Benign prostatic hyperplasia
डिस्क्रिप्सन
Definition
Benign prostatic hyperplasia (BPH) is an overgrowth of the prostate gland, a gland located between the penis and the bladder. The prostate gland surrounds the urethra and produces a fluid that forms a part of the semen. BPH is not cancer.
Causes and Risk Factors
The cause of BPH is not clearly known. The risk factors include:
1. Age -- BPH usually occurs in men above the age of 50 years. Its incidence increases with age. Almost 88% of men develop BPH by the 80 years of age.
2. Testicular function -- the presence of testicular function increases the risk of BPH. It does not occur in men who have been castrated (testicles are removed) for some reason.
Signs and Symptoms
The enlarged prostate compresses the urethra and makes the passage of urine through it difficult. The symptoms include:
1. Frequent need to urinate
2. Inability to void completely
3. Leakage of urine
4. Inability to hold the urine
5. Need to wake up at night to urinate
6. Incomplete emptying of the bladder
The size of the prostate gland is not related to the severity of symptoms. However, increased inflammation may increase the severity of BPH.
Severe BPH symptoms include:
1. Blood in the urine
2. Stones in the bladder
3. Inability to empty the bladder
4. Urinary tract infection
Investigations
The investigations for BPH include the following:
1. History of the symptoms and how long you have had them.
2. Digital rectal exam to check the size of the prostate gland. The doctor will insert a gloved finger into the rectum and feels the prostate gland.
3. Urine tests and urine culture to check for infections
4. Blood test to check prostate specific antigen (PSA) levels. The PSA is a protein made by the prostate glands. Elevated levels of PSA may indicate prostate cancer.
Other tests for severe BPH may include:
1. Uroflowmetry to measure the flow rate and the force with which urine is passed. It is also called uroflow test.
2. Post-void residual (PVR) test to measure the volume of urine left in the bladder after passing urine.
3. Urethrocystoscopy to look for abnormalities inside the bladder
5. Ultrasound of the prostate gland may be done before doing an invasive procedure such as a surgery to correct BPH.
Treatment
BPH is treated through both invasive and non-invasive procedures. The treatment mainly aims at:
1. Reducing the size of the prostate gland
2. Correcting the smooth muscle tone of the prostate gland
The doctor may prescribe the following medicines for BPH:
1. Antiandrogens: These drugs block the effect of the male sex hormone testosterone and dihydrotestosterone.
2. a-Adrenergic receptor antagonists: These medicines relax the muscle of the prostate. They act quickly and improve the symptoms in 1 to 2 weeks. These do not affect the size of the prostate gland. Examples include tamsulosin.
3. 5a-Reductase inhibitors: These medicines block the conversion of testosterone to dihydrotestosterone (DHT) and help in reducing the size of the prostate gland. However, the effect may not be seen very soon and it may take up to 6 months. These are usually prescribed when there is a large increase in the size of the prostate gland. Examples include finasteride and dutasteride.
Surgery may be required if the patient is not able to pass urine. The doctor may perform transurethral resection of the prostate (TURP). This process involves removing the tissue of the prostate gland that is obstructing the urine flow.
Other invasive procedures to remove the obstructing prostate tissue may include the use of:
1. Hyperthermia
2. Microwave thermotherapy
3. Laser-based tissue coagulation
Complications and When Should You See a Doctor
If BPH is not treated it may lead to complications such as:
1. Inability to pass urine
2. Bladder dysfunction
3. Kidney disease that may require dialysis
In extreme cases, BPH can lead to death.
Using antiandrogens for treatment may have side effects. These include:
1. Increase in breast size
2. Weakening of bones
3. Loss of libido
4. Problems with erection
5. Problems with metabolism of glucose
Conditions that may be associated with BPH include:
1. Obesity
2. Diabetes
3. Heart diseases
Prognosis and Prevention
The symptoms of BPH may get better with treatment. However, the medications may cause some side-effects. It is not possible to prevent BPH.
References
Beardsley EK, Frydenberg M, Risbridger GP. Endocrinology of benign prostatic hyperplasia and prostate cancer. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143.
Roehrborn CG. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 103.
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Last updated on:
02 Nov 2017 | 12:31 PM (IST)
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According to various research studies, it has been observed that intake of vitamin D causes reduction of prostate volume by blocking certain biochemical pathways in the body that promote growth of your prostate gland. So, intake of vitamin D may be useful in patients suffering from benign prostatic hyperplasia (BPH).
Benign prostatic hyperplasia (BPH) usually affects area surrounding urethra, i.e., transition zone, and enlargement of this zone causes blocking of urethra and difficulty in urination.
Whereas prostate cancer mainly affect peripheral part away from urethra. It can also cause difficulty in urination when cancer is in advanced stage and block urethra. As compared to BPH, prostate cancer is life threatening and should be investigated for early diagnosis and treatment.
