Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. It is more frequently associated with older men.
SIGNS & SYMPTOMS OF BPH
- Frequent urination
- Nocturia i.e. waking up at night once or more to urinate.
- Involuntary urination
- Urinary urgency i.e. an immediate unstoppable urge to urinate, due to a sudden involuntary contraction of the muscular wall of the bladder.
- Urge incontinence (urine leak following a strong sudden need to urinate)
- Urinary hesitancy (a delay between trying to urinate and the flow actually beginning)
- Involuntary interruption of voiding
- Weak urinary stream
- Straining to void, a sensation of incomplete emptying.
- Uncontrollable leaking after the end of urination
- Dysuria i.e. bladder pain or pain while urinating.
- Urinary retention
- Urinary tract infection
- Bladder stones
- Obstruction of the bladder
- Damage to the bladder & its ducts
- Kidney damage
CAUSES & RISK FACTORS
- Androgens play a permissive role in the development of BPH.
- As aging in men occurs enzymes like aromatase & 5-alpha reductase convert androgens to estrogen & DHT, due to an increased activity.
- Increase in DHT is a contributing factor for prostate growth.
Diet & metabolic factors
- Impaired glucose metabolism/diabetes
- High level of LDL
- Fibrosis/Scarring & weakening of the muscular tissue of the prostate which is responsible for functionality of the prostate.
- The muscle provides force & contraction for excretion of fluid.
- Increasing age.
DIAGNOSIS OF BPH
The clinical diagnosis of BPH is based on
- Digital rectal exam: The size of the prostate is checked manually by the doctor, the physical exam is also done to rule out prostate cancer.
- Urine Analysis: For detection of sugar level, protein level or any presence of infection causing agents.
- Blood test: Kidney function test for evaluation of kidney damage if any & detection of prostate cancer.
- Prostate-specific antigen (PSA) blood test: PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate, and it may indicate BPH.
- Ultrasound of the prostate, testes, bladder & kidneys.
- Cystourethroscopy, a camera is used for examination of the prostate.
TREATMENT FOR BPH
- Various drugs that lead to urinary retention & should be avoided are, anticholinergics, antihistamines, decongestants, opioid drugs & TCA antidepressants on medical advise.
- Voiding position when urinating may influence urinary flow rate.
- Some drugs used for treatment & management of BPH are:
- Alpha blockers. Examples: Alfuzosin, doxazosin, silodosin.
- 5α-Reductase inhibitors. Examples: Finasteride and dutasteride.
- Phosphodiesterase-5 inhibitors like tadalafil 5mg.
- Antimuscarinic drugs.
- Surgical methods:
- Transurethral resection of the prostate (TURP)
- Open prostatectomy
- Transurethral incision of the prostate (TUIP)
- Photoselective (laser) vaporization of the prostate (PVP)
- Prostatic artery embolization (PAE)
- Transurethral microwave thermotherapy (TUMT)
- Inhibition in alcohol intake
- Cessation of smoking
- Lower fluid intake before going to bed at night
- Low sodium diet
- Low sugar diet
- Less consumption of caffeine
- Management of underlying conditions like hypertension & diabetes.