What is benign prostatic hyperplasia?

(BPH)
The prostate is a gland the size of a chestnut. It is only present in men, and it is situated
under the bladder surrounding the urethra, the passageway that takes the urine to the
outside. The gland produces seminal fluid, which is mixed with sperm to make semen.
With age, the gland may begin to grow - this happens to most men. The growth may
eventually cause problems with urination, because the gland pinches off the urethra as it
increases its size.
The growth in itself is harmless and so the condition is called benign prostate hyperplasia
!"#$. It occurs most often in men over the age of %&. 'p to (& per cent of men in their
)&s have !"# that causes them symptoms.
What kinds of problems can an enlarged prostate cause?
The enlargement of the prostate gland stretches and distorts the urethra and so obstructs
the urine flow. *ymptoms include+
a weak or interrupted urinary stream. *everal attempts to empty the bladder may
be necessary.
difficulty starting the urine flow, even when the bladder feels full.
a feeling the bladder is not completely empty.
a need to urinate often during the day and during the night. Increased need to
urinate in the night is usually a very early symptom.
a need to urinate right away. *ome men may experience involuntary discharge of
urine.
dribbling of urine after urination.
burning sensation or pain during urination.
,ifferent men get different symptoms - the symptoms may also vary with each individual
throughout the course of the disease. It is important to emphasise that the above
symptoms do not necessarily prove that the prostate is enlarged. -ther diseases may
cause similar symptoms. .en with problems urinating should always see their doctor.
Can other problems arise?
There are further complications with this disease.
/or some men, it suddenly becomes impossible to urinate known as acute
retention$. *tudies have shown that acute retention affects between 0 and 1 per
cent of men with !"# each year. This condition is very painful and demands
immediate medical treatment to avoid damage to the kidneys, among other things.
-ther men find it gradually harder to empty the bladder. 2s the condition
develops, more and more urine is left in the bladder after urination known as
chronic retention$.
-ther complications of the disease include+ repeated attacks of cystitis infection of the
bladder$ and the development of stones in the bladder.
How does the doctor diagnose the disease?
2 3" can often make the diagnosis on the following grounds.
"atients will be asked about their symptoms and may also be asked to fill out a
symptom 4uestionnaire to let the doctor know the nature of the symptoms and
how troublesome they are.
They may also be asked to record their drinking and urination over a period of
three days.
!y carrying out a rectal examination, the doctor can feel through the rectum wall
whether or not the prostate is enlarged.
'sually, the patient5s urine will be examined, and may be sent for culture, when it
will also be tested for sensitivity to antibiotics. 6idney function will also be
examined by a blood test.
If there is a need for further tests, they will usually be carried out by a specialist. #e or
she will be able to check for specific urinary functions like the flow rate of the urine and
whether the bladder is emptied on urination. 7-rays, including ultrasound examinations,
and blood tests, may be necessary. .any hospitals and a number of general practices
have specialised prostate clinics where a full prostate check is carried out.
How is benign prostate hyperplasia treated?
There are a variety of treatment strategies for this condition and the following factors
should be considered+
treatment is only necessary if the symptoms are bothersome or complications are
present.
each treatment has advantages and disadvantages. The patient and his doctor will
have to decide which is most appropriate.
Wait and see watchful waiting$+ if there are only a few minor symptoms it might be best
to wait and see how it develops. 2 doctor should be consulted regularly to avoid
complications setting in.
What kinds of medicines are used?
There are two types of medication for this problem.
2lpha-blockers. These medicines help to relax muscle fibres within the prostate,
thereby reducing the obstruction to the urine flow. They do not reduce the size of
the prostate. 8xamples include terazosin #ytrin$, alfuzosin 7atral$ and
tamsulosin /lomax .9$. "atients occasionally experience side effects such as
dizziness, headache, drowsiness and retrograde e:aculation.
;-alpha-reductase inhibitors such as finasteride "roscar$ inhibit the growth of the
prostate and decrease the size of the gland.
9esearch studies have shown that both types of medical treatment are effective at
improving urinary symptoms in men with !"#.
There are also different kinds of over-the-counter herbal medicine on the market.
#owever, these preparations are not generally recommended because their effect has not
been completely documented. Those which do have some supporting evidence are saw
palmetto and beta-sitosterol plant extracts and rye grass pollen extract.
What kind of surgery is available<
2n operation on the prostate will involve the removal of parts of the enlarged tissue.
The most common operation is an endoscopic surgical procedure where parts of the
enlarged tissue are peeled off. This is called transurethral resection of the prostate
T'9"$.
If the prostate is only slightly enlarged, it may be enough to make a little cut in the
prostate, without removing tissue, to reduce the constriction of the urethra. This is called
transurethral incision T'I$.
If the prostate is considerably enlarged, it may be necessary to make an incision in the
lower abdomen and to carry out an open operation. !ut this procedure is rarely carried
out.
*urgery carries more risk than medical treatment and there are possible complications
including retrograde e:aculation. In retrograde e:aculation, the sperm enters the bladder
during e:aculation instead of being expelled through the penis. =ater it is flushed out with
urine.
*tudies estimate that )> per cent of men will experience retrograde e:aculation after
transurethral resection of the prostate T'9"$.
*urgery has also been linked with side effects of erectile dysfunction in 0> per cent of
men after T'9"$ and urinary incontinence ; per cent$. !ut studies are inconclusive as to
whether the same rates of these problems would have occurred anyway in men not
undergoing surgery.
The benefits of surgery are long lasting, but because only part of the prostate is removed,
some men may eventually need another operation.
2re there other more gentle surgical treatments<
?ewer treatments for benign prostate hyperplasia already exist and are continually being
developed. These techni4ues are minimally invasive. *ome need only local anaesthesia
and the risk of complications is smaller.
2 couple of general points about these new techni4ues+
it is still not fully known whether the results are as effective as endoscopic
surgery. ,octors are continually learning which patients are most suitable for each
treatment.
the techni4ues concerned are still being developed and tested.
Microwae thermotherapy
In this treatment, the prostate tissue is heated to around >;@A by means of
microwaves. This reduces the size of the prostate by causing cells in the centre of
the prostate to die. This treatment is carried out through the urethra.
!lectroaporisation
In this procedure, part of the prostate tissue is removed by evaporation by means
of electrical current. The treatment is performed with an endoscope.
"aser#resection
2nother endoscopic treatment, in which part of the prostate tissue is removed
with laser energy. /or this treatment, a passage is created by inserting a tube made
of metal or plastic - which remains in place where the prostate gland obstructs the
urethra.
This procedure is used only on rare occasions, for those patients who are unable
to be considered for other forms of treatment.
$s treatment with a catheter a possibility?
*ome patients with urine retention who cannot endure an operation, may have to have a
permanent catheter. This can be placed through the urethra or through the lower abdomen
into the bladder. !ut with a permanent catheter, the patient is at greater risk of cystitis
infection of the bladder$.
2n alternative, is for the patient to learn to empty the bladder himself with a catheter.
This way the catheter is removed after each use and the danger of infection is reduced.