Diabetes significantly enhance chances of development of benign prostatic hyperplasia (BPH). Though the exact cause is not clearly known, but increased sympathetic tone, enlargement of prostate by insulin, effects on male sex hormones may be some of the possible reasons.
Although allopathic medicine and surgery are most effective treatments available for benign prostatic hyperplasia (BPH), phytotherapy, i.e., using herbal medicines are also commonly used. Saw Palmetto (Krakach taal), African prune tree, and common nettle (bichu booti) have shown to be very useful in improving urinary symptoms of BPH.
Prognosis of benign prostatic hyperplasia (BPH) depends on severity of the disease. Majority of patients with mild to moderate symptoms without infection or kidney damage, usually show improvement with medical treatment. Complete blockage of urethra with presence infection may need long-term treatment and patient may not return fully to normal health. Urinary symptoms and medical treatment sometimes cause sexual problems.
As age advances there is more formation of dihydrotestosterone (DHT) which is produced from testosterone. So, there is imbalance between DHT and some growth factors leading to benign prostatic hyperplasia (BPH).
Also, there is increase in levels of estrogen due to aging. This increased estrogen causes cells of the prostate to grow leading to benign prostatic hyperplasia (BPH).
Benign prostatic hyperplasia (BPH) is a common condition affecting elderly people. Sixty percent of males over the age of 60 years and 80% of males over the age 80 years get BPH. It is uncommon in people with age less than 60 years.
Yes, when benign prostatic hypertrophy (BPH) is mild and at initial stage, one may not suffer from outlet obstruction. When BPH severity increases it can leads to outlet obstruction giving rise to lower urinary tract symptoms.
Certain foods and dietary items have bad effects in benign prostatic hyperplasia (BPH). So, avoid these things when having BPH:
• Alcohol
• Cereals
• Bread
• Red meat
• Eggs and poultry
• Dairy products
Enlarged prostate is usually a disease of elderly known as benign prostatic hyperplasia (BPH). Sometimes an infection of prostate, i.e., called prostatitis which usually affect middle age and young people. This may cause swelling of prostate and gives rise to similar urinary symptoms as BPH.
No, prostate enlargement is not a cause or sign of prostate cancer, but symptoms of both prostate enlargement and prostate cancer are similar. So differentiating these two by various investigations like digital rectal examination, level of PSA, ultrasound, etc. is of utmost important.
Enlarged prostate is usually a disease of aging where size of prostate gland increases and it may block urethra giving rise to lower urinary tract symptoms like frequency, difficulty in voiding.
In overactive bladder (OAB) there is some abnormal functioning of nerves that supply bladder leading to uncontrolled contraction of bladder. OAB causes sudden urge to urinate which is difficult to control.
As symptoms of both enlarged prostate and OAB are similar, proper evaluation and diagnosis is very important.
When prostate enlarges to a great extent, it may compresses nearby colon or large intestine. So, stools will get blocked due to narrowed colon leading to constipation. You can eat fruits or vegetables that will prevent constipation.
Decongestants like pseudoephedrine, xylometazoline, etc. are medications used to treat congestion associated with common cold. These drugs should be avoided in benign prostatic hyperplasia (BPH) or enlarged prostate as they contract bladder neck and therefore block the flow of urine worsening urinary symptoms associated with BPH.
Some studies show that bicycle riding is associated with worsening of certain prostate related diseases including benign prostatic hyperplasia (BPH). By cycling there is pressure exerted over perineal area and it can irritate your already enlarged prostate. Specially designed prostate friendly saddles are available for cycling fans to avoid undue pressure over prostate.
Also, cycling causes increased levels of blood prostate-specific antigen (PSA) which is used to diagnose prostate problems. So, temporarily stop cycling before your laboratory test of PSA so that you do not get false results.
Calcification in the prostate is common in men over the age of 50 years. Enlarged prostate with associated inflammation causes narrowing of prostate gland openings leading to retention of salt from urine and subsequent calcium deposition. Complications arises from calcification of prostate include, urinary tract infection, blood in urine, obstruction, and pain.
Enlarged prostate has been found to be associated with erectile dysfunction and problems of ejaculation. The exact reason is not known, but enlarged prostate causes abnormalities in functioning of nitric oxide and other chemicals responsible for erection. Treatment of benign prostatic hyperplasia (BPH) with medications like alpha blockers can cause difficulty in ejaculation. Surgical procedures to remove prostate may cause retrograde ejaculation, i.e., the semen is ejaculated into the bladder rather than coming out through urethra.
Yes, operation is not required in each and every patient of enlarged prostate. If mild enlargement is there, only watchful waiting is needed. Moderate disease can be managed by giving certain medications like finasteride, tamsulosin, etc. If symptoms are severe and they are difficult to manage by giving medications then only surgery is preferred.
