Benign Prostatic Hyperplasia (Enlarged Prostate in Older Men)

What is BPH?

Benign prostatic hyperplasia (BPH) is a condition mainly seen in older males where the prostate gland enlarges and leads to a number of urinary symptoms. Although this enlargement occurs in all men, some do not suffer with it significantly while for others it can be debilitating. There are number of different treatment options, ranging from oral medication to surgery. Where necessary the prostate gland is surgically removed (prostatectomy).

Signs and Symptoms

Prostate enlargement starts around the age of 30 years in men. By the age of 50 years half of all men will have some urinary symptoms. This rises to 75% of all men by the age of 80 years. The severity of symptom varies among men but it gradually worsens over time. Common presenting symptoms of benign prostatic hyperplasia include:

• Narrow urine stream.
• Difficulty starting urination.
• Interrupted urine flow.
• Dribbling after urinating.
• Frequent urge to pass urine, especially at night (nocturia).
• Straining during urination.
• Inability to empty the bladder completely.

The size of prostate does not always determine the severity of the symptoms. In some men even a moderate enlargement causes severe symptoms, while in other men with a very enlarged prostate the symptoms may be mild or even barely noticeable.

Complications

BPH may lead to number of urinary complications such as:

• Acute retention of urine. Sometimes there may be sudden onset of pelvic pain with the inability to pass urine. This condition is more likely to occur after taking OTC decongestant medication.
• Repeated urinary tract infections. Episodes may be easily treated by antibiotics in many instances but tends to occur again within days, weeks or months.
• Bladder stone. The disturbances in urination can eventually increase the chance of bladder stones forming. These stones can further worsen the symptoms.
• Bladder dysfunction. Chronic retention of urine due to an enlarged prostate may stretch the muscular bladder walls to such an extent that the walls become weak. It can therefore not contract properly during urination.
• Kidney dusfunction. Sometimes urinary tract infection may spread upwards to the kidney or retention of urine may cause back pressure on the kidneys gradually resulting into swelling of urine forming parts of the kidney (hydronephrosis).

However, most men with an enlarged prostate do not experience these complications.

Causes of Enlarged Prostate

The prostate is the male gland responsible for the production of a milky white fluid is part of semen. It is located just beneath the bladder. The urethra which carries urine outside the body passes through the prostate gland. Therefore when this prostate gland is enlarged the urethra is compressed resulting in a range of urinary symptoms. Growth in the size of prostate occurs in males throughout their life.

The exact reason why the prostate become excessively large is not definitively known but it is believed to be due to an alteration in the balance of the male sex hormones. Common risk factors include:

• Advancing age: symptoms of BPH are rare in men below 40 years of age.
• Family history of BPH.

Treatment of BPH

The treatment options for BPH has increased significantly in recent years. However, not every case of an enlarged prostate needs treatment. It depends on the severity of the individual case. Treatments options include drugs and surgery.

• Drugs: alpha blockers, 5-alpha reductase inhibitors, phosphodiesterase inhibitors and combination of these drugs.
• Standard surgical procedures are :
  – Open prostatectomy
  – TURP
  – TUIP
  – Minimally invasive procedures include laser surgery like HoLAP and VLAP.