By the age of 60 one-third of men will experience symptoms due to enlarged prostate.
By the age of 80, that percentage increases to half of all men. In this video we will be discussing
Prostate Gland Enlargement also known as Benign Prostatic Hyperplasia or BPH including its causes,
symptoms, diagnosis and treatment.
What is BPH?
BPH is enlargement of the prostate gland from non-cancerous causes which can lead to subsequent difficulties with urination.
Causing symptoms such as a slow stream, getting up multiple times in the middle of the night
to urinate, and increase frequency of urination.
What is the prostate gland?
BPH affects the prostate gland, which is a male organ located in the pelvis next to the bladder.
The prostate has only one function which is solely reproductive in nature,
to produce semen. It is normally a small gland usually the size of a walnut, but in cases of BPH,
it can grow to a size many times larger than that.
Why would enlargement of the prostate gland cause difficulties in urination?
Because urine has to pass through the prostate as it leaves the bladder
when the prostate grows it can block the flow of urine out of the bladder.
Why is BPH important to understand?
BPH is an extremely common condition especially as men grow older, affecting an estimated 15 million men in the United States alone.
And it almost certainly will affect you or someone that you know.
What causes BPH?
All the causes of BPH are not completely understood, although higher levels of the male hormone testosterone is a contributor.
It is not the only cause of BPH. Family history of BPH is another important cause and
additional factors include obesity, metabolic syndrome, diabetes, and a sedentary lifestyle.
Why is BPH a problem?
Although lacking the urgency of a situation like prostate cancer,
BPH is a major health burden costing the healthcare system billions of dollars a year.
BPH issues can range from quality of life issues of inconvenient urinary habits, to issues as severe
as progressive bladder decompensation requiring men to use catheters to empty their bladder.
BPH can also result in kidney failure, due to chronic long-term urinary retention, necessitating dialysis,
or even kidney transplantation. It can also cause the formation of bladder stones
and also long-term bladder infections, which can eventually lead to widespread infection,
also known as sepsis, which can be life-threatening.
What causes these more serious effects of BPH?
Persistent difficulty in emptying the bladder of urine can cause the bladder wall to stretch and
thin out, rendering it unable to contract properly to expel urine. If this condition is not corrected
then the only way to empty the bladder is to either place a permanent indwelling catheter
or manually put a catheter in and out several times a day. Also, progressive bladder distension
can go further backwards, and as mentioned can cause problems with the kidneys as well.
How is BPH treated?
BPH can be managed with medications or surgery. Medications are usually the first line treatment except in severe cases.
Medications are designed to help in one of two ways: medications like Finasteride are known as five alpha reductase inhibitors, and are designed
to shrink the prostate by altering hormonal pathways in the body, thereby causing the prostate
to shrink. Medications like Tamsulosin or Doxazosin, known as alpha blockers, allow urine to flow more
freely through the prostate by causing relaxation of the urine channel that runs through it.
As with any medications there can be side effects. Side effects of finasteride can include erectile
dysfunction, and loss of libido. Dizziness is the most common side effect of Tamsulosin.
There are many surgical options for BPH. Surgery is typically used when medications stop working
or the BPH situation is too advanced for medication alone. The concept of surgery is
to remove the blockage as completely as possible. Unlike surgery for prostate cancer, where the whole
prostate is removed, the principles for BPH surgery are to leave the outside of the prostate intact
but remove the part on the inside causing the obstruction.
By doing this the likelihood of side effects such as urinary incontinence and erectile dysfunction
are greatly diminished.
What kind of surgical options exist for BPH?
Traditional surgery for BPH is known as a TURP or T-U-R-P or Transurethral Resection of the Prostate.
Many patients find it helpful to think of a TURP as a kind of plumbing procedure for the prostate
where the blockage is cleaned out from the inside, usually with a small metal loop that
is used to remove the excess tissue. There are also a multitude of newer surgical options available as
well. Some use a laser to relieve the blockage, others use water under high pressure, and still
others use steam. There are also prostatic urethral lift procedures where no removal of tissue occurs
and a series of implants opens the channel inside the prostate and makes it wider.
There are also procedures that shut down blood flow to the prostate causing it to shrink and allow
freer flow of urine. If you have more questions or are having issues with BPH reach out to your doctor.