BENIGN PROSTATE HYPERPLASIA
(ENLARGED PROSTATE)
The prostate is a small, muscular gland that is part of the male reproductive system. The prostate surrounds the urethra and makes most of the fluid in the semen. The prostate has a muscular action that helps propel the fluid and semen through the penis during sexual climax. The prostate can become enlarged among many men. Sometimes it leads to symptoms and, over time, other complications.
The enlargement of the prostate is called benign prostatic hyperplasia (BPH). It happens when the cells of the prostate gland begin to multiply. These additional cells cause the prostate gland to swell, as it enlarges, it squeezes the urethra and thus limits the flow of urine. BPH is not the same as prostate cancer and doesn't increase the risk of cancer. However, it can cause symptoms that can affect a person's quality of life. BPH is common in men older than 50 years.
WHAT IS BENIGN PROSTATIC HYPERPLASIA?
Benign prostatic hyperplasia, also known and called BPH, is a condition in men in which the prostate gland becomes enlarged but not cancerous. It is referred to other times as benign prostatic hypertrophy or benign prostatic obstruction.
The prostate goes through two main growth periods as a man ages. The first, the prostate doubles in size early in puberty, the second phase of growth happens around age 25 and this continues during most of a man's life. BPH often occurs within the second growth phase.
As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention are mostly the cause of many of the problems associated with benign prostatic hyperplasia. Scientists have established that men who do not produce DHT do not develop benign prostatic hyperplasia.
CAUSES
The cause of benign prostatic hyperplasia is yet to be completely understood, however, it occurs mainly in older men. BPH does not develop in men whose testicles were removed before puberty. Because of these, many researchers believe that factors related to aging and especially the testicles may be the cause of benign prostatic hyperplasia.
Throughout their lives, men produce a male hormone called testosterone and small amounts of estrogen, a female hormone. However, the amount of active testosterone in their blood decreases as men age. This leaves a higher proportion of estrogen. A lot of studies suggests that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the actions of substances that promote prostate cell growth.
Another theory attributes the cause to dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some other research indicates that even with a drop in blood testosterone levels, elderly men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have established that men who do not produce DHT do not develop benign prostatic hyperplasia.
SYMPTOMS
Symptoms of enlarged prostate can include:
- Frequent urination
- A weak or slow urinary stream
- Incomplete emptying of bladder
- Having to urinate again minutes after finishing
- Difficulty starting urination
- A persistent urgency to urinate
- Frequent night urination
- A urinary stream that starts and stops
- Straining to urinate
- Dribbling of urine
RISK FACTORS
Risk factors for prostate gland enlargement include:
- Ageing; Prostate gland enlargement seldom causes signs and symptoms in men younger than age 40. About thirty percent (30%) of men experience moderate to severe symptoms by age 60.
- Family history. If a blood relative, such as a father or a brother, has or had prostate problems, it would mean a major likelihood that the individual could have similar problems.
- Diabetes and heart disease. Diabetes, as well as heart disease and use of beta blockers, have been shown to increase the risk of BPH.
- Lifestyle. Obesity definitely increase the risk of BPH, while exercise can lower the risk.
COMPLICATIONS
The complications of an enlarged prostate can include:
Sudden inability to urinate (urinary retention). One might need to have a tube (catheter) inserted into the bladder to drain the urine. Some men with enlarged prostate need surgery to relieve the retention of urine.
- Urinary tract infections (UTIs): Inability to fully empty the bladder can increase the risk of infection in the urinary tract. If UTIs occur frequently, one might need surgery to remove part of the prostate.
- Bladder stones: They are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruct urine flow.
- Bladder damage: A bladder that does not empty consistently can stretch and weaken with time. When that happens, the muscular wall of the bladder no longer contracts, thus making it harder to fully empty the bladder.
- Kidney damage: Pressure in the bladder from retention of urine can directly damage the kidneys or allow bladder infections to reach the kidneys.
Most men with an enlarged prostate do not develop these complications. Nonetheless, acute urinary retention and kidney damage can be serious health threats.
