Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy is the enlargement of the prostate gland. The word "benign" means the cells are not cancerous. "Hyperplasia" means an increased number of cells.

It is common for the prostate gland to enlarge as a man ages. The prostate gland encircles the urethra, so problems with urination can occur if the gland restricts urine flow through the urine channel. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

• The bladder wall becomes thicker and irritable
• The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination
• Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder

The narrowing of the urethra and partial emptying of the bladder cause many problems associated with BPH.

Some problems associated with BPH are:

• Urinating more often during the day and night
• Urinary urgency, which means the urge to urinate is so strong and sudden, that you may not make it to the toilet in time.
• The urine stream is slow to start and dribbles toward the end. 
• A sensation that the bladder isn't fully emptied after urination
• The sensation of needing to go again a few minutes after urinating
• Urinary retention (unable to pass urine)
• Urinary tract infection
• Hematuria (blood in urine) 

Diagnosis and Investigations

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may do a physical examination to assess the condition of the prostate.

The tests vary from patient to patient, but the following investigations such as blood tests (renal function, PSA test), renal tract ultrasound, uroflow and urodynamic studies, and cystoscopy can be useful.

Treatment

1. Conservative treatment

If the person has BPH but is not bothered by the symptoms, you and your doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with your doctor - usually once a year - to see if the condition is getting any worse. Your doctor may advise you on some lifestyle changes to minimize your symptoms.

2. Drug Therapy

Your doctor may advise drug therapy that aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind your general health condition, medical history, medications taken for other conditions, and quality of life considerations.

3. Surgery

Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (TransUrethral Resection of the Prostate). A TURP is effective at relieving symptoms quickly. Nowadays you have the option of having the TURP performed with a conventional endoscopic resection method or laser therapy. Laser therapy allows you to have your prostate surgery without needing to cease antiplatelet (eg. plavix, clopidogrel) or anticoagulants (eg. warfarin). Furthermore, men who receive laser TURP can be discharged home earlier. More recently, a new minimally invasive day surgery prostate therapy called UroLift has been introduced and men can get relief of bothersome urinary symptoms without actual cutting or coagulation of prostate tissue. Urolift allows for some preservation of sexual function that is commonly affected by TURP. Rezum, another minimally invasive prostate surgery can be performed as day surgery too.