40 Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia – What is it?

Benign Prostatic Hypertrophy (BPH) is sometimes called benign prostatic hyperplasia and it is a non-cancerous enlargement of the prostate.  All biological males will experience some prostate enlargement by age 70.  It is likely that cellular accumulation occurs as a result of too much epithelial cell proliferation and/or reduced levels of apoptosis.  The prostate gland is walnut-sized and donut-shaped.  As the prostate gland encircles the urethra, the growth of the prostate often pinches the urethra and restricts the flow of urine through the urethra.  Over time, the bladder wall can become thickened and irritable leading to urinary frequency.  This overactivity of the bladder detrusor muscle may cause it to eventually weaken, resulting in urine retention, which can lead to urinary tract infections and/or kidney damage.  Urine obstruction can cause hydronephrosis (distension of the renal pelvis causing pressure and renal atrophy).

Benign Prostatic Hyperplasia – Risk Factors

The biggest risk factor for BPH is age.  BPH occurs in 33% of biological males after the age of 50, 50% of biological males after the age of 65 and 90% of those over 85yrs old.  Lifestyle factors do play a role, as abdominal obesity and sedentary behaviour are predisposing factors.

Benign Prostatic Hyperplasia – Signs and Symptoms and Lifestyle Changes

The enlargement of the prostate can pinch the urethra leading to Lower Urinary Tract Symptoms (LUTS) such as difficulty urinating, incomplete bladder emptying, low flow rate, frequency of urination, nocturia, urinary urgency, urinary incontinence and dribbling.

At times, urinary retention can lead to impaired kidney function, bladder calculi (stones), hematuria, and urinary tract infections (UTIs).

Often lifestyle changes are recommended to reduce the symptoms.  These include: avoiding alcohol. decongestants and caffeine, as well as drinking smaller amounts throughout the day, using the washroom as frequently as required without delay, exercising regularly, reducing stress and implementing relaxation strategies.

Warning signs that warrant a trip to the hospital emergency department include inability to urinate as permanent bladder or kidney damage could occur without immediate medical intervention.

Benign Prostatic Hyperplasia – Diagnosis

Diagnosis is based on signs and symptoms in addition to a physical exam and digital rectal examination (DRE).  The DRE is used to assess the prostate for any changes in size or presence of nodules that can indicate the presence of either BPH or prostate cancer.  Other diagnostic tools include urinalysis which can reveal signs of urinary tract damage and/or infection:  hematuria, bacteriuria, pyuria, and leukocytes.  At times urine flow rate is measured which can become slower with BPH.

Blood tests to assess prostate-specific antigen (PSA) levels are helpful, though not specific, in that higher levels of PSA occur with both BPH and prostate cancer.  BPH does not cause prostate cancer, but age is a risk factor for both BPH and prostate cancer, so frequently biological males are screened for both at the same time when measuring PSA as well as by performing DRE.

Blood tests can also be used to assess kidney function (i.e., BUN and creatinine levels) which can also be helpful.

Endoscopy and cystoscopy and biopsies may be performed to rule out prostate cancer or urethral strictures which can be caused by prolonged catheterization, sexually transmitted diseases or trauma.

 Benign Prostatic Hyperplasia – Treatment

Often BPH is monitored and treated before the signs and symptoms become problematic.  This is sometimes called “Watchful Waiting”.  Muscle relaxants that relax muscles in the bladder, urethra and prostate may be prescribed in addition to drugs to slow enlargement and reduce the progression of hyperplasia.  Once warranted, often surgery such as Transurethral Resection of the Prostate (TURP) may be used.  A TURP involves inserting a resectoscope through the urethra, which has a camera and uses an electric current to cut away prostate tissue around the urethra.  The debris is then captured and removed with the resectoscope.  Other types of similar surgeries (e.g., laser surgery, cryosurgery) used are also less invasive than the rarely performed or required radical prostatectomy. The removal of entire prostate gland and surrounding lymph nodes is termed a radical prostatectomy.  Less invasive procedures reduce blood loss, involve shorter hospital stays and lower the risk of impotency.  Surgical treatments are delayed until necessary as there is a small risk of making the problem worse causing incontinence or erectile dysfunction.  Surgery is necessary when LUTS become problematic or there is a risk of hydronephrosis and permanent kidney damage.

Think about question;

Why is Benign Prostatic Hyperplasia a more accurate name for this condition instead of Benign Prostatic Hypertrophy?