally inserts a finger in your rectum to inspect your prostate if it is enlarged.
  • Test of your urine: Your doctor will analyze your urine, which can help rule out an infection or other conditions.
  • Blood test: Your doctor may need to collect your blood and run some tests on it. The blood test can help your doctor identify problems with your prostate.
  • Prostate-specific Antigen (PSA): Your doctor may also need to run the example to see the level of your prostate-specific antigen (PSA), which is a substance in your prostate. If you have a small and increasing level of PSA, it may indicate that you are having an enlarged prostate. The higher level of PSA over 4 ng/ml may indicates the possibility of having recent procedures, infection, surgery or prostate cancer. With the increasing level of PSA, you may be advised to undergo additional tests to help confirm enlarged prostate as well as ruling out other conditions.
  • Testing urinary flow: This test tends to measure the strength and amount of your urine flow. This test can tell you if your condition gets worse.
  • Postvoid residual volume test: The purpose of this test is to find out you can empty your bladder. Your doctor may ask you to undergo an ultrasound to see it. In some cases, a doctor may ask you to have a catheter inserted into your bladder after you urinate to test the level of your urine.
  • Keep a record on your urinal activity: Check how often you urinate and how much it is might be helpful. If one-third of your urine takes place at night, you may need to consult your doctor.


When your conditions become more complex, you may be recommended as follows:

  • Uroflowmetry (UFM): You need to pass your urine in computer-conncted special toilet to detect any abnormal urination pattern.
  • Transrectal ultrasound: Your doctor may want to inspect your rectum to further investigate your rectum and assess your prostate.
  • Prostate biopsy: Your tissue samples may be taken from your prostate, which is called a biopsy. Inspecting the tissues can help your doctor to diagnose and rule out prostate cancer.
  • Urodynamic and pressure flow: Your doctor may ask you to undergo some urodynamic and pressure flow of your urine. Water will be injected into your bladder so that your doctor can then evaluate the pressure in your bladder and how well your bladder muscles work. However, this method is normally used with men with neurological problems, including those who had the prostate procedure before and still have symptoms.
  • Cystoscopy: A cystoscope which is a lighted and flexible telescope will be inserted into your urethra. With this instrument, your doctor can see the internal condition of your urethra and bladder. A local anaesthetic will be applied before the test.

 

What are the treatments for BPH?

Various treatments can be used to handle an enlarged prostate, such as medication, minimally invasive therapies as well as surgeries. Your doctor may need to evaluate many factors before deciding to employ any treatments. The factors may be based on the following questions:

  • What size is your prostate?
  • How old are you?
  • How is your overall health condition?
  • How annoying are you feeling with the symptoms you have?

If you can still bear with your current symptoms, you may skip treatments and monitor your them instead. Symptoms in some men can be alleviated without treatments. 

 

What are the medications for BPH?

Men with mild to moderate symptoms of an enlarged prostate may require medications as follows:

  • Alpha-blockers: The medications help ease muscles in the bladder neck and help relax muscle fibre in the prostate, which helps you urinate easier. The medications include alfuzosin (Xatral), doxazosin (Cardura), tamsulosin (Harnal) and silodosin (Urief). These medications work well with men with relatively small prostate. However, you may experience some side effects such as dizziness and harmless condition, such as retrograde ejaculation, which is the condition of semen going back into the bladder instead of going out of the head of the penis.
  • 5-alpha reductase inhibitors: These medications suppress your hormonal changes, which is one of the causes of prostate growth. By using these medications, your prostate shrinks. The medications are finasteride (Proscar) and dutasteride (Avodart), and they may take up to six months to be effective. However, retrograde ejaculation may be included as the side effect.
  • Therapy with drug combination: You may be advised to use a variety of medicines along with a therapy; for instance, your doctor will prescribe you alpha-blocker and 5-alpha reductase inhibitors altogether when one medicine does not work.
  • Tadalafil (Cialis): Your doctor may prescribe you tadalafil (Cialis) to treat prostate enlargement. Normally the medicine is used for men with erectile dysfunction; however, studies also show that tadalafil can also treat BPH.


