Enlarged Prostate (BPH)

What is a Prostate Gland?

It is a gland in the male reproductive system, which is muscular in nature. It is positioned around the urethra and is responsible for making most of the fluid in the semen. 

The muscular action of this gland is responsible to propel the semen through the urethra during the climax.

With aging in men, practically half of all the male population develop an enlargement of the prostate by the age of 50 years. 

However, it will be termed as BPH, with symptoms such as incontinence (urinary urgency) results. Prostate enlargement is medically termed as Benign Prostatic Hyperplasia (BPH)/ Benign Prostatic Hypertrophy.

What is Benign Prostatic Hyperplasia condition?

Hyperplasia is an abnormal multiplication of cells. BPH is a condition that resulted from the multiplication of cells of the prostate gland, thereby increasing its size.

 The result is it compresses the urethra it surrounds and impedes the regular flow of urine. BPH is not equivalent to prostate cancer and neither does it contribute to the risk of cancer.

 BPH affects the lifestyle of the individual developing the condition, because of its symptoms, but is not a life-threatening condition. 

What are the causes of BPH?

• Aging: Older men above the age of 80 years commonly show the symptoms of BPH.
• Exact cause: Unknown. Although, change in male sex hormone attributed to aging could be a factor.
• Family history: Prostate problems in the family can have individuals prone to BPH. E.g. a father or brother with diagnosed prostate problems.
• Anomalies in the function of the prostate could also lead to BPH.

What are the symptoms of BPH?

BPH generally begins with mild symptoms. The intensity of the symptoms may vary from person to person. The general trend is, from mild to worse over a period of time. 

If the symptoms are neglected; the most severe cases report kidney failure. There are no specific predisposing factors determining one's proneness to BPH. 

Some men may have severe symptoms with little enlargement, while others may have substantial enlargement of the prostate with mild symptoms.

 In some cases, it has been observed that symptoms stabilize and may even improve gradually with time.

What are the risk factors associated with BPH?

• Heart disease: Studies have shown the use of beta-blockers increases the risk of BPH.
• Diabetes.
• Lifestyle: BPH poses an increased risk to obese men. A regular exercise regimen can lower the risk.

What are the complications associated with BPH?

Complications in BPH are rare and may arise only when the mild symptoms are medically unattended. 

However, the observed ones are as described below-

• Urinary tract infection: Due to incomplete release of urine.
• Bladder damage: Constant retention of urine could lead to the weakening of the bladder muscles. This could further contribute to an inability to empty the bladder.
• Bladder stones: Caused by the constant retention of urine that irritates the bladder and can lead to a bladder infection, blockage of urine flow, and could be a cause of blood in the urine.

What are the preventive measures for BPH?

• A balanced diet comprising a variety of vegetables and fruits.
• Maintaining optimal weight.
• Regular exercises.

What is the diagnosis for Enlarged Prostate (BPH or Benign Prostatic Hyperplasia)?

It begins with the medical history, to identify whether one's father or brother has been diagnosed with the condition, followed by a physical examination. 

Here the doctor evaluates the size and shape of the patient's prostate through rectal examination. After which the following diagnostic tests may be recommended, depending on the severity of the condition-

• Post-void residual: To measure the amount of urine left in your bladder after urination.
• Urinalysis: Urine is tested for the presence of bacteria and/or blood.
• Prostate-Specific Antigen (PSA) Test: A blood test to check prostate cancer.
• Urodynamic test: The bladder is filled with a liquid using a catheter. The pressure exerted by the bladder is measured while urinating.
• Cystoscopy: A tiny lighted scope is inserted through the urethra to examine the urethra and the bladder.Intravenous pyelography or urography: It is an X-ray or a CT-scan procedure after injecting a dye into the body. The dye highlights the complete urinary system, the images for which are captured using the X-ray or CT-scan technique.
• Prostatic Biopsy: Anomalies in the prostate tissue are evaluated by laboratory examination of a small amount of prostate tissue.
• Uroflowmetry: The speed of the urine flow is measured.

What are the treatment options for Enalrged Prostate (BPH)?

• Prostate Artery Embolization (PAE):

This procedure is performed under local anesthesia. Here doctors insert a tiny tube into the femoral artery of the thigh, by making a small incision in the appropriate location on the body.

This tube is directed to the prostate artery, surrounding the gland. On the positioning, a fluid containing tiny particles is injected into the artery. These tiny particles block the blood supply to the prostate, thereby shrinking the gland.

Interventional Radiologists perform this technique. Studies have shown very few side effects of this technique.

 This procedure may not require hospitalization and in most cases, the patient is sent home the same day.

• Transurethral Resection of the Prostate (TURP):

This procedure is performed under general anesthesia. It does not require any incisions to be made on the body.

   The doctor inserts a resectoscope into the tip of the penis, through the urethra to the position of the prostate gland. The prostate tissue is clipped from the inside and flushed into the bladder by constant irrigation, using a fluid. 

On completion, the irrigated fluid is flushed out of the bladder.

After the procedure, a catheter is placed for 24 to 28 hours. The catheter is removed when the swelling subsides and the patient can urinate on his own. Post-surgery, blood may be seen in the urine.

 But, if the consistency is thick like blood, the doctor needs to be contacted immediately. Urination post-surgery is painful but improves over a period of eight weeks.

This procedure requires hospitalization for a day or two.