If you are an adult male over fifty years of age and suffer from problems with urinating, like hesitancy (taking a lot of time for urine to start flowing), impaired flow, urinary retention (some urine left after voiding), discomfort while passing urine, etc., it is likely you have a condition called BPH (Benign Prostatic Hyperplasia ) otherwise known as benign enlargement of Prostate.
What is the prostate gland?
The prostate gland is a tiny organ about the size of a walnut. It lies below the urinary bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The Prostate gland produces fluid components of the semen and has an important role in reproduction for men. Prostate problems like enlargement and tumors become more frequent with age and are common in men who are 50 and older.
What happens in BPH? What are the symptoms of BPH?
In BPH, the Prostate gland grows in size compressing the urethra which passes through the center of the Prostate. This can prevent the flow of urine from the bladder through the urethra to the outside. It can cause urine retention in the bladder resulting in the need to urinate frequently during the day and night. The problem may also result in slow flow of urine, the need to urinate urgently and difficulty starting the urinary stream. It can even result in more serious problems like urinary tract infections and complete blockage of the urethra, which may be a medical emergency and can lead to injury of the kidneys.
BPH generally begins in a man’s 30s, evolves slowly, and most commonly only causes symptoms after 50. BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10% need medical or surgical intervention.
Note: BPH is a benign condition. It is not Prostate Cancer.
Effects of BPH if left untreated
i) Urinary Tract Infection
The inability to fully empty urine can cause bacteria to grow in the bladder. This can lead to urinary infections (UTIs). These infections may cause the urine to darken or result in foul-smelling or bloody urine.
ii) Bladder stones
Bladder stones, like UTIs, usually occur due to an inability to empty the bladder completely, which is one of the main symptoms of BPH. They are hard lumps of minerals in the bladder that form when urine in the bladder becomes highly concentrated. This causes the minerals in urine to crystallize. Stones can cause severe infections, blood in the urine, bladder irritation, and a blockage of urine flow.
iii) Bladder and kidney damage
The bladder may stretch and weaken if it cannot empty completely. This can cause the muscular wall of the bladder to lose its ability to contract normally, making it more difficult to empty the bladder completely. Urinary retention due to BPH can also put pressure on the bladder, damaging the kidneys. Additionally, infections that start in the bladder may spread to your kidneys, causing damage.
Diagnosis of BPH
If you have any of the symptoms mentioned above, you will most likely be referred to a urologist, a specialist in urinary problems. The doctor will perform a rectal exam to identify an enlarged Prostate. The doctor also may examine the urethra, prostate, and bladder using a cytoscope, an instrument that is inserted through the penis or with ultrasound.
If you are unable to pass any urine, it’s important to seek immediate medical care. Your doctor will have to insert a tube known as a catheter into your bladder to drain the urine.
Treatment of BPH
A variety of treatments are available for enlarged Prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:
i) The size of your prostate
ii) Your age
iii) Your overall health
iv) The amount of discomfort or bother you are experiencing
Medication:
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
Alpha-blockers:
These medications relax the bladder neck muscles and muscle fibers in the Prostate, making urination easier. Alpha-blockers usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
5-alpha reductase inhibitors:
These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications might take up to six months to be effective. Side effects include retrograde ejaculation.
Combination drug therapy:
Your doctor might recommend taking an alpha-blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
Tadalafil:
Studies suggest that this medication, which is used to treat erectile dysfunction, can also treat prostate enlargement. However, this medication is not routinely used for BPH and is generally prescribed only to men who also experience erectile dysfunction.
Surgical Therapy
Transurethral resection of the prostate (TURP)
TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder, and you’ll be able to do only light activity until you’ve healed.
Transurethral incision of the prostate (TUIP)
This surgery might be an option if you have a small or moderately enlarged Prostate gland, especially if you have health problems that make other surgeries too risky.
Transurethral microwave thermotherapy (TUMT)
Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.
Transurethral needle ablation (TUNA)
In this outpatient procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow. This procedure might be a good choice if you bleed easily or have certain other health problems. However, like TUMT, TUNA might only partially relieve your symptoms and it might take some time before you notice results.
Laser therapy
A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy can be ablative, where a portion of the obstructive prostate tissue is vaporized to increase urine flow, or enucleative, such as holmium laser enucleation of the prostate (HoLEP), where all the the prostate tissue is removed relieving urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions.
Follow-up care
Your follow-up care will depend on the specific technique used to treat your enlarged Prostate. Your doctor might recommend limiting heavy lifting and exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. Whichever procedure you have, your doctor likely will suggest that you drink plenty of fluids afterward.