[vc_row][vc_column][vc_column_text]Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy or enlarged prostate, is a disease where most patients develop an abnormally enlarged prostate, which affects the urinary and reproductive systems. The probability of developing BPH increases with age and it is thought that all men will eventually develop it if they live long enough. The disease is non-cancerous and doesn’t threaten patients’ lives, but it can cause discomfort, which is why it is treated.

The prostate is a walnut-shaped gland with two lobes located below the bladder about halfway between the rectum and the base of the penis. The gland is responsible for the production of a fluid that is expelled along with semen through the urethra during ejaculation. Since the prostate surrounds the urethra, which is the tube that carries urine and semen from the body, when it become enlarged, the urethra may become squeezed or partly blocked.

BPH’s Development and Causes

Causes for the development of BPH are not fully understood. The only exceptions are men whose testicles were removed when they were young due to cancer or another condition. In men whose testicles were removed when they developed BPH, the size of the prostate may reduce on its own. BPH can be inconvenient and cause problems urinating.

BPH is seen as a normal part of men’s aging process caused by alterations in hormone balance and cell growth. According to the National Institutes of Health (NIH), “the prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.”

Since most men do not experience symptoms, physicians may decide to do nothing more than watch and wait. But about half of men older than 75 experience symptoms of BPH.

BPH’s Symptoms and Diagnosis

As the prostate enlarges, it obstructs the urethra and consequently affects the urine flow. Patients may experience symptoms like abnormal urinary frequency, urinary urgency, difficulty initiating the urinary stream (hesitancy), interrupted or weak urine stream, incomplete bladder emptying, feeling of persistent residual urine, needing to strain or push to initiate and maintain urination, decreased force of stream, and loss of small amounts of urine due to a poor urinary stream (dribbling).

In order to diagnose the disease, physicians often request a familial and medical history and complete physical examination, including examination of the patient’s body to check for discharge from the urethra, enlarged or tender lymph nodes in the groin, a swollen or tender scrotum, and performing a digital rectal exam, a routine physical exam for men age 40 or older.

Additional medical tests include urinalysis, a prostate-specific antigen (PSA) blood test, urodynamic tests, cystoscopy, transrectal ultrasound, and a biopsy.

BPH’s Treatment and Prognosis

Depending on the patient’s age, physical condition, severity of BPH and symptoms experienced, physicians may opt to treat the disease with lifestyle changes, medications, minimally invasive procedures, surgery, or a combination of treatments.

According to the NIH, “a healthcare provider may recommend lifestyle changes for men whose symptoms are mild or slightly bothersome. Lifestyle changes can include reducing intake of liquids, particularly before going out in public or before periods of sleep, avoiding or reducing intake of caffeinated beverages and alcohol, avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics, training the bladder to hold more urine for longer periods, exercising pelvic floor muscles, [and] preventing or treating constipation.”

Regarding medication, alpha blockers relax the smooth muscles of the prostate and bladder to improve urine flow and reduce bladder blockage, phosphodiesterase-5 inhibitors are mainly used for erectile dysfunction, and 5-alpha reductase inhibitors to block the production of dihydrotestosterone (DHT), which accumulates in the prostate and may cause prostate growth.

Minimally invasive procedures that relieve BPH symptoms when medications are not effective include transurethral needle ablation, transurethral microwave thermotherapy, high-intensity focused ultrasound, transurethral electrovaporization, water-induced thermotherapy and prostatic stent insertion.

There is also the possibility of surgery. “For long-term treatment of benign prostatic hyperplasia, a urologist may recommend removing enlarged prostate tissue or making cuts in the prostate to widen the urethra. Urologists recommend surgery when medications and minimally invasive procedures are ineffective, symptoms are particularly bothersome or severe, and complications arise.”

The most common type is transurethral resection of the prostate (TURP), during which the interior of the prostate is removed, but patients may also be submitted to laser surgery, open prostatectomy or transurethral incision of the prostate (TUIP). If not treated, BPH may result in acute urinary retention, chronic urinary retention, blood in the urine, urinary tract infections (UTIs), bladder damage, kidney damage, or bladder stones.

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