Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is enlargement of the prostate due to an increase in the number of cells. Enlargement of the prostate can compress the urethra which it surrounds. This partially obstructs the flow of urine through the urethra. After many years the prostate can become very large and can cause complete obstruction of the urethra. 

Cause
The cause of BPH is not fully understood, but it is related to hormones naturally produced, such as testosterone.

Risk Factors
BPH is a disease of the prostate, and therefore can only happen in males. It is a common condition in men over 50 years old, and the risk of developing BPH increases with age. 

Signs and Symptoms
Symptoms may include passing small amounts of urine often (urinary frequency), difficulty beginning the flow of urine (urinary hesitancy), having sudden and strong urges to urinate (urinary urgency), incomplete bladder emptying, weak stream, dribbling and passing urine at night (nocturia). Symptoms typically appear slowly and gradually progress over a period of years.

Complications
BPH can cause obstruction to the flow of urine out of the bladder, causing incomplete bladder emptying. Incomplete bladder emptying predisposes the patient to recurrent urinary tract infections.

Severe BPH can cause urinary retention. As the bladder fills, it distends and may be palpable. If untreated, this can progress to bilateral hydronephrosis and renal dysfunction.

Investigations
A digital rectal examination should be done to assess the prostate. BPH causes symmetrical enlargement of the prostate.

Analysis of the urine should be performed to examine for leucocytes, nitrites and blood. Hematuria is a frequent finding. Routine blood tests include kidney function tests (creatinine and urea), electrolyte levels and white blood cell count.

Since enlargement of the prostate can also be caused by malignancy, it is important that prostate cancer is also considered as a differential diagnosis.

Treatment
BPH with mild symptoms does not usually require treatment. However, if symptoms have a significant impact on the patient’s quality of life, then treatment can be given.

Treatment that can be commenced includes medications that relax the prostate (such as tamsulosin) and medications that reduce the size of the prostate (such as finasteride). Since BPH is a chronic disease, therefore these medications are usually continued indefinitely.

If BHP is causing complications, such as recurrent infection, urinary retention, hydronephrosis, or renal dysfunction, then surgery shall be required. The most common surgical procedure to treat BPH is transurethral resection of the prostate (TURP).