Definition & Overview

Benign Prostatic Hyperplasia (BPH) is a medical condition characterized by the enlargement of the prostate gland, which is located just in front of the rectum, between the penis and the bladder. It surrounds the urethra, a small tube that connects the urinary bladder to the genitals which main function is to carry urine from the bladder and out of the body. As the prostate gland gets bigger, it begins to squeeze the urethra. If left untreated, the gland can block the urine passageway and cause urination problems.

BPH is a common occurrence in men. Almost 50% of men above the age of 75 will already be showing some symptoms of BPH. The condition is not considered to be a serious problem, such as cancer or other diseases. However, it can undoubtedly be a nuisance. Most, if not all, men with the condition will experience problems releasing urine from their systems. In most cases, urine will not flow fluidly but instead in dribbles.

Although BPH is not a serious problem in itself, it can be the primary cause of other serious problems, such as bladder infections, bladder stones, or kidney damage. Fortunately, the condition is not known to be the cause of cancer.

Cause of Condition

Even though a large percentage of men who are 50 years old and above experience BPH, the condition is not known to be a part of the normal aging process. Unfortunately, the exact cause or causes of the condition are yet to be understood. However, it is believed that some of the primary causes of BPH are changes in hormonal balance, genetics, and cell-growth factors.

Key Symptoms

BPH is known to produce a variety of symptoms, such as the need to urinate frequently, especially during the night. However, despite the necessity to urinate, a person with BPH is unable or has difficulty in beginning to urinate. When urine begins to flow, instead of flowing in a continuous stream, the strength of the flow is weak and usually ends in dribbles, which often results in a sensation that the bladder is not empty. Another key symptom is the inability to postpone or stop urinating once it begins. In severe cases, a person with BPH will not be able to urinate at all. When this happens and the bladder becomes infected or stones develop, other symptoms may appear that are associated with the infection, or disease.

Who to See and Types of Treatments Available

If you experience frequent problems urinating, the first person to see is your physician. If you refrain from consulting a doctor at this stage, the symptoms can progress to painful urination or blood in the urine.

Your doctor will first need to know the symptoms you’re experiencing, when they began, and how frequent they are. This information will help the doctor to determine the presence of BPH and its severity. Additionally, your doctor will need to form an in depth examination of your health history and also the history of diseases in your family. It’s important to realize that at this stage, the doctor may not only be considering the presence of BPH, but also other prostate diseases such as cancer.

Once the doctor has all the necessary information, you will undergo a physical examination, which can include an examination for urethral discharges, tender or enlarged lymph nodes, and tender or swollen scrotum. You may also undergo a digital rectal exam. This examination involves feeling the prostate. Before the exam, you will be asked to lie down on a table with your knees to your chest. Your doctor will then slide on a glove and lubricates a finger. He or she will slide the lubricated finger into your rectum and feel the prostate, which lies right beside the rectum. This exam helps the doctor determine if the prostate is indeed enlarged.

You will then likely to undergo several tests, such as a urinalysis and urinary cytology, which is a test to determine the presence of cancer. Other tests include prostate specific antigen, a urine flow study, cystoscopy, ultrasound of the kidney or prostate, urodynamic pressure flow study, and a measurement of the post-void residual volume (PVR).

The results of the tests will help the doctor determine the next step, which is either to begin treatment for BPH or to refer you to an urologist or oncologist if he or she suspects the presence of cancer. Your doctor may also decide to refer you to an andrologist, a specialist in male specific health problems.

If your doctor confirms the condition, you will likely need to begin treatment. The type of treatment will largely depend on the severity of the condition. Treatment for mild to moderate cases of BPH can include medications and lifestyle changes. In mild cases, the doctor may also opt not to treat the condition with medications, but just inform you of the lifestyle changes you’ll need to make in order to prevent the condition from developing.

Severe cases of the condition will likely require surgery. The type of surgical procedure will depend on your doctor. In some cases, a minimally invasive procedure could be requested in order to minimize your discomfort during the procedure and significantly reduce the recovery time.

Minimally invasive surgical procedures, or any type of surgery, will only be recommended if medications have proven to be ineffective. These procedures can include one or a combination of the following:

  • Prostatic Stent Insertion
  • High intensity ultrasound
  • Water-induced thermotherapy
  • Transuretheral microwave therapy
  • Transuretheral needle ablation

The objectives of the procedure may differ. In some cases, the goal is to widen the urethra. Other surgical procedures may be performed to remove enlarged prostate tissues. Your doctor or specialist will need to decide on the procedure that will best treat your condition.

References:

  • National Kidney and Urologic Diseases Information Clearinghouse - www.kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/index.htm
  • Urology Care Foundation - www.auafoundation.org/urology/index.cfm?article=144
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