Benign Prostatic Hyperplasia (BPH)

written by Dr George Lee Eng Geap on 16 August 2011

Benign Prostatic Hyperplasia

What is the prostate?

The prostate is part of the male reproductive system which is about the same size and shape as a walnut. It is located below the bladder and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH? 
BPH is a common urological condition caused by the non-cancerous enlargement of the prostate gland in with advancing age. It can cause men to have trouble passing urine and results in symptoms of BPH.
BPH is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80. 
The risk factors for developing BPH include increasing age and a family history of BPH.
What are the symptoms associated with BPH? 
The benign enlargement of the prostate can cause symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours. 
You may also experience the need to wake up at night and pass urine. Some men may also have the symptoms of urgency once have the desire to pass urine. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, weak urinary stream, dribbling of urine, or the need to stop and start urinating several times in order to empty the bladder.
BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. If the symptoms are prolonged, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
How is BPH diagnosed? 
A symptom score, such as IPSS, may be used in order to help assess the severity of BPH symptoms. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is — ranging from mild to severe.
When a doctor evaluates a man with possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the BPH Symptom Score Index.
In addition, the doctor will generally do a urine test called a urinalysis. Other tests may also be carried out depending on the clinical situation of the man. 
These include:
prostate specific antigen (PSA), a blood test to screen for prostate cancer
urinary cytology, a urine test to screen for bladder cancer
uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates 
urodynamic pressure-flow study that tests the pressures inside the bladder during urination
ultrasound of the kidney bladder or the prostate
Are there risks in not seeking treatment for BPH?
In the majority of men, BPH is a progressive disease. It can lead to bladder damage, infection, blood in the urine, and even kidney damage. It is therefore important for men with this condition to continue to be followed.
What are the treatments for BPH?
If you are diagnosed with BPH, you should discuss all treatment options with your urologist. The treatment may include medications, minimally invasive therapy or surgical treatment.
When should I see a doctor about BPH? 
A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.
What are some of the medical treatments available for BPH?
Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. 
Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. The side effects can include headaches, dizziness, light-headiness, fatigue and ejaculatory dysfunction.
5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, the drugs can shrink the prostate size. Studies suggest that these medications may be best suited for men with relatively large prostate glands. 
It may take as long as six months to a year, however, to achieve maximum benefits from this drug. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.
When is surgical treatment suggested as a form of treatment?
When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant bleeding or stones in the bladder.
What are the different surgical treatments available?
Removal of the prostate can be accomplished in several different ways, depending on the size of the prostate and the patient's general health.
Transurethral resection of the prostate (TURP): Transurethral resection is the most common surgery for BPH. After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. 
An electrical loop can cuts tissue and seals blood vessels. With this instrument, the prostate tissue is removed one piece at a time. The removed tissue pieces are sent to a pathologist for examination under a microscope. 
At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter.
The catheter may be removed two to three days after the operation depending on your conditions.
Holmium laser enucleation of prostate (HoLEP): After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the penis into the urethra.
A visual lens and laser are passed through the hollow center of the instrument. The prostate tissue is vaporized using the holium: YAG laser.
 There is very little bleeding and recovery time is cut significantly. Typically, the patient has a catheter removed the next day and stays overnight in the hospital one day.
Transurethral radio frequency needle ablation of the prostate (TUNA): The procedure involves anesthesia and medications to make the patient sleepy. The technology involves heating of tissue using radio frequency energy transmitted by needles inserted directly into the prostate.
High frequency radiowaves heat the prostate up to very high temperatures. The heated prostate tissue is destroyed and initially swells but then shrinks.
Most men require a catheter for a period of time after this procedure.
Advantages in the use of TUNA include the limited anesthesia requirement, the ability to perform the procedure in an office setting and avoidance of serious complications sometimes associated with other procedures.
Photoselective vaporization of the prostate (PVP) or Greenlight Laser: This is fast becoming a very popular procedure performed either in a well equipped office or as an out-patient at the hospital. 
It uses a high-powered laser that vaporizes the obstructing prostate tissue with minimal bleeding or side effects. This procedure can serve to get men off of medical therapy. It is effectively replacing more invasive surgical treatment.
Frequently Asked Questions:
Is BPH a rare condition?
No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
Does BPH lead to prostate cancer?
No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer; so yearly physical examinations and PSA testing are highly recommended.
Which type of drugs are the best?
To date, there are not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient.
How do I know if oral medications are the best treatment for me?
If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication or surgical treatment is best for you.