Benign
prostatic hyperplasia (benign
enlargement of the prostate)
What is benign prostatic hyperplasia? (BPH)
The prostate is a gland the size of a chestnut. It is only present
in men, and it is situated under the bladder surrounding the urethra,
the passageway that takes the urine to the outside. The gland
produces seminal fluid, which is mixed with sperm to make semen.
With age, the gland may begin to grow - this happens to most men.
The growth may eventually cause problems with urination, because
the gland pinches off the urethra as it increases its size.
The growth in itself is harmless and so the condition is called
benign prostate hyperplasia (BPH). It occurs most often in men
over the age of 60. Up to 30 per cent of men in their 70s have
BPH that causes them symptoms.
What
kinds of problems can an enlarged prostate cause?
The enlargement of the prostate gland stretches and distorts the
urethra and so obstructs the urine flow. Symptoms include:
*
a weak or interrupted urinary stream. Several attempts to empty
the bladder may be necessary.
* difficulty starting the urine flow, even when the bladder feels
full.
* a feeling the bladder is not completely empty.
* a need to urinate often during the day and during the night.
Increased need to urinate in the night is usually a very early
symptom.
* a need to urinate right away. Some men may experience involuntary
discharge of urine.
* dribbling of urine after urination.
* burning sensation or pain during urination.
Different
men get different symptoms - the symptoms may also vary with each
individual throughout the course of the disease. It is important
to emphasise that the above symptoms do not necessarily prove
that the prostate is enlarged. Other diseases may cause similar
symptoms.
Men
with problems urinating should always see their doctor.
Can other problems arise?
There
are further complications with this disease.
* For some men, it suddenly becomes impossible to urinate (known
as acute retention). Studies have shown that acute retention affects
between 1 and 2 per cent of men with BPH each year. This condition
is very painful and demands immediate medical treatment to avoid
damage to the kidneys, among other things.
* Other men find it gradually harder to empty the bladder. As
the condition develops, more and more urine is left in the bladder
after urination (known as chronic retention).
Other
complications of the disease include: repeated attacks of cystitis
(infection of the bladder) and the development of stones in the
bladder.
How does the doctor diagnose the disease?
A
GP can often make the diagnosis on the following grounds.
*
Patients will be asked about their symptoms and may also be asked
to fill out a symptom questionnaire to let the doctor know the
nature of the symptoms and how troublesome they are.
* They may also be asked to record their drinking and urination
over a period of three days.
* By carrying out a rectal examination, the doctor can feel through
the rectum wall whether or not the prostate is enlarged.
* Usually, the patient's urine will be examined, and may be sent
for culture, when it will also be tested for sensitivity to antibiotics.
Kidney function will also be examined by a blood test.
If
there is a need for further tests, they will usually be carried
out by a specialist. He or she will be able to check for specific
urinary functions like the flow rate of the urine and whether
the bladder is emptied on urination. X-rays, including ultrasound
examinations, and blood tests, may be necessary. Many hospitals
and a number of general practices have specialised prostate clinics
where a full prostate check is carried out.
How is benign prostate hyperplasia treated?
There
are a variety of treatment strategies for this condition and the
following factors should be considered:
* treatment is only necessary if the symptoms are bothersome or
complications are present.
* each treatment has advantages and disadvantages. The patient
and his doctor will have to decide which is most appropriate.
Wait
and see (watchful waiting):
if there are only a few minor symptoms it might be best to wait
and see how it develops. A doctor should be consulted regularly
to avoid complications setting in.
What
kinds of medicines are used?
There
are two types of medication for this problem.
*
Alpha-blockers. These medicines help to relax muscle fibres within
the prostate, thereby reducing the obstruction to the urine flow.
They do not reduce the size of the prostate. Examples include
terazosin, alfuzosin and tamsulosin. Patients occasionally experience
side effects such as dizziness, headache, drowsiness and retrograde
ejaculation.
* 5-alpha-reductase inhibitors such as finasteride inhibit the
growth of the prostate and decrease the size of the gland.
Research
studies have shown that both types of medical treatment are effective
at improving urinary symptoms in men with BPH.
There are also different kinds of over-the-counter herbal medicine
on the market. However, these preparations are not generally recommended
because their effect has not been completely documented. Those
which do have some supporting evidence are saw palmetto and beta-sitosterol
plant extracts and rye grass pollen extract.
What kind of surgery is available?
An
operation on the prostate will involve the removal of parts of
the enlarged tissue.
The most common operation is an endoscopic surgical procedure
where parts of the enlarged tissue are peeled off. This is called
transurethral resection of the prostate (TURP).
If the prostate is only slightly enlarged, it may be enough to
make a little cut in the prostate, without removing tissue, to
reduce the constriction of the urethra. This is called transurethral
incision (TUI).
If the prostate is considerably enlarged, it may be necessary
to make an incision in the lower abdomen and to carry out an open
operation. But this procedure is rarely carried out.
Surgery carries more risk than medical treatment and there are
possible complications including retrograde ejaculation. In retrograde
ejaculation, the sperm enters the bladder during ejaculation instead
of being expelled through the penis. Later it is flushed out with
urine. Studies estimate that 74 per cent of men will experience
retrograde ejaculation after transurethral resection of the prostate
(TURP).
Surgery has also been linked with side effects of erectile dysfunction
(in 14 per cent of men after TURP) and urinary incontinence (5
per cent). But studies are inconclusive as to whether the same
rates of these problems would have occurred anyway in men not
undergoing surgery.
The benefits of surgery are long lasting, but because only part
of the prostate is removed, some men may eventually need another
operation.
