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Benign prostatic hyperplasia Causes and Risks:
The actual cause of benign prostatic hyperplasia
(BPH) is unknown. However, it has been noted that eunuchs (men who have had their testicles destroyed or removed) do not develop
BPH. Furthermore, after castration, benign prostatic hyperplasia has been observed to regress. Since the presence of normally functioning testicles appears to be necessary for the development of
BPH, it is supposed that the tumor tissue uses the androgenic (male) hormones differently than normal prostate tissue does. Although the tumor is benign (not cancerous), progressive growth of the tumor may cause significant obstruction of the urethra and interfere with the normal flow of urine.
The incidence of BPH increases with advancing age. BPH is so common, that it has been said, "All men will have benign prostatic hyperplasia if they live long enough!" Some degree of BPH is present in 80% of all men over 40 years old and this figure increases to 95% of all men 80 years old. No risk factors have been identified other than the presence of normally functioning testicles in men.
Prevention:
The benign enlargement of the prostate is a normal physiological process of aging. Although the castration of men prior to puberty would most certainly prevent the development of benign prostatic hyperplasia, it is not a feasible option.
Symptoms:
Less that half of all men with BPH show any symptoms of the disease, which may include:
Signs and Tests:
A digital rectal exam (health care provider inserts a finger into the rectum to feel the size of the prostate gland) will reveal an enlarged, soft prostate.
- Urine flow rate may be measured (men with BPH have a rate less than 10 ml per second).
- Post-void residual urine (the amount of urine left in bladder after urination) may be measured.
- Pressure flow studies to measure the pressure in the bladder as you urinate
- An IVP may be done to confirm the diagnosis or look for blockage.
- Urinalysis to check for blood or infection
- Urine culture if signs of infection
- Voiding cystourethrogram
- Prostatic-specific antigen ( PSA ) blood test
- Cystoscopy to visualize the prostate and bladder
Additionally, you will be asked to complete a self screening form, evaluating the severity of your symptoms and the impact on your daily life. Your score on the screening tool will be compared to past records to evaluate progression of the disease.
Treatment:
The choice of an appropriate treatment is based on the severity of your symptoms, the extent to which they affect your lifestyle, and the presence of any other medical conditions. Treatment options include "watchful waiting", various drug therapies aimed at decreasing the size of the prostate or reducing the severity of symptoms, and several surgical methods to remove or compress the enlarged prostate.
MEDICATIONS: Current medical therapy may involve a trial use of alpha 1-blockers (doxazosin, prazosin, and terazosin), which are usually used to treat high blood pressure . These medications may be used to treat BPH because they relax the muscles of the bladder neck, allowing easier urination. Of the people treated with alpha 1-blocker medications, 74 percent reported an improvement in symptoms.
This drug has recently been approved for treatment of BPH. Finasteride lowers prostate hormone levels , thus reducing the size of the prostate. This drug has been shown to increase the urine flow rate and decrease the symptoms of BPH. It may take up to 6 months before you notice a significant improvement in your symptoms. However, potential side effects related to use of finasteride include decreased sex drive (3.3%) and impotence (2.5 - 3.7%).
Antibiotics may also be prescribed to treat chronic prostatitis , which commonly accompanies BPH. Some men note symptom relief after a course of antibiotics.
SURGERY:
Surgery is usually indicated for men with symptoms of incontinence , blood in the urine , urinary retention, and recurrent urinary tract infections . The choice of a specific surgical procedure is usually based on the severity of symptoms and the size and shape of the prostate gland. Surgical treatment options include transurethral resection of the prostate ( TURP ), transurethral incision of the prostate ( TUIP ), and open prostatectomy . Various studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia , thermal therapy, prostatic stents , and hormonal therapy.
Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the urethra. The primary advantage of this procedure is that it does not involve an incision, thus reducing the risk of infection. Other surgical approaches include transvesical (through the bladder), retropubic (behind the pubic structures), and supra pubic (above the pubic structures). The perineal (through the pelvic floor including the region from the scrotum to the anus in men) surgical approach is rarely used because the impotence rate after surgery may be as high as 50%.
Among men who have had a TURP, 88% reported an improvement in symptoms lasting from 10 to 15 years. Impotence occurred in 13.6% of the men who had a TURP and one percent of the men reported experiencing urinary incontinence after a TURP.
Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is performed on an outpatient basis and does not require a hospital stay. A small incision is made in the prostatic tissue to enlarge the lumen (opening) of the urethra and bladder outlet, thus improving the urine flow rate and reducing the symptoms of BPH. Eighty percent of the men who had this procedure reported some improvement in their symptoms. Possible complications include bleeding , infection, urethral stricture , and impotence (11.7%).
An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (through the pelvic floor including the region from the scrotum to the anus in men). This is a lengthy procedure, and it requires a hospital stay of seven to 10 days. Most of the men (98%) who had open prostatectomy surgery reported some improvement in their symptoms. Possible complications include impotence (16 to 32% depending on surgical approach) and urinary incontinence (less than 1%). However, nerve sparing procedures that reduce the risk of these complications are becoming increasingly popular.
LIFESTYLE:
Self-help measures may prove beneficial if the degree of obstruction is minimal. These include hot baths, avoiding alcohol or excessive fluid intake (especially at night), urinating upon the earliest urge to do so, and sexual activity or ejaculation on a regular basis. Herbalists suggest that saw palmetto berries and extracts may potentially ease prostate symptoms.
You can reduce the frequency of nighttime trips to the bathroom by eliminating fluids a few hours before you go to sleep. Symptoms of urinary incontinence may be decreased by spreading your fluid intake out over the course of the day. Avoid drinking large amounts of fluids at one time; instead take sips of fluids with meals.
Men with BPH should avoid taking over-the-counter cold and sinus medications that contain decongestants since these medications can increase the symptoms of BPH.
"WATCHFUL WAITING":
Less that half of all men with BPH show any symptoms of the disease, or their symptoms are minor and do not severely restrict their lives. Treatment will often involve simply monitoring the symptoms for worsening or possible complications including urinary retention, infection, hematuria (blood in the urine), and hydronephrosis (back up of fluid into kidney causing damage). Studies show that of the men who receive no treatment for BPH, 31 to 55% show an improvement, and only 1 - 5% develop complications. Also, although impotence is a possible complication of various surgical and medication therapies, 2% of those men who did not receive treatment still developed some degree of impotence. Men who opt for "watchful waiting" should receive yearly exams to monitor progression of the disease.
MONITORING:
All men who have BPH should receive a yearly exam to monitor the progression of symptoms.
Support Groups:
Several national groups provide information on BPH. See support group - BPH .
Prognosis:
About 70% of all men with BPH are relatively symptom free, and only 30% require some form of treatment.
Complications:
Men who have had long-standing BPH with a gradual increase in symptoms may develop an acute (sudden) inability to urinate. This may result from either inadequate muscle tone and strength of the bladder to exert sufficient pressure to allow urination or from increased obstruction caused by the growth within the prostate. A recurrence of BPH may develop over time.
Additional complications of BPH include an increased risk of bladder or kidney infections, and kidney injury ( hydronephrosis ) caused by an chronic retention of urine in the bladder.
Call Your Healthcare Provider:
Call for an appointment with the health care provider if symptoms of BPH occur.
This is an internal view of the male reproductive system.
This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.
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