Having an enlarged prostate does increase one's risk of developing prostate cancer
WHEN TO SEE A DOCTOR
A person may have urinary symptoms caused by bladder problems that may be unrelated to benign prostatic hyperplasia these could be UTIs, or inflammation of the prostate (prostatitis). Symptoms of benign prostatic hyperplasia can also signal some more serious conditions, including prostate cancer.
Men with the following symptoms should seek immediate medical care:
- Pain in the lower abdomen and urinary tract
- Complete inability to urinate
- Painful urination
- Frequent and urgent need to urinate, with fever and chills
- Blood in the urine
- Great discomfort or in the lower abdomen and urinary tract
DIAGNOSIS
People should see their doctor immediately if they see blood in their urine, pain or burning when urinating or if they cannot pass urine.
The following tests are a few of the many that are used to diagnose and track BPH.
- Symptom Score Index
A BPH Symptom Score Index has been developed. It is a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe.
- Physical Exam
A digital rectal exam (DRE) is often the second step. During a DRE, the patient would lie on their side or bend over. The doctor inserts a gloved, lubricated finger into the rectum to feel the back wall of the prostate gland.
In conducting this test, the health care provider would be looking out for enlargement, tenderness, lumps or hard spots. This 10-15 second exam is an important way to find problems.
- Urine Tests
Urine tests are done to measure how well the patient releases urine it will show the doctor if the urethra is blocked or obstructed. There are several types:
Urinalysis tests the urine sample to check for important things as blood, signs of infection, glucose (sugar), protein and other factors that can tell the urologist the cause of symptoms. Urine tests are also used to screen for bladder cancer. Should there be blood in the urine, pain or burning when urinating, or if one cannot pass urine, it is important to see a doctor right away.
Post-void residual volume (PVR) measures urine left in the bladder after passing urine. This is done to diagnose the problem. It may also be done before surgery.
Uroflowmetry measures how fast urine flows. It may also be done before surgery. This is done to diagnose the problem.
Urodynamic pressure flow ia a procedure that tests pressure in the bladder during urination.
- Scans
These are tests that are done to see the size and shape of the prostate.
Some BPH scans include:
Ultrasound scan will be used to look inside the body to see the size and shape of the prostate.
Cystoscopy is an exam used to look at the urethra or bladder with a scope.
For more detailed scans, the magnetic resonance imaging (MRI) and computed tomography (CT) are done if surgery is necessary to re-open the flow of urine. These scans have the ability to provide a very clear image of the prostate and surrounding area. It will show exactly how and where the prostate is enlarged.
- Blood Test
Prostate-specific antigen (PSA) blood test is used to screen for prostate cancer. The PSA blood test checks the level of PSA, a protein made only by the prostate gland. For several days prior to the test, sexual activity should be avoided since it may artificially increase the PSA reading.
When the prostate is healthy, very little PSA will normally be found in the blood. A rapid rise in PSA may be an indication that something may be wrong. A benign enlargement of the prostate can cause a rise in PSA levels, as can an inflammation of the prostate (prostatitis). Cancer remains the most serious cause of a rise in PSA.
TREATMENT
The treatment of BPH can begin with self-care. If symptoms don't subside through self-care, the doctor may recommend medication or surgery. The prescribed treatment would be influenced by age and general health of the patient.
BPH natural treatment
Natural treatment can include specific actions or lifestyle changes that can be made to help relieve the symptoms of BPH. These will include:
- Urinating as soon as one feels the urge
- Keeping warm (being cold can make symptoms worse)
- Reducing stress levels, nervousness for example can increase the frequency of urination
- Going to urinate, even without the urge
The avoidance of decongestants or antihistamine medications bought over-the-counter. (These can make it more difficult to empty the bladder).
- The avoidance of alcohol and caffeine, especially after supper
- Regular exercise, a lack of exercise can aggravate the symptoms
- The learning and practicing of Kegel exercises to strengthen the pelvic muscles
BPH drugs
When lifestyle changes aren't enough to relieve the symptoms, the doctor may recommend medication. There are several medications that can help to both treat the symptoms of BPH and BPH itself. These medications include alpha-1 blockers, hormone reduction medications, and antibiotics.
