General Illness Information
Medical Term: Benign Prostatic Hyperplasia (BPH)
Common Name: Prostate Enlargement (Benign)
Benign glandular growth of prostate which may result in bladder outlet obstruction.
The prostate gland is situated at the base of the urinary bladder, and encircles the urethra at the bladder outlet.
This condition is common in males over the age of 60. It must be distinguished from Prostate Cancer.
Exact cause unknown, but evidence suggests BPH arises from a systemic hormonal alteration which may act in combination with growth factors stimulating glandular overgrowth.
- This appears to be part of the aging process.
- Growth of the prostate may be retarded with a low fat, no caffeine diet. Saw Palmetto has been shown to reduce the rate of growth in BPH.
Signs & Symptoms
The commonest symptoms are:
- Frequency of urination;
- Nocturia (waking up at night a number of times to urinate);
- Decrease force or caliber of stream;
- Post-void dribbling;
- Sensation of incomplete bladder emptying;
- Overflow incontinence;
- Inability to voluntarily stop stream;
- Urinary retention;
- Urge incontinence.
Other symptoms and signs:
- Gross hematuria (blood in urine);
- Observation of weak stream;
- Distended bladder;
- Prostate enlarged (normal 20 gram prostate – size of horse chestnut);
- Clinical clues suggesting renal failure due to obstructive uropathy (edema, pallor, nutritional deficiencies, etc.).
- Intact testes (BPH rare in castrated males);
- Aging (thus, rare in men < 40 years old);
- Dietary and environmental may be implicated.
Diagnosis & Treatment
- BPH is a pathologic diagnosis – lab data is only suggestive;
- Urinalysis: pus cells in urine, pH changes due to chronic residual urine;
- Elevated serum creatinine (if obstructive uropathy present);
- Urine culture positive for bacteria;
- Prostate specific antigen (PSA) may be elevated but usually less than 8;
- Increased post-void residual urine measurement is over 100 mL);
- Transrectal prostate ultrasound gives volumetric estimate of gland;
- Needle biopsy (to rule out cancer).
- CT scan or MRI of pelvis;
- Uroflow – volume voided per unit time;
- Pressure-flow curve (urine flow versus voiding pressures);
- Cystoscopy shows occlusive prostatic lobes and bladder trabeculation.
- Treatment usually as out patient;
- Inpatient emergent treatment required to manage fluid and electrolyte abnormalities of obstructive uropathy;
- Avoid large boluses of oral or IV fluids;
- Avoid prolonged periods of not voiding;
- Avoid sympathomimetic or anticholinergic medications (e.g., cold/flu preparations);
- Urethral catheterization if in retention.
- If surgery is necessary, the following options are available:
- These range from the minimally invasive (top) to more invasive at the bottom of the list:
- Interstitial laser coagulation (ILC);
- High frequency focused ultrasound (HIFU);
- Transurethral needle ablation (TUNA);
- Transurethral microwave thermotherapy (TUMT);
- Water-induced thermotherapy (WIT);
- Prostate stenting;
- Transurethral balloon dilation (TUDP);
- Transurethral ethanol ablation of prostate;
- TURP (trans-urethral resection of the prostate);
- Open prostatectomy;
- Transurethral laser ablation, laser-induced prostatectomy or laser enucleation of prostate;
- Transurethral vaporization of prostate.
- Medications are generally preferred, unless strong indications exist for surgery;
- Alpha adrenergic antagonists: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax);
- Hormonal (anti-androgens) agents: finasteride (Proscar) works best for larger prostates;
- Phytotherapy (e.g., serenoa repens (Saw Palmetto), similar to finasteride in efficacy). A very large number of physicians now recommending Saw Palmetto and Pygeum as first line therapy (see Prostanutrix).
Growth of the prostate may be retarded with a low fat, no caffeine diet. Saw Palmetto has been shown to reduce the rate of growth in BPH.
Possible Complications :
- Bladder stones;
- Renal failure;
Generally very good. A careful search must be undertaken to rule out prostate cancer.