Benign Prostatic Hyperplasia (BPH)
This is a non-cancerous enlargement of the prostate gland which is usually associated with older age. The enlarged prostate can interfere with passage of the urine through the urethra causing symptoms.
It is important to know that BPH will not become cancerous; however both BPH and prostate cancer are age related conditions and can coexist together.
What are the symptoms of BPH?
An enlarged prostate can cause voiding symptoms by restricting the urinary flow including:
Delay in starting urinary flow.
Weak or "stop and start" urinary flow.
Straining to pass urine.
Taking longer to finish urinating.
Dribbling of urine towards the end of the stream.
Feeling of incomplete bladder emptying.
BPH may also affect the bladder function causing storage symptoms:
Having a sudden urge to pass urine which is difficult to postpone, and may be associated with urinary leakage.
Needing to urinate more often than usual.
Urinating at night (during bedtime).
It is important to know that BPH may not cause any symptoms. On the other hand, many of the above symptoms can also be caused by other medical conditions; therefore the diagnosis of BPH can only be made after a comprehensive assessment.
Diagnosis of BPH
This requires a careful assessment with medical history taking, examination and carrying out several tests.
You will be asked to complete the I-PSS questionnaire and possibly a bladder diary chart. Physical examination will include examination of the prostate with a gloved finger in the back passage to assess the size and the contours of the prostate.
The following tests might be carried out (depending on your condition):
Urine analysis to rule out infection.
Renal function blood test.
PSA (Prostate Specific Antigen) test can be used as a marker for the size of the prostate in this situation.
Flow assessment to determine the severity of the obstruction. This is an easy test done in your privacy. It is important that you have a full bladder at the start of the test, and then you will be asked to pass urine into a container to assess the speed of the urinary stream. At the end, a small scanner is used to measure the volume of the urine left in the bladder.
What are the possible complications of BPH?
These are not common, but include:
Acute retention of urine: this is a sudden onset of inability to pass urine which can be very distressing. It requires an urgent drainage of the bladder with a catheter. This is more common in men who have fairly troublesome symptoms.
Chronic retention of urine: this is an ongoing problem with emptying the bladder adequately when passing urine. This could results in:
Urinary tract infections.
Formation of bladder stones.
Damage to the kidneys.
Passing blood in the urine.
What are the treatment options for BPH?
Mild cases of BPH without bothersome symptoms do not necessarily require treatment. Alternatively, treatment options include:
Lifestyles changes (in mild cases): include fluid management and bladder training.
Medications (in mild to moderate cases):
Alpha-blockers: help to improve symptoms within 24 to 48 hrs and work by relaxing the smooth muscles of the prostate and bladder neck.
5-alpha reductase inhibitors: help to shrink the prostate by approximately 30% but take around 6 months to take effect.
Combination of alpha-blockers and 5-alpha reductase inhibitors.
PDE5-inhibitors: Daily dose of Tadalafil is the only drug in its class that has been licensed to be used for BPH. It works by smooth muscles relaxation.
Surgery (in moderate to severe cases): this is the most effective treatment. Both of the following techniques can be offered:
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