Alpha-1 blockers
Alpha-1 blockers are medications that relax the muscles of the bladder and prostate. Alpha-1 blockers relax the neck of the bladder and make it easier for urine to flow. Examples of alpha-1 blockers include:
- Terazosin
- Doxazosin
- Tamsulosin
- Prazosin
- Alfuzosin
Hormone reduction medications
Medications that reduce the levels of hormones produced by the prostate gland such as dutasteride and finasteride are commonly prescribed. These are two medications that lower the levels of testosterone. Sometimes, lowering the hormone levels will make the prostate get smaller and improve urine flow. Except that these medications may also lead to undesired side effects such as impotence and a reduced sex drive.
Antibiotics
If the prostate becomes chronically inflamed from bacterial prostatitis related to BPH, antibiotics may be used. If bacterial prostatitis is treated with antibiotics, it may improve the symptoms of BPH by reducing the inflammation. It must be noted however, that antibiotics won't help prostatitis or inflammation if it is not caused by bacteria.
Surgery for BPH
There are different types of surgical procedures that can help treat BPH if medications fail to resolve the symptoms. Some procedures are either not at all invasive or minimally invasive and can often be done even in the doctor's office or clinic under outpatient procedures. Others are more invasive and need to be done as an inpatient procedure in a hospital.
OUTPATIENT PROCEDURES
Outpatient procedures involve inserting an instrument into the urethra and into the prostate gland.
It includes:
Transurethral needle ablation (TUNA): This procedure is one in which radio waves are used to scar and shrink prostate tissue.
Transurethral microwave therapy (TUMT): This procedure uses microwave energy to eliminate prostate tissue.
Water-induced thermotherapy (WIT): In this process, heated water is used to destroy prostate tissue.
High-intensity focused ultrasonography (HIFU): Sound energy is used to eliminate excess prostate tissue.
INPATIENT PROCEDURES
Inpatient procedures might be recommended in the advent of the following symptoms:
- Persistent episodes of blood in the urine
- An inability to empty the bladder
- Kidney failure
- Bladder stones
- Recurrent urinary tract infections
- Incontinence
Inpatient procedures include:
Transurethral resection of the prostate (TURP): The most commonly used surgical treatment for BPH, a small instrument is inserted through the urethra into the prostate. The prostate is then removed in bits and pieces.
Simple prostatectomy: The doctor makes an incision in the abdomen or perineum, which is the area behind the scrotum and remove the inner part of the prostate. After this procedure, the patient may have to stay in the hospital for up to 10 days.
Transurethral incision of the prostate (TUIP): This is similar to TURP, but in this procedure, the prostate isn't removed. Instead, a small incision is made in the prostate that will enlarge the outlet of the bladder and urethra. The incision allow urine to flow more freely. Patients aren't always required to be admitted in a hospital with this procedure.
BPH vs. prostate cancer
BPH and prostate cancer actually share many symptoms, however prostate cancer is a more serious condition than BPH. In most cases, prostate cancer will need to be treated. That's why it's important for a doctor to make sure that the symptoms aren't related to prostate cancer.
Can benign prostatic hyperplasia be prevented?
A way has not been found yet to prevent benign prostatic hyperplasia. Men can get early treatment and minimize benign prostatic hyperplasia effects by recognizing lower urinary tract symptoms and identifying an enlarged prostate. Men with risk factors for benign prostatic hyperplasia should talk with their doctors about any lower urinary tract symptoms and the need for regular prostate exams.
Eating, Diet, and Nutrition
Although eating, diet, and nutrition have not been found to play any role in causing or preventing benign prostatic hyperplasia. Yet a doctor can give information about how changes in diet, eating or nutrition could help with treatment. Men should talk with a dietitian about what diet is right for them.
After Treatment
Symptoms of BPH improve after treatment for most men. Infection, bleeding, incontinence and erectile dysfunction may occur after some treatments. In some cases, scar tissue may form.
The Long term Side Effects of Treatment
Side effects vary between the types of treatment but are mostly temporary. It may take a while for sexual function to fully return. Most experts agree that a person who was able to have an erection shortly before surgery, will most likely be able to do so after surgery. Most men found little or no difference in orgasm. It is entirely possible to have retrograde ejaculation (i.e. when semen enters the bladder rather than being sent out through the penis). For most men, side effects reduces with time.
Some treatments may still cause long-term side effects for some men.
