Beyond The Size! Benign Prostate Hyperplasia (BPH)

The prostate gland is part of the male reproductive system. It’s main job is to make fluid for semen. The size of a prostate is comparable to that of a walnut and weighs about 25-30 grams. Prostate is placed below the urinary bladder and in front of the rectum.

Benign Prostatic Hyperplasia (BPH) or benign prostate enlargement is when the prostate and tissue surrounding it expands, or grows. It refers to the increase of smooth muscle and epithelial cells within the prostate transition zone. The prostate grows with normal aging processes and is subdivided into two main groups. The 1st group is early in puberty, when the prostate doubles in size. The 2nd group begins from the middle age of 25 until most of a man’s life. The enlarged gland will contribute to Lower Urinary Tract Symptoms (LUTS) complex via direct Bladder Outlet Obstruction (BOO) from enlarged tissue (static component) and from increased smooth muscle tone and resistance within the enlarged gland (dynamic component).

Who Is At Risk of BPH?

  • Men over the age of 50
  • Family history of BPH (Paternal/Grandfather)
  • Metabolic syndrome/ overweight or obese
  • Lack of exercise
  • Erectile dysfunction (ED)

Clinical Features:

As the prostate gets enlarged, it will constrict the flow of urine and nerves within the prostate and bladder will contribute symptome as stated below.

  • Increase urinary frequency and urgency
  • Nocturia – get up frequently at night to urinate
  • Hesitancy – weak urinary stream
  • Incomplete bladder emptying – regardless of the frequency of urination, still have the feeling of persistent residual urine.
  • Straining – trouble starting to pass urine or the need to push or strain to pass urine.
  • Decreased force of stream
  • Dribbling – small amount of urine dribbling due to poor urinary stream

Diagnosis:

he important instruments that are available to quantify the severity of LUTS is the American Urological Association Symptom Score Index (AUASI) also known as the International Prostatic Symptom Score (IPSS). This questionnaire consists of seven items that determine the severity.

Treatment:

Drug Therapy

Finasteride and doxazosin

To shrink or stop the growth of the prostate or open the urethral channel within the prostate, without using surgery.

Conventional Surgical Therapy

Indication:

urinary retention, gross hematuria, bladder stones, and urinary tract infection

  • Transurethral resection of the prostate (TURP) = Gold standard treatment
  • Surgical “open” prostatectomy
  • Transurethral laser surgery

Minimally Invasive Therapy

  • Transurethral microwave procedures
  • Transurethral needle ablation (TUNA)
  • Water-induced thermotherapy
  • High-intensity focused ultrasound (HIFU)

Role of PSA (Prostate Specific Antigen):

PSA is a serine protease produced by both benign and cancerous prostate tissue. It is responsible for liquefaction of seminal fluid after one has ejaculated. PSA markers will be raised in cases of BPH and prostate cancer. It may also transiently increase in enzyme for cases of prostatitis or prostate infection. This test will be done followed by digital rectal examination by the practitioners. Yet, this test is controversial in terms of difficult to distinguish between cancer, inflammation or enlargement. Therefore, the PSA test is not a diagnostic test for BPH.

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