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November 20, 2022
Benign prostatic hyperplasia (BPH) is an increase in the size of the prostate. The condition is also commonly referred to as benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia or benign prostatic hypertrophy. The latter is technically incorrect.
BPH entails hyperplasia of prostatic stromal and epithelial cells, which leads to the formation of large nodules in the periurethral region of the prostate. When they grow large enough, these nodules compress the urethral canal and partially obstruct the urethra, which in turn affects the normal flow of urine. This condition leads to urinary hesitancy, frequent urination, painful urination (dysuria), increased risk of urinary tract infections, and urinary retention. BPH patients may present elevated levels of prostate-specific antigens due to increased organ volume and inflammation caused by urinary infections. BPH, however, does not lead to cancer nor does it increase the risk of cancer.
Signs and Symptoms of Benign Prostatic Hyperplasia (BPH)
BPH symptoms are classified as either storage or voiding symptoms. The first category includes urinary frequency, urgency, urgency incontinence and nocturnia (the need to urinate at night). Voiding symptoms, meanwhile, include urinary stream hesitancy (waiting for the stream to begin), intermittency, straining to void, and dribbling. Pain and dysuria are typically not present among these voiding symptoms, but can occur in some patients. The symptoms of BPH are evaluated based on the International Prostate Symptom Score (IPSS) questionnaire, which is designed to assess the severity of the disease.
Benign prostatic hyperplasia can be a progressive disease especially if the sufferer does not get proper treatment. Incomplete voiding can lead to stasis of bacteria in the bladder residue, increasing the risk of urinary tract infection. The crystallization of salts in the residual urine forms urinary bladder stones.
Another form of progression is urinary retention, which can be acute or chronic. Acute urinary retention refers to the inability to void the bladder, while chronic retention distends the bladder as the residual urinary volume gradually increases. This, in turn, can lead to bladed hypotonia. In some cases, BPH patients suffering from chronic urinary retention may eventually experience renal failure. This condition is called obstructive uropathy.
Diagnosing Benign Prostatic Hyperplasia (BPH)
The palpation of the prostate through the rectal, i.e. a rectal examination, may find a markedly enlarged prostate. This usually affects the middle lobe. Blood tests are often performed in order to rule out prostatic malignancy.
Elevated prostate-specific antigen (PSA) levels require further investigations, including reinterpretation of PSA results, rectal examination and transrectal ultrasonography. Combined, such measures allow for an early detection of BPH. Patients also often undergo an ultrasound examination of the testicles, prostate and kidneys to rule out malignancy and hydronephrosis.
Some signs and symptoms of benign prostatic dysplasia (BPH) include weak urinary stream, abdominal straining, urinary hesitancy, prolonged emptying of the bladder, irregular need to urinate, post-urination dribble, incomplete bladed emptying, irritation during urination, frequent urination, nocturia, urgency, incontinence (involuntary urine leakage), bladder pain, dysuria, and problems in ejaculation.
Benign Prostatic Hyperplasia Management & Medication
Signs and symptoms of BPH may be ameliorated with certain lifestyle changes, such as decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products, or following specific voiding schedules. Currently there are two main types of medications for managing BPH: alpha blockers and 5α-reductase inhibitors.
In the U.S. and Europe, alpha blockers are the most common choice for initial treatment. Such alpha blockers used for treating BPH include terazosin, doxazosin, alfuzosin, tamsulosin, and silodosin. All of these five alpha blockers are equally effective in treating BPH, but carry different side effects. Older drugs such as phenoxybenzamine and prazosin are not recommended.
Alpha blockers provide relief by relaxing smooth muscle in the prostate and the bladder neck, thus reducing the blockage of urine flow. Alpha blockers may present some side effects, but usually nothing serious (some nasal congestion, headaches, weakness, subtle changes in ejaculation).
Another treatment option consists of 5 α-reductase inhibitors finasteride and dutasteride. By inhibiting 5 α-reductase, these medications also inhibit DTH production. DTH is a hormone responsible for enlarging the prostate. The effects of these medications may not appear as soon as those of alpha blockers, but they persist for many years.
Other treatment options include antimuscarinics such as tolterodine, especially in combination with alpha blockers. These medications decrease acetylcholine effects on the smooth muscle of the bladder, which in turn helps control symptoms of an overactive bladder.
Cialis is also an FDA-approved medication for treating the signs and symptoms of benign prostatic hyperplasia. Sildenafil citrate, meanwhile, shows some symptomatic relief as well, which indicates BPH may have a common etiology with erectile dysfunction. Tadalafil was considered, but rejected in the UK as a BPH treatment.
Transurethral resection of prostate (TURP) is considered the gold standard of prostate interventions for those who require surgery. Surgery is usually necessary if medical treatment fails, if the patient refuses to try office-based therapies, or if the physician deems the patient as a better candidate for TURP. This procedure involved removing part of the prostate through the urethra. Meanwhile transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), ethanol injection are studied as alternatives. Post-surgery care frequently entails placing a Foley catheter or a temporary prostatic stent to permit healing while allowing urine to drain from the bladder.
Benign prostatic hyperplasia affects roughly 210 million men worldwide as of 2010, i.e. six percent of the world’s population. Most men experience an increasingly larger prostate as they grow older. For a symptom-free 46-year-old man, for instance, the risk of developing BPH sits at 45 percent, which is quite high.
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