Benign Prostatic Hyperplasia (BPH)

What is the Prostate Gland?

The prostate is part of the male reproductive system. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra. It produces fluid that makes up a part of semen.

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia also called prostate gland enlargement is a very common condition as men get older. The prostate goes through two main growth periods as man ages. The first is early puberty and the second is around age 25. It will continue to grow for the rest of your life. As man ages, the prostate gets larger and will cause benign prostatic hyperplasia.

What are the symptoms of Benign Prostatic Hyperplasia?

Below are the common sign and symptoms of BPH:
1) Frequent or urgent need to urinate
2) Increased frequency of urination at night
3) Difficulty starting urination
4) Weak/poor urine flow
5) The need to start and stop several times when passing urine
6) Feeling of incomplete bladder emptying even after passing urine

The symptoms will gradually worsen with them

What are the causes of Benign Prostatic Hyperplasia?

The causes of BPH are still unclear. Hormone changes play an important role to cause prostate enlargement. When men age, testosterone levels drop and dihydrotestosterone(DHT) levels become higher. Some study shows that DHT level will trigger prostate cell growth.

Who is at risk for BPH?

Men over the age of 50
Family history of BPH
Obese or overweight
Sedentary lifestyle
Men with underlying chronic illnesses (eg: diabetes, hypertension)

How BPH can be diagnosed?

Usually, BPH can be diagnosed with some history, physical examination and some test/scan.
Your doctor might ask you to answer a questionnaire called International Prostate Symptom Score (IPSS) to determine the severity of the symptoms.

The doctor will perform a digital rectal exam— put finger into the rectum to check on prostate size and surface. Then, a urine test and blood test will be sent to confirm the diagnosis. The urine test will be sent to rule out infection.

A prostate-specific antigen (PSA) blood test will be sent. A rise in PSA level can indicate enlarged prostate. However, elevated PSA could be due to a recent procedure, infection, surgery or prostate cancer.

Some additional tests could help to confirm prostate enlargement:

  • 1) Ultrasound: To look for the size of prostate
  • 2) Urinary flow test
  • 3) Postvoid residual volume test
  • 4) 24 hours voiding diary
  • 5) Cystoscopy
  • 6) Prostate biopsy

Not all the tests above will be done if you suspect having benign prostatic hyperplasia. The doctor will order the test according to the symptoms, severity and other factors.

What is the treatment for BPH?

There is a variety of treatments available for BPH. Doctors will decide which treatment is the best for the patient based on the symptoms, severity and patient overall health.

1) Medications
Most common treatment for mild to moderate BPH.

  • Alpha blockers: it helps to relax the bladder neck and muscle fibers in the prostate.
  • 5-alpha reductase inhibitor: it helps to shrink the prostate by preventing hormonal changes that cause prostate growth
  • Combination drug therapy: alpha blocker + 5-alpha reductase inhibitor

2) Minimally invasive or surgical treatment
This treatment is usually offered when the symptoms are moderate to severe or medications cannot relieve the symptoms.

  • Transurethral resection of the prostate (TURP)
  • Transurethral incision of the prostate (TUIP)
  • Transurethral microwave thermotherapy (TUMT)
  • Transurethral needle ablation (TUNA)
  • Laser Therapy
  • Prostatic Urethral Lift (PUL)
  • Open prostatectomy

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