Benign Prostatic Hyperplasia

What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia (sometimes called Benign Prostatic Hypertrophy) occurs when
the prostate gland becomes enlarged, usually as men become older.
The prostate is a walnut-sized gland located between the bladder and the urethra. As the size
of the prostate increases it may begin to press on the urethra, reducing the flow of urine from
the bladder through to the urethra. Urination will become slower and less forceful.
Over time, Benign Prostatic Hyperplasia causes the bladder wall to thicken and become
irritable. The bladder will contract even when it contains only small amounts of urine,
resulting in more frequeunt urination. Eventually the bladder weakens and loses the ability to
empty itself and urine remains in the bladder.

What are the Syptoms of Benign Prostatic Hyperplasia?

Most symptoms of benign prostatic hyperplasia are the result of the obstruction between the
bladder and urethra. The gradual loss of bladder function and incomplete emptying of the
bladder may cause varied symptoms. The syptoms of BPH often begin gradually.
Some of the more common symptoms of BPH include:
• the need to get up at night more often to urinate
• increased frequency of urination during the day
• reduced volume and force of urination
• interrupted flow during urination
• difficulty starting urination
• dribbling toward the end of urination (overflow incontinence)
• blood in urine due to straining to urinate (hematuria)

Diagnosis of Benign Prostatic Hyperplasia

If symptoms of BPH are noticed, or your doctor notices an enlarged prostate during a regular
checkup, your doctor will usually ask for a complete history of your symptoms. This may
include the AUA Symptom Index. The AUA (American Urological Assocation) Symptom
Index is a question containing seven questions regarding the syptoms of BPH. The
questionaire is designed to determine the seriousness of urinary problems and to help with
diagnosis.
You may then be referred to a urolgist to further identify the problem and determine if surgery
will be required. Several of the symptoms mentioned above may be the result of other
conditions such as a bladder infection or bladder cancer, so further investigation is needed to
confirm that BPH is the cause.
Digital Rectal Exam - usually the first test performed, a digital rectal exam (DRE) generally
takes less than one minute. The doctor inserts a glover finger into the rectum. This allows the
doctor to feel the part of the prostate next to the rectum and get a general indication of the
size, shape and consistency of the prostate.
Prostate-Specific Antigen Blood Tests - Prostate-Specific Antigen (PSA) is a protein
produced by the cells of the prostate. Elevated levels of PSA in the blood may be caused by
BPH, or may indicate prostate cancer. PSA levels alone do not give sufficient information to
distinguish between benign prostate conditions and cancer. However, the results of the PSA
test helps decide whether to check further for signs of prostate cancer.
Rectal Ultrasound - a probe is inserted into the rectum and transmits sound waves towards
the prostate. The resulting echo patterns provide a three-dimensional image of the prostate.
Uroflowmetry - this is a simple test used to determine the speed at which the bladder can be
emptied, and how completely the bladder can be emptied. You will be asked to urinate into a
device that will measure the volume of urine, the time taken for urination to be completed and
the rate of urine flow.
Pressure Flow Study - this test measures the pressure in the bladder during urination . A
catheter is inserted through the urethra and into the bladder. This is the most accurate method
of evaluating urinary loackages, however it is an uncomfortable procedure and in some cases
can lead to urinary tract infections.
Poid-void Residual (PVR) - residual urine is measured immediately after urination. The
volume of urine remaining in the bladder can be accurately estimated by ultrasound or
catheterization.
Cystoscopy - a small tube is inserted through the opening of the urethra in the penis. The
tube, called a cystoscope, contains a lens and a light system which allows the inside of the
urethra and the bladder to . This test shows the size of the gland and identify the location and
degree of the obstruction.

Benign Prostatic Hyperplasia Treatments

Several forms of treatment are available, depending on the severity of BPH. If the syptoms do
not threaten your health or cause discomfort, you may not need any form of treatment.

Drug Treatments for Benign Prostatic Hyperplasia

Two groups of medications are indicated for treatment of BPH.
Dutasteride (Avodart™) and Finasteride (Proscar) belong to a group of medicines called 5-
alpha-reductase inhibitors. These drugs treat BPH by preventing the conversion of
testosterone to dihydrotestosterone (DHT), a natural hormine involved with prostate
enlargement.
Alpha blockers such as terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and
alfuzosin (Uroxatral) work by relaxing the smooth muscle of the prostate and bladder nexk.
This increases urine flow and reduces obstructions. Terazosin and doxazosin were developed
first to treat high blood pressure, however tamsulosin and alfuzosin were developed
specifically to treat BPH.

Surgical Treatment and Minimally Invasive Therapy for BPH

For more pronounced cases of BPH, drugs alone may not be a sufficient form of treatment.
Minimally Invasive Treatments are generally less painful and have faster recovery times than
surgery. The may also have lower costs involved than surgical treatments. Most of these
treatments involve applying heat to destroy the excess prostate tissue. Heat is commonly
applied through use of laser devices or microwave procedures.
In some cases, the best option for treatment, particulary as a long term solution, is surgical
removal of the enlarged part of the prostate that is causing the obstruction of the urethra.
Transurethral surgery is the most common form of surgical treatment. transurethral resection
of the prostate (TURP) is used in about 90% of all prostate surgery. A resectoscope into the
penis through the urethra. The surgeon removes the obstructing tissue and the irrigating fluids
carry the tissue to the bladder. This debris is removed by irrigation and any remaining debris
is eliminated in the urine over time.
Occasionally transurethral procedures will not be possible, and open surgery may be required.
If the prostate is greatly enlarged, if the bladder has been damaged, or if the patient has
complications prohibiting transurethral surgery, prostatectomy (removal of the obstructing
prostate) may be necessary. This procedure is sometimes the best and safest approach.
Laser Surgery is also a possible treatment option, however laser surgery may not be effective
on larger prostates and the long term effectiveness of laser surgery is not known.
For more information about BPH, read our article about living with benign prostatic
hyperplasia and some tips on living with BPH.