What is Benign Prostatic Hypertrophy or BPH?
Benign prostatic hypertrophy is defined as a non-cancerous enlargement of the prostate gland. It is an age-related increase in the size of the prostate seen in elderly males, causing distressing symptoms in over 20% males above 80years of age. It is however present to some extent in all males above 50 years of age.
The prostate is a walnut sized gland, present in males between the bladder and the penis. The urethra passes through the gland. In normal health, the prostate secrets prostatic fluid, which nourishes and protects the sperm in the semen. The gland is dependent on hormones for the increase in size.
With increasing age the conversion of androgens (male sex hormones) to estrogens (female sex hormones) gradually increases, even in healthy males. The gland tissue as well as the fibro-muscular stroma thus undergoes hypertrophy (increase in number and size of cells).
The growing gland has pressure effects on the urethra that passes through the substance of the gland. This causes the characteristic symptoms of BPH. It is called benign because it is non cancerous and rarely turns malignant.
What are the causes and risk factors for BPH?
Most significant risk factor is age. BPH starts in all (even otherwise) healthy males by middle age, around 50-60 of age. Other risk factors are
What are the symptoms of Benign Prostatic Hypertrophy or BPH?
Symptoms are typically associated to the lower urinary tract, i.e. the urethra and the bladder. Symptoms are:
- Increased frequency: night time awakenings for voiding
- Urgency to use the restroom cannot be deferred
- Involuntary dribbling
- Urge incontinence (voiding involuntarily before a socially suitable space is available, after a sudden impulse to void)
- Reduced or poor stream
- Hesitancy: Delay between wanting to urinate and actual urination beginning.
- Pain or burning discomfort while voiding
- Sensation of a full bladder but inability to void due to bladder outlet obstruction
- Acute urinary retention due causing painful distension of the bladder and inability to void
- Bladder infection due to stagnant urine for long durations of time.
- Long-standing bladder outlet obstruction lead to dilatation, pressure effects and infection spreading to the upper urinary tract – ureters and kidneys.
How is BPH diagnosed?
Diagnosis is based on the clinical history of the classical symptoms. The doctor may conduct the following examinations or order the following tests:
- Examination of the external genitalia
- Abdominal exam
- Per-rectal exam
- Urine analysis – biochemistry and microscopy
- Urine cultures
- Kidney function test (blood test)
- Prostate specific antigen
- Ultrasound (abdominal and/or trans-rectal)
- Ultrasound of testes and kidney
What is the treatment for BPH?
- In very elderly males the abdominal muscles tend to lose tone. Voiding in sitting position may improve the urine stream and ensure more complete voiding.
- Self catheterisation – periodic emptying of bladder by passing a catheter into the bladder through the urethra.
- Alpha blockers (like Tamsulosin)
- Inhibitors of androgen converters – 5alpha reductase inhibitors (like Finasteride)
- Phospho-diesterase inhibitors (like Sildenafil) : since erectile dysfunction is a common associated complaint in elderly males.
- Trans urethral resection of prostate (TURP)
- Photosensitive (Laser) vaporisation of prostate (PVP)
- Endovascular (blocking blood vessels that supply the prostate gland so that it fails to grow.
What are the complications with Benign Prostatic Hypertrophy or BPH?
- Repeated urinary tract infection
- Acute urinary retention
- Social embarrassment
How can Benign Prostatic Hypertrophy or BPH be prevented?
It is an inevitable consequence of aging in males. Only delay is possible, by maintaining good diet and reducing the metabolic risk factors.
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