Enlarged prostate is a condition in which there is increase in growth of tissue inside the prostate and it usually affect aged people above age of 60 years. Whereas prostatitis means infection of prostate gland leading to painful, swollen, and inflamed prostate. Prostatitis usually affect people with age 30 to 50 years.
Benign prostatic hyperplasia (BPH), i.e., enlargement of your prostate gland becomes problematic when it gets so much bigger in size that partly blocks the urethra leading to difficulty in urination.
Yes, as chances of getting benign prostatic hyperplasia (BPH) and hypertension increase with advancing age. Hence, patients of hypertension should be examined for symptoms of BPH, so that appropriate medications can be used to treat both these conditions.
Yes, few patients of benign prostatic hyperplasia (BPH) can get stones. Enlargement of prostate causes blocking of urethra, so there is problem with urination leading to backed-up urine. This retained urine is responsible for development of stones and infections of bladder or kidney.
Patients with benign prostatic hyperplasia (BPH) most often get lower urinary tract symptoms. These include daytime frequency and urgency, waking up at night to urinate, straining while urinating, weak stream and intermittent flow of urine, feeling of incomplete emptying of bladder, and dribbling of urine.
Benign prostatic hyperplasia (BPH) when untreated can leads certain complications like:
• Inability to urinate due to complete blockage of urethra
• Kidney damage
• Prolonged retention of urine
• Urinary tract infection
• Urinary bladder stones
• Blood in urine
Only mild enlargement of prostate may not present with symptoms. When prostate is enlarged to such an extent that it partly or completely blocks your urethra then symptoms like difficulty in urination, retention of urine, etc. appear. Such an enlargement of prostate giving rise to symptoms is known as symptomatic benign prostatic hyperplasia (BPH).
Frequent ejaculations either by sexual intercourse or masturbation may be useful to prevent benign prostatic hyperplasia (BPH), but there is no clear-cut evidence suggesting relationship between these two factors. Diet rich in fruits and vegetables may help reduce chances of getting BPH. It is usually difficult to prevent urinary symptoms of BPH.
Natural supplements that are extracts from certain plants are used to treat benign prostatic hyperplasia (BPH). These supplements include beta-sitosterol, Pygeum (iron wood or African plum), ryegrass, and saw palmetto (Krakach taal). Research studies suggest that supplements improve symptoms of BPH, but well established evidence is lacking.
Phytosterols such as beta-sitosterol are substances that are obtained from plants and naturally found in certain vegetables and fruits. Some people use it to treat their benign prostatic hyperplasia (BPH), but scientific evidence is lacking. Phytosterols bind to prostate and may reduce the swelling and inflammation.
In benign prostatic hyperplasia (BPH), surgery is indicated in following circumstances:
• Inability to urinate, i.e., complete blockage of urethra
• Blood in urine
• Bladder stones
• When medications are not improving your lower urinary tract symptoms.
It is extremely uncommon that enlarged prostate occur in teenagers. Prostate enlargement is problem of old age usually in men with age more than 60 years. It occurs due to abnormality in cell growth of prostate due to aging and hormonal issues in old age, i.e., increased dihydrotestosterone (DHT) and estrogen level.
Yes, fruits and vegetables that rich in vitamin C and beta-carotene may be helpful in protecting against enlarged prostate. You can get vitamin C in abundant amount by having citrus fruits, broccoli, cauliflower, dark green leafy vegetables, guavas, berries, kiwi fruit, etc. Recommended daily intake of vitamin C for an adult male is 90 to 2,000 milligrams per day.
Yes, enlarged prostate may lead to blood in the urine or hematuria.
As prostate enlarges, there is growth of blood vessels within the prostate. Growing prostate may cause rupture of these blood vessels leading to leakage of blood through urethra. Hematuria may also be due to growth of blood vessels after surgical removal of prostate.
When enlarged prostate is associated with cancer of prostate then it can spread to bone giving rise to bone pain especially back pain. Sometimes, infection of prostate may also cause back pain.
Yes, enlarged prostate or benign prostatic hyperplasia (BPH) patients are more prone to get urinary tract infection (UTI). BPH leads to urinary retention that serves as a good medium to grow bacteria giving rise to UTI.
Enlarged prostate may cause pain only in severe disease or complications arising out of it. Pain in enlarged prostate may be due to growing nodules that pressure on urethrae. Patient may feel bladder pain while urinating, pain in the lower abdomen and lower back.
Enlarged prostate become dangerous when there is complete blockage of urethra and complete inability to urinate. This can cause kidney damage. This is a medical emergency and one must seek medical help as early as possible. A catheter may be required to drain the urine.
As age increases, level of testosterone decreases while that of dihydrotestosterone (DHT) and estrogen increases. These changes lead to growth of cells in the prostate.
Prostate-specific antigen (PSA) is a marker or a substance that is produced by prostate and it is used to diagnose certain diseases of prostate. PSA level is increased in enlarged prostate (BPH), prostate cancer, and prostatitis.