BPH is a urological term to denote Benign Prostatic Hyperplasia. It is used in the common clinical setting referring to benign (non-cancerous) enlargement of the prostate gland is associated with urinary symptoms such as difficulty in urination and increased frequency of urination.
Strictly speaking it has nothing to do with an enlargement of the prostate gland, but rather it is actually related to prostatic compression – the amount of compression exhibited by the prostate on the urethra.
In simpler words, it is not the centrifugal enlargement of the prostate that matters, but rather the centripetal compression of the urethra on the prostate that results in poor flow and the various symptoms of BPH. For this some people denote this disease as BPO (Benign Prostatic Obstruction) rather than just BPH.
An enlarged prostate compresses and gradually obstructs the urethra which is the outlet channel for urine stored in the bladder. In the early stages of BPH, the patient may notice that the flow is reduced.
Patients with BPH subsequently suffer from obstructive and irritative lower urinary tract symptoms including:
- Nocturia (getting up in the night to pass urine)
- Poor urine flow and straining to urinate
- Inability to completely empty the bladder
- Hesitancy (Difficulty to initiate urination)
- Urgency, frequently urinating and sometimes urge incontinence
- Accidentally leaking urine (urinary incontinence)
To confirm BPH various tests may be required which includes uroflowmetry, ultrasound of the kidneys and bladder before and after passing urine, PSA and rectal examination to assess the prostate.
BPH – Pic From North Island Urology NIU
Uroflowmeter to assess urine flow
A poor flow may denote a compression of the flow of urine and may be related to BPH
Uroflowmetry tracing to assess urine flow
Poor urine flow suggests either an obstruction to the urinary flow, or a weakness of the bladder to expel the urine
Rectal examination of the prostate (Pic from Urology Care Foundation)
This is done to assess if there is a nodule in the prostate, which will then raise the suspicion of an underlying prostate cancer
The International Prostate Symptom Score (IPSS) is an eight-question written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of benign prostatic hyperplasia (BPH).
Treatment of BPH is directed towards alleviation of bothersome symptoms which may be assessed using the IPSS scoring.
Complications of BPH
BPH can sometimes lead to complications, such as:
- Urinary tract infection (UTI)
- Acute urinary retention (completely unable to pass urine)
- Hydronephrosis (swelling of the kidneys)
- Bladder stones
- Gross hematuria (blood in the urine)
- Progressive kidney damage
The treatment of BPH includes:
Medications – alpha blockers, 5-ARI inhibitors may be indicated
There are times when medications may not work when the disease has already progressed to a very severe state. For this an endoscopic procedure will be required.
Your urologist can discuss on the various procedures that may be required, which in general is TURP (Transurethral Resection of the Prostate) or its various modifications of the procedure including TUIP, TUNA, bipolar TURP, laser TURP, etc.
TURP involves placing in a scope into the urethra under anesthesia, and then resecting or scraping the prostate. It is a relatively painless procedure done under anesthesia.
There are many other minimally invasive procedures for BPH, but most of them have not been as effective as TURP in the treatment of BPH.
Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope.
TURP procedure – Pic from National Cancer Institute NCI
Pic from Urology Care Foundation
TURP Procedure – Resection of the Prostate
Prostate artery embolization (PAE) as a new treatment option for men with benign prostatic hyperplasia (BPH), or an enlarged prostate has been investigated. Advice may be obtained from the urologist first if this is a suitable indication in the first place. However, PAE for the treatment of BPH is not supported by current data and trial designs, and benefit over risk remains unclear; therefore, PAE is currently not recommended outside the context of clinical trials.