Benign prostatic hyperplasia means a non-cancerous growth of prostate in older men. It is an age-related problem that begins after the age of 40. It affects around 10% of men in their 30s, 20% of men in their 40s, 50-60% in their 60s, 80-90% in their 70s to 80s.
Many patients don’t even seek treatment for the same because they don’t have symptoms. It becomes a problem only when the symptoms start appearing.
Symptoms of BPH include - urinary hesitancy, straining, dribbling, weak flow, urinary retention, and incontinence.
DHT (dihydrotestosterone), which is the active form of the prostate, is one of the factors responsible for the abnormal enlargement of the prostate gland. Testosterone is converted into DHT with the help of the enzyme 5-Alpha reductase in the prostate and many other organs in the body like liver, hair follicles, brain, epididymis.
Benign prostatic hyperplasia affects the central i.e., transitional zone of the prostate gland.
If you have urinary symptoms like urinary dribbling, straining while urinating, or you have to get up at night multiple times to pee, or the urinary stream is prolonged, then you should consult a doctor.
What are all tests needed?
If your doctor suspects an enlarged prostate on the digital rectal examination, then he may order the following tests to be sure about the diagnosis.
Firstly, you need a routine urine test to check for blood in urine because if blood is present, then further investigations are required to rule out cancer of the bladder or the prostate.
Secondly, a post-void residual volume (PVR) measurement (i.e., the amount of urine left in your bladder after you urinate) is needed to check for urinary retention (>250 ml is considered alarming).
High PVR may indicate that the current treatment is not working and may be an indication for surgical management.
Thirdly, uroflowmetry in which your urine flow rate is measured is done. Rates <10mL/s indicate an obstruction in your urinary passage.
What is the treatment of BPH?
The treatment of BPH is divided into medical and surgical.
Medical treatment of BPH include-
- Alpha-1 blockers like silodosin, terazosin, alfuzosin, doxazosin, tamsulosin.
- 5-alpha reductase inhibitors like finasteride and dutasteride.
- Anticholinergic drugs such as oxybutynin, solifenacin, tolterodine, etc.
- Beta-3 adrenergic agonists like mirabegron.
- PDE-5 inhibitors like tadalafil,sildenafil,vardenafil etc.
Surgical treatment of BPH-
Transurethral means that the prostate is removed through the ureter.
Transurethral resection techniques include:
- Transurethral resection of the prostate (TURP)
- Transurethral laser enucleation (HoLEP or ThuLEP)
- Plasma vaporization (the "button" procedure)
- Photoselective vaporization (PVP)
- Transurethral incision (TUIP)
- Microwave thermotherapy (TUMT)
- Water vapor energy ablation (WAVE)
Potential complications of BPH
If you have BPH, then there is a chance that you may have acute urinary retention depending on the size of the prostate.
The risk of urinary tract infections is also drastically increased. Kidney damage and bladder stones can also occur.
Medically reviewed by Rishabh Verma, RP