Minimally invasive or surgical therapy

In some cases, your doctor may assign you to undergo a minimally invasive or surgical therapy when:

  • You are having moderate to severe symptoms.
  • The medications that your doctor assign does not work with you.
  • You lose the ability to urine; you have some bladder stones; you have blood in your urine or kidney problems.
  • Your conditions require specific treatments.

However, minimally invasive or surgical therapy may not be suitable for the following conditions:

  • Your urinary tract infection remains untreated.
  • You have a urethral stricture.
  • You have some neurological disorders, such as Parkinson’s disease or multiple sclerosis.


Besides, your doctor should discuss side effects and complications with you if you decide to choose any type of prostate procedure. The side effects and complications may include:

  • Having retrograde ejaculation or the condition when semen flows backwards into the bladder instead of going out from the tip of the penis while ejaculating
  • Having a temporary difficulty when urinating
  • Having an infection in your urinary tract
  • Having some bleedings
  • Having an erectile dysfunction may happen after prostate surgery but less after minimal invasive surgery (i.e. Laser surgery)
  • Having incontinence or loss of bladder control


Nevertheless, if you are required to undergo any type of minimally invasive or surgical therapies, here can be options:

  • Transurethral resection of the prostate (TURP): With this method, your surgeon may use a light scope to insert into your urethra to remove some outer part of the prostate. TURP normally helps relieves symptoms quickly, and most men have a stronger urine flow right after the procedure. However, you may be advised to temporarily use a catheter to pass your urine in the bladder.
  • Transurethral incision of the prostate (TUIP): Your surgeon may opt for this procedure to make one or two small incisions in the prostate gland to make the urine easy to pass through the urethra. This procedure is suitable for you if you have a small and moderately enlarged prostate gland. This procedure will be opted for on the condition that you have other health conditions that post risks to other surgeries.
  • Transurethral microwave thermotherapy (TUMT): With this procedure, a special electrode will be inserted through your urethra and be pushed a long way to your prostate area. And then, microwave energy from the electrode will be used to break the inner part of the enlarged prostate gland, which helps shrink the gland and ease the urine flow. However, TUMT may partially help alleviate your symptoms. It may also take sometimes to see the results. If you have a small prostate in special circumstances; for instance, you receive treatments again, your doctor may recommend this option for you. You may also feel continuous discomfort due to unhealthy prostate tissue that remains.
  • Transurethral needle ablation (TUNA): With the TUMT, a scope will be inserted into your urethra, which allows your doctor to place needles into your prostate gland. Then, radio waves will be used to pass through the needles to heat and break excessive prostate tissue that comes in the way of the urine flow. Presently, TUNA is rarely used as it is an option for very selected cases. It may cause some discomfort same as TUMT.
  • Laser therapy: This procedure may be an option for those men who do not have choices for other procedures or want to avoid more invasive surgery, especially when they take blood-thinning medications. With this procedure, your surgeon uses a high-energy laser to break and remove the enlarged prostate tissue. The procedure generally relieves symptoms right away with lower risks of side effects.
  • Ablative procedures: Your surgeon will use this procedure to vaporize obstructive tissue to increase urine flow. It causes less bleeding and quicker recovery time than invasive surgery.
  • Enucleation procedures: This procedure is aimed at removing all the prostate tissue that is blocking urine flow as well as preventing the recurrence of the tissue. Technically, the removed tissue from this procedure is examined for prostate cancer as well as other conditions.
  • Prostatic urethral lift (PUL): Your surgeon will use special tags to compress the sides of the prostate to increase the urine flow. If your urinary tract symptoms are mild, your surgeon may recommend this procedure. The surgeon will also advise those men who are concerned about the impact on their current treatment for erectile dysfunction and ejaculatory problems. With PUL, the impact on ejaculation and sexual function are pretty much lower, compared with TURP. You may in the future need more invasive surgery.
  • Embolization: This procedure, however, still lacks long-term data on effectiveness. The surgeon normally uses this procedure to prevent blood flow to the prostate, which causes its size to decrease.
  • Open or robot-assisted prostatectomy: With this procedure, an incision will be made in your lower abdomen where your surgeon can reach the prostate and get the problem tissue removed. Your surgeon will opt for open prostatectomy if your prostate is very large with bladder damage or other complications. You may be requested to be admitted in hospital as you may need a blood transfusion. It is the most invasive treatment and causes more side effect and complication like incontinence or impotency.