BENIGN PROSTATIC HYPERPLASIA
Most people don’t know what the prostate is actually for and how it may interfere with a man’s ability to pee. The prostate is a walnut-sized gland at the base of a man’s bladder. It surrounds the urethra, which is the tube that connects your bladder to your pee hole allowing your pee to exit finely. The prostate’s main purpose is to produce a fluid that transports a man’s sperm during ejaculation ensuring a perfect delivery every time. Now imagine if the prostate surrounding the urethra gets bigger and bigger and essentially chokes off the urethra.
- MEDELIN ZECH RUIZ in the book I MARRIED A DICK DOCTOR
What is BPH?
Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement and it is not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction. It is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract, or kidney problems.
The prostate goes through two main growth periods as a man ages. The first occurs early in puberty when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia often occurs with 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, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder—cause many of the problems associated with benign prostatic hyperplasia.
What is the Main Cause of Prostate Enlargement?
The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra — the “chute” through which urine and semen exit the body. As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.
Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.
Risk factors for prostate gland enlargement include:
- Aging: Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
- Family history: Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.
- Diabetes and heart disease: Studies show that diabetes, as well as heart disease and the use of beta-blockers, might increase the risk of BPH.
- Lifestyle: Obesity increases the risk of BPH, while exercise can lower your risk.
What are the Symptoms of Prostate Enlargement?
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include
- urinary frequency—urination eight or more times a day
- urinary urgency—the inability to delay urination
- trouble starting a urine stream
- a weak or an interrupted urine stream
- dribbling at the end of urination
- nocturia—frequent urination during periods of sleep
- urinary retention
- urinary incontinence—the accidental loss of urine
- pain after ejaculation or during urination
- urine that has an unusual color or smell
- incomplete bladder emptying
- the need to strain when urinating
- blood in the urine
The size of the prostate does not always determine the severity of the blockage or symptoms. Sometimes men may not know they have a blockage until they cannot urinate. Your doctor can diagnose BPH based on:
- Personal or family history
- A physical exam
- Medical tests
The American Urological Association (AUA) has built a BPH Symptom Score Index. It’s a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe. Take the test and talk with your doctor about your results. Your doctor will review your Symptom Score and take a medical history. You will also have a physical exam that involves a digital rectal exam (DRE).
Your doctor may also want you to have some or all of these tests:
- Cystoscopy to look at the urethra or bladder with a scope
- Post-void residual volume to measure urine left in the bladder after urinating
- PSA blood test to screen for prostate cancer
- Ultrasound of the prostate
- Urinalysis (urine test)
- Uroflowmetry to measure how fast urine flows
- Urodynamic pressure to test pressure in the bladder during urinating
- A urinary blood test to screen for bladder cancer
What is the Difference between Benign Prostatic Hyperplasia and Benign Prostatic Hypertrophy?
The terms are often used interchangeably by patients and clinicians alike. While both represent an increase in the size of the prostate, the two phrases do have slightly different meanings.
Hyperplasia involves the growth in the number of prostatic cells. Each cell remains roughly normal in size, but the sheer increase in the number of these cells causes the prostate to expand. Hypertrophy, on the other hand, represents the growth of the size of each cell – no significant number of new cells are formed.
In-office treatment for BPH, whether caused by hyperplasia or hypertrophy, is the same. Whether hyperplasia or hypertrophy, the first steps are the same.
What is the Best Treatment for Benign Prostatic Hyperplasia?
A health care provider treats benign prostatic hyperplasia based on the severity of symptoms, how much the symptoms affect a man’s daily life, and a man’s preferences. Men may not need treatment for a mildly enlarged prostate unless their symptoms are bothersome and affecting their quality of life.
Lifestyle changes can include
- reducing intake of liquids, particularly before going out in public or before periods of sleep
- avoiding or reducing intake of caffeinated beverages and alcohol
- avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics
- training the bladder to hold more urine for longer periods
- exercising pelvic floor muscles
- preventing or treating constipation
- Alpha-blockers: These medications relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage. These include terazosin (Hytrin), doxazosin (Cardura), and others.
- Phosphodiesterase-5 inhibitors: Urologists prescribe these medications mainly for erectile dysfunction. They can reduce lower urinary tract symptoms by relaxing smooth muscles in the lower urinary tract
- 5-alpha reductase inhibitors: These medications can prevent the progression of prostate growth or shrink the prostate in some men. Finasteride and dutasteride act more slowly than alpha-blockers and are useful for only moderately enlarged prostates.
- Combination medications. Several studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two classes of medications, instead of using just one, can more effectively improve symptoms, urinary flow, and quality of life. A urologist may prescribe a combination of alpha-blockers and antimuscarinics for patients with overactive bladder symptoms.
Minimally invasive or surgical therapy
Minimally invasive or surgical therapy might be recommended if:
- Your symptoms are moderate to severe
- Medication hasn’t relieved your symptoms
- You have a urinary tract obstruction, bladder stones, blood in your urine, or kidney problems
- You prefer definitive treatment
There are several types of minimally invasive or surgical therapies.
Transurethral resection of the prostate (TURP): A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.
Transurethral incision of the prostate (TUIP): A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.
Transurethral microwave thermotherapy (TUMT): Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.
Transurethral needle ablation (TUNA): In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer.
Laser therapy: A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does non-laser surgery. Laser therapy might be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.
The options for laser therapy include:
- Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations, another resection procedure might be needed at some point.
- Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent the regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.
Prostatic urethral lift (PUL): Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL than it is with TURP.
Embolization: In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure isn’t available.
Open or robot-assisted prostatectomy: The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage, or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.
Does an Enlarged Prostate Affect a Man Sexually?
An enlarged prostate can cause sexual problems in men, such as:
- Erectile dysfunction (the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time)
- Reduced sex drive
- Decreased sexual satisfaction
Sexual problems, such as erectile dysfunction or ejaculation problems, may occur in men with BPH). Sexual dysfunction in BPH usually results from the treatment rather than the disease.
BPH is a condition that can impact your life greatly. However, treatments are available which will help in the improvement. Hopefully, this article helped in knowing about BPH.
To understand more about urology and the different problems faced by men, pick up I MARRIED A DICK DOCTOR by MEDELIN ZECH RUIZ. It is an insightful book, compassionately touching upon sensitive issues.