Benign Prostatic Enlargement – Evaluation and Management

Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland. The word "benign" means the cells are not cancerous. "Hyperplasia" means an increased number of cells. The prostate gland usually enlarges with age but doesn't always cause problems.

Anatomy

The prostate is made up of anatomical zones, BPH typically occurs in the central and transitional zones of the prostate, and prostate cancer typically occurs in the peripheral zones of the prostate.

Symptoms of Benign Prostate Enlargement

Symptoms are rarely seen before the age of 40, but over half of all men in their sixties and about 90% of men in their seventies and eighties show some symptoms of BPH.

The prostate gland encircles the urethra, so when the gland enlarges, it presses against the urethra, restricting urine flow through the tube and causing problems with urination. The following changes may occur over a period of time if prostatic enlargement causing obstruction is not treated:

Bladder wall thickens, capacity of the bladder is reduced and becomes irritable
Frequent urination as the bladder walls begin to contract even with small amounts of urine
Bladder may become weak and loses the ability to empty; thereby retaining urine

The partial emptying of the bladder and narrowing of the prostatic urethra may lead to many problems such as:

Urinating more often during the day
Urge to urinate frequently during the night
Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time
The urine stream is slow to start
Needing to strain and push with abdominal muscles to start urination
Urine dribbling for some time after urination
A sensation that the bladder isn't fully emptied after urination
Lack of force to the urine flow
The sensation of wanting to go again a few minutes after urinating

Diagnosis of Benign Prostatic Enlargement

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may do a physical examination to assess the condition of the prostate.

The tests vary from patient to patient, but the following are the most common:

Urine test: A urine sample is taken to look for signs of blood and infection.
Digital rectal examination (DRE): Your doctor inserts a gloved finger into the rectum to assess the size and condition of the prostate that can be felt under the rectal wall. If your doctor feels something suspicious, such as a lump or bump, further tests will be carried out.
Prostate specific antigen (PSA) test: A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

Further tests may be required to assess the prostate.

Flow test and bladder scan: Your doctor may ask you to urinate into a device that measures how fast the urine flows. A decrease in the flow can suggest BPH. A bladder scan is then performed to assess how much urine is left in the bladder after urination.
Ultrasound: Ultrasound imaging is used to estimate the size of the prostate gland and look for growth of the prostate gland into the bladder. This can be done over the abdomen or through the rectum.
Cystoscopy: Your doctor inserts a small tube called a cystoscope (contains a lens and light system) through the urethral opening in the penis. It helps your doctor closely view the urethra and bladder, and determine the size, location and extent of obstruction.
Urodynamics study: This measures pressure in your bladder and in the surrounding region during bladder filling and urination. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with water. Another catheter with a pressure-measuring sensor is placed in your rectum. This procedure can differentiate between several conditions that can cause difficulties voiding, including bladder outlet obstruction caused by BPH, overactive bladder and underactive bladder. This test is recommended when the doctor is not sure if the urination symptoms are caused by BPH.

Treatment of Benign Prostatic Enlargement

If you do not experience any symptoms of BPH, your doctor may decide to wait-and-watch for the progression of the condition with regular monitoring, usually once a year.

Your doctor may advise drug therapy, which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person's general health condition, medical history, medications taken for other conditions and quality of life considerations.

Surgery is another option for the treatment of BPH. Modern surgical procedures usually access the prostate through the urethra, so no incision is required. Different approaches to benign prostate surgery include:

Transurethral resection of the prostate (TURP): Removal of part of the prostate causing obstruction with the help of surgical instruments passed through the urethra.
Transurethral incision of the prostate (TUIP): Making incisions on the prostate with instruments introduced through the urethra to decrease the pressure on the urethra
Laser therapy: Using laser to make cuts or destroy the obstructive part of the prostate
Transurethral needle ablation (TUNA): Destroying part of the prostate with a heated needle
Transurethral microwave therapy (TUMT): Using heat from microwave energy to destroy part of the prostate
UroLift: A new system which uses implants to shift and hold prostate tissue away from the urethra
Open prostatectomy: Making an incision on the skin to access and remove the prostate (rarely used and mostly recommended for very large prostates)

Uroflow / Urodynamics

Urodynamics is the investigation of the function of the lower urinary tract to diagnose the reason for voiding dysfunction.

TURP – Trans Urethral Resection of Prostate

The prostate gland is an organ found in men, surrounding the neck of the urinary bladder. The gland grows with age, but if it grows too big, it can exert pressure on the urethra (tube that drains urine) and may obstruct the flow of urine. This condition is called benign prostatic hypertrophy (BPH) and causes urinary problems, such as difficulty in emptying the bladder and frequent urinary infections.

Laser Surgery for Benign Prostatic Enlargement

Laser prostate surgery is a minimally invasive surgery indicated for the treatment of bladder outlet obstruction due to enlargement of the prostate. It utilizes a powerful laser to either remove the complete gland or a portion of the prostate blocking the urethra, through cutting or vaporization.

Lower Urinary Tract Symptoms / Prostatism

Lower urinary tract symptoms or LUTS are symptoms connected to issues with the lower urinary tract organs, such as the urethra, bladder, and prostate. LUTS are widely categorized into symptoms involving the passing or storage of urine. An affected individual might have symptoms related to one or the other, or a combination of both.