Dr. Sharath Shetty
Specialist - Urologist
MBBS, MS (General Surgery), DNB
INTRODUCTION:
Benign prostatic hyperplasia is a condition that occurs when the prostate gland enlarges, slowing or blocking the urine stream. BPH occurs only in men; approximately 8 percent of men aged 31 to 40 have BPH. In men over age 80, more than 80 percent have BPH.
Many men with BPH have no symptoms. In men with symptoms, the most common include needing to urinate frequently (during the day and night), a weak urine stream, and leaking or dribbling of urine. These symptoms are called lower urinary tract symptoms (LUTS). For men with bothersome symptoms in whom lifestyle changes have fallen short, treatment with one or more medicines or surgery is available.
THE PROSTATE GLAND
The prostate is a small walnut sized gland sitting just below the bladder and surrounding the urethra, the tube that carries urine from the bladder through the penis and outside the body.
BPH
The cause of prostate enlargement is unknown.As the prostate gland enlarges, it presses against the urethra. The pressure causes the urethra to narrow and the bladder to work harder to eliminate urine through it. The bladder wall becomes thicker and irritable. The bladder may contract even when it contains only a small amount of urine. Eventually, the bladder wall weakens and is unable to completely empty the urine. This leads to the symptoms associated with BPH.
It is not clear why some men develop symptoms of BPH or lower urinary tract symptoms (LUTS) and others do not.
BPH SYMPTOMS
The symptoms of BPH usually begin after age 45. The most common symptoms of BPH include:
- - Frequent urination, especially at night
- - A hesitant, interrupted, or weak stream of urine
- - The need to urinate frequently
- - Leaking or dribbling of urine, Sense of incomplete emptying of bladder.
A small percentage of men may present with blood in the urine, or urinary retention (unable to urinate). The risk of urinary retention increases with age.
BPH DIAGNOSIS
- - Rectal exam – to feel the size and shape of the prostate gland.
- - Urinalysis – to look for bladder infection.
- - Ultrasound scan - To look for the size of prostate, post void residue
- - Uroflowmetry — a simple diagnostic screening procedure used to calculate the speed of urination.
BPH TREATMENT
Men with mild BPH might not need treatment. Lifestyle changes — may be helpful, particularly as an adjunct to medication. Lifestyle changes include
- - Stop drinking fluids a few hours before bedtime or going out.
- - Avoid or drink less fluids like caffeine and alcohol.
- - Double void. This means that after the bladder is emptied, retry to urinate.
MEDICINES
The types of medicine used to treat BPH include alpha blockers and alpha-reductase inhibitors, used alone or in combination.
- - Alpha blockers — These medications relax the muscle of the prostate and bladder neck, which allows urine to flow more easily.
- - Alpha-reductase inhibitors — can stop the prostate from growing further or even cause it to shrink.
TRANSURETHRAL PROCEDURES — If medicines do not relieve symptoms of BPH, procedures are performed through the urethra using a special scope like:
- Resection of the prostate (to remove prostate in pieces), Ablation of the prostate (destroy the prostate tissue using electrical, light, heat energy or LASER ).
OTHER PROCEDURES: Other surgical procedures may be available for men with BPH.
- Removal of the prostate – Surgery to remove the prostate (prostatectomy) might be recommended for men who are healthy and have a very large prostate (over 100 g).
- Suprapubic catheter – A catheter placed directly into the bladder might be used as a temporary measure to manage bladder outlet obstruction prior to surgery; or, in some circumstances (uncommon), it may be a permanent option.
COMPLICATIONS: include a sudden inability to urinate, urinary tract infections, urinary stones, kidney damage, and blood in the urine.
