Benign Prostatic Hyperplasia - Symptoms and Treatments

What Is Prostate?

The prostate is a gland in the male reproductive system. The prostate gland’s size resembles a walnut, and it is exactly located between the penis and the bladder. It secretes a fluid that constitutes 30% of the seminal fluid. This fluid is necessary for maintaining the health of the sperms. The prostate surrounds the urethra, which is the outlet for urine.

What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia (BPH) is an age-related growth and enlargement of the prostate gland. As the condition is benign, it does not spread to other body organs and remains confined to the gland. The prostate gland goes through two important growth periods. The first growth phase occurs at the time of puberty, and the second one begins at around 25 years of age. The prostate gland doubles in size during the first growth phase, while the second phase continues throughout a person's life. As the gland enlarges, it presses against the urethra, resulting in the thickening of the bladder wall. The bladder becomes weak and is unable to function properly. As a result, the urine remains in the bladder, making it difficult for the patient to urinate. This condition is known as urinary retention. So, the enlargement of the prostate gland also increases the risk of urinary tract problems.

What Are the Causes of Benign Prostatic Hyperplasia?

The actual cause for benign prostatic hyperplasia could not be identified. Any alteration in the level of male sex hormones can be the reason. The condition occurs not only in old men but also in those individuals who underwent orchiectomy or testicle removal surgery before puberty. In order to explain the cause of prostate enlargement, the following two theories have been put forward by the researchers:

1. Hormonal Changes - Males produce two hormones throughout their lives, mainly testosterone and estrogen. Normally, estrogen is produced in very small amounts because it is a female hormone. As the age of a person increases, testosterone levels decrease, leaving a large amount of estrogen in the blood. Scientists believe that this estrogen might be responsible for promoting cell growth and prostate enlargement.

2. Dihydrotestosterone - Dihydrotestosterone is a male hormone that regulates the growth of the prostate gland. When the testosterone levels decrease with age, the person continues secreting dihydrotestosterone. As a result, this hormone accumulates in the prostate gland and encourages the growth of prostate cells.

What are the Symptoms of Benign Prostatic Hyperplasia?

• Urinary urgency.

• Frequent urination, especially at night.

• Weak urine stream.

• Dribbling of urine towards the end of micturition.

• Feeling of incomplete voiding.

• Recurrent urinary tract infections.

• Rarely, blood in the urine.

• Erectile dysfunction.

What Are the Complications of Benign Prostatic Hyperplasia?

The several complications of benign prostatic hyperplasia are:

• Urinary infections.

• Prostatitis (infection of the prostate).

• Urinary retention.

• Bladder stone.

• Kidney dysfunction.

How Is Benign Prostatic Hyperplasia Diagnosed?

The diagnosis of benign prostate hyperplasia is based on medical history, physical examination, laboratory tests, and imaging tests. The diagnostic methods are described below:

• Medical History - The medical history provides an idea about the patient's medical conditions. The following questions are usually asked in medical history:

  • What symptoms did the patient experience?

  • When did the patient notice the symptoms first?

  • Is anyone in the family (father or brother) suffering from prostate problems?

  • Is the patient taking any medications?

  • Did the patient suffer from urinary tract infections in the past?

  • How many times does the patient pass urine during the day?

  • Does the patient experience any trouble while urinating?

• Digital Rectal Examination: The doctor will perform a clinical examination to identify any presence of abnormal growth in the form of lump or mass. The prostate gland will also be assessed by insertion of the lubricated and gloved fingers into the rectum. The presence of nodules or any inflammatory conditions can be identified with the help of this digital rectal examination procedure.

• Transrectal Ultrasound: The other name for transrectal ultrasound is prostate ultrasound. A probe with an ultrasound option is inserted into the rectum. This will help in assessing the condition of the prostate gland.

• Urine Test: The urine is collected from the patient and tested to identify the presence of any infection.

• Blood Test: A blood test will play a vital role in the identification of any problems in the kidney.

• Prostate-Specific Antigen (PSA) Blood Test: A prostate-specific antigen is a component that is produced by the prostate glands. Whenever there is an enlargement of the prostate gland, the level of the prostate-specific antigen gets elevated.

• Postvoid Residual Volume Test: Postvoid residual volume test helps in identifying the ability of the individual to excrete the urine completely and empty the bladder. This test is done with the help of catheter insertion or an ultrasound.

• Biopsy of the Prostate Gland: A tissue sample of the prostate gland is taken for the assessment of the cells. A guided needle might be needed for this purpose. The analysis of the tissue can help in ruling out other conditions related to the prostate gland.

• Cystoscopy: An instrument called a cystoscope is inserted into the bladder to see the internal parts of the bladder.

