Introduction:
The prostate belongs to the male reproductive system. It is a small gland below the bladder that surrounds the urethra. It produces a fluid (semen) that protects and nourishes the sperm. Generally, with age, it increases in size in men.
When the prostate grows in size, it narrows down the urethra. This enlargement obstructs the path of urine during urination. As a result, the patient suffers from frequent urination during nighttime, incomplete emptying of urine, and many other symptoms. This condition is called benign prostatic hyperplasia, which is best treated through various surgical techniques.
What Is Benign Prostatic Hyperplasia?
It is an overgrowth of tissues in the prostate of men. The overgrown tissues or increase in the number of tissues is called hyperplasia. It is also called prostate enlargement.
What Is the Prostate?
The male reproductive system has different parts, such as the penis, seminal vesicles, testicles, and prostate. The prostate is a small gland below the bladder that surrounds the urethra. The urethra is a tube that carries urine from the bladder during urination. The primary function of the prostate is to protect and nourish the sperm.
Which Age Group Is Most Commonly Affected by Benign Prostatic Hyperplasia?
It most commonly occurs in men who are above the age of 60 years. However, up to 80 to 90 % of cases occur in men who are above the age of 70 years.
What Are the Causes of Benign Prostatic Hyperplasia?
The common causes are:
- The effect of testosterone on the tissues of the prostate. Testosterone is the sex hormone in males responsible for sexual development.
- High blood pressure, insulin resistance, and an imbalance of cholesterol and other fats are risk factors for benign prostatic hyperplasia.
- Obesity is also a risk factor for this condition. However, the exact mechanism is unknown.
- Genetics, such as the family history of benign prostatic hyperplasia, is also one of the causes.
What Is the Pathophysiology of Benign Prostatic Hyperplasia?
The obstruction in the urinary bladder and infection in the urinary tract results in men's enlarged prostate. This compresses or narrows the urethra (a tube that carries the urine) and obstructs the base or neck of the bladder. In addition, the prostate's smooth muscles lose their elasticity and collagen activity upon compression. As a result, hyperplasia causes an increase in the number of cells in the prostate.
What Are the Symptoms of Benign Prostatic Hyperplasia?
The common symptoms are:
- Nocturia - Frequent urination at night because of excessive liquid intake (also called prolonged micturition), sleeping disorder, and others.
- Poor Stream - Difficulty in maintaining or starting the urine stream.
- Loss in weight.
- Pain in bones.
- Involuntary urination while sleeping. It is also called nocturnal enuresis.
How Is Benign Prostatic Hyperplasia Diagnosed?
1. Patient’s Medical History - The doctor must ask for information and other lower urinary tract infection symptoms. Identifying the location, which could be bladder or prostate, is essential. History of medicines patients may have taken in the past must be asked, such as anticoagulants and antiplatelets. These medications increase bleeding during the surgery.
2. Physical Examination - The doctor will examine the patient's lower abdomen and external genitalia. The patient may feel pain upon gentle pressure. The doctor may perform a digital rectal examination to explore the prostate's shape and size. Other bedside examinations include:
- Urine Dipstick Examination - A special strip made from chemicals is dipped into the patient's urine sample. It helps in identifying pathological changes in the urine.
- Post-Void Residual Volume (PVR) - It is the volume of the urine left in the bladder after urination.
- International Prostate Symptom Score (IPSS) - It is a questionnaire used to screen and diagnose benign prostatic hyperplasia. Scoring zero to seven shows mild symptoms, eight to 19 shows moderate, and 20 to 35 shows severe symptoms.
- Frequency Volume Chart - A simple chart records the patient's fluid or liquid intake and urination.
3. Blood Tests - Renal function tests help identify renal failure or kidney injury that may cause benign prostatic hyperplasia.
4. Imaging Tests - Ultrasound is indicated to identify the presence of obstructions, stones, or leakage of blood in the urine (hematuria).
5. Cystoscopy - Examining the internal structures and bladder through a cystoscope (a thin tube with a camera).
How to Treat Benign Prostatic Hyperplasia?
1. Lifestyle Changes - It is important to make changes in the lifestyle and diet such as weight loss, less intake or consumption of liquids during night time, low intake of caffeine, and many others. These changes will help in reducing or lowering urination during nighttime.
2. Medications - Alpha-blockers are types of medicines that help in lowering blood pressure. These also help relax the prostate's smooth muscle and thus increase the urine flow. Alpha reductase inhibitors help shrink the enlarged prostate. Antimuscarinics are types of agents that treat the urgency and frequency of urination.
3. Surgery - The surgical approaches to benign prostatic hyperplasia are mentioned below:
- Transurethral Resection Surgery (TURP): General or local anesthesia is given to the patient. A part of the prostate is surgically removed. It is done for enlarged prostates that fail to heal from other treatment therapies. No incision is made on the patient's skin, and the surgery is carried out through a resectoscope. It is a thin metal tube passed through the urethra and into the prostate. It also has a camera that provides images of the internal structures on a screen or monitor. A wire loop is attached to the resectoscope. It is then heated, and a part of the prostate gland is cut through the hot wire loop. A catheter is inserted into the urethra to flush out the removed or cut prostate pieces.
- Holmium Laser Enucleation of the Prostate (HoLEP): It is a minimally invasive procedure used to treat enlarged prostate. There is no incision or cut made on the skin of the patient. A laser beam removes the part of the prostate that is creating an obstruction.
- Tissue Sparing: The UroLift device is used to perform this procedure in which the lumen or hollow space of the urethra is expanded. The device is placed into the enlarged prostate and lifts the prostate tissues. In this way, the tissues are compressed, creating an opening for normal urine flow.
- Prostatectomy: It is the surgical removal of the prostate or a part of the prostate. If open surgery is done, it is called a traditional approach in which a long incision or cut is made on the patient's skin, and the prostate gland is removed. The incision is closed with sutures. The traditional approach is now less commonly used. If laparoscopic prostatectomy is performed, then multiple small incisions are made. A laparoscope with instruments and a camera is inserted through the incisions. The surgeon cuts the prostate through direct visualization on a screen.
What Are the Complications of Benign Prostatic Hyperplasia?
The common complications are:
- Long-standing or chronic retention of the urine.
- Urinary tract infections because of incomplete emptying of the urine.
- Leakage of blood in the urine (hematuria).
Conclusion:
Benign prostatic hyperplasia commonly occurs in men, especially those above the age of 60 years. In this condition, the prostate, a part of the male reproductive system, becomes enlarged due to the overgrowth of the tissues. There are various minimally invasive surgical procedures available to treat benign prostatic hyperplasia. Besides surgical management, lifestyle changes such as diet and medications are also helpful in treating it.