What Are the Different Treatment Options for Benign Prostatic Hyperplasia?

The treatment for benign prostatic hyperplasia depends on the following factors:

• Overall health status of the patient.

• Size of the prostate.

• Age of the patient.

The various treatment options for benign prostatic hyperplasia are discussed below.

1) Lifestyle Changes: Taking small amounts of fluid spread throughout the day and limiting fluid intake during the evenings can help with increased urinary frequency at night. Whenever you need to urinate, try relaxing and void as completely as possible. This can help in reducing the volume of residual urine in the bladder and help with symptoms of urinary urgency and frequency. One of the common habits which men have is the usage of gadgets like a laptop by placing them on their lap for a very long time. This is particularly noticed in men who are working in the IT profession or who continuously work from home on computers. Laptops have a capacity to emit heat on prolonged usage. When a working professional is in the situation of using the laptop for a long time, then the heat gets directly transferred to their prostate gland. It can have a direct effect on the reproductive system. This negative effect can happen for women too, but men are under a zone of higher risk. The temperature of the prostate gland should be maintained ideally for healthy functioning. When an individual places the laptop over the gland, the excessive heat transmitted can invite a lot of health-related problems. It is also advisable to wear loose clothing at home so that sufficient airflow reaches the prostate gland.

2) Medications:

• Alpha-Blockers Like Terazosin and Tamsulosin: They relax the muscles in the urethra, thus helping with the urine flow.

• 5-Alpha-Reductase Inhibitors Like Finasteride and Dutasteride: They reduce the size of the prostate.

• Phosphodiesterase Type 5 Inhibitors Like Tadalafil (Tadalafil): Tadalafil has been approved by the FDA for the treatment of both BPH and erectile dysfunction. Tadalafil improves the blood flow to the penis, thereby treating erectile dysfunction. It also relaxes muscles in the urethra and the prostate, thus increasing urinary flow. Both alpha-blockers and 5-alpha-reductase inhibitors can cause sexual side effects like decreased sexual urge or libido and erectile dysfunction. If the sexual side effects are bothersome, then Tadalafil can also be tried. However, Tadalafil and alpha-blockers should not be taken together as they can dangerously lower blood pressure. It is important to stop alpha-blockers before starting Tadalafil.

3) Less Invasive Procedures: Transurethral needle ablation (TUNA), transurethral microwave therapy, and laser therapy. Less invasive procedures have faster recovery time and less incidence of complications like urinary incontinence, erectile dysfunction, and retrograde ejaculation.

4) Surgery: Transurethral resection of the prostate (TURP), which is more effective than less invasive procedures. The other evolving surgical methods for benign prostatic hyperplasia are:

• Transurethral Microwave Thermotherapy (TUMT) - As the name suggests, this procedure uses microwaves to destroy the tissues of the prostate gland. A catheter is inserted into the prostate gland through the urethra. Next, the device, known as an antenna, sends microwaves to the heated portion of the gland through the catheter. The extra tissues are removed with the help of heat.

• Transurethral Incision of the Prostate (TUIP) - A cystoscope is inserted into the prostate gland through the urethra. The doctor widens the urethra by making small cuts in the gland and the bladder neck.

• High-Intensity Focused Ultrasound - The doctor inserts the ultrasound probe into the rectum to reach the prostate gland. The heat produced by the probe removes the excess prostate tissues.

• Prostatic urethral lift (PUL) - It is a minimally invasive medical procedure to relieve the lower urinary tract symptoms due to prostate enlargement.

• Embolization - It is a medical procedure wherein a small puncture is made in the groin. Next, a catheter is inserted into the prostatic artery. Finally, small particles are injected that block the blood flow. This process is known as embolization.

• Prostatectomy - Prostatectomy is done when the prostate gland has to be removed completely or partially. It is done to treat prostate cancer and benign prostatic hyperplasia. In this procedure, a cut is made in the lower abdominal region to access the prostate gland and the nearby structures. The surgical tools are inserted to remove the gland or a part of it.

• Laser Therapy - A high-energy beam of laser is used to remove prostate tissues. The biggest advantage of this procedure is that the patient is immediately relieved of the symptoms, and it is less traumatic.

The choice of treatment depends on the severity of the symptoms, complications, and response to the medications.

Conclusion:

Benign prostate hyperplasia is characterized by the non-cancerous enlargement of the prostate gland. As the gland is present near the neck of the urinary bladder, the patient experiences problems related to the urinary tract. Treatment depends upon the severity of the prostate enlargement. Mild to moderate cases can be treated by antibiotics. However, severe cases can only be treated surgically. Consult the doctor to know more about benign prostatic hyperplasia and the treatment options available for it.