Benign prostatic hyperplasia (BPH) — also called Benign prostatic enlargement (BPE) is a non-cancerous increase in size of the prostate gland as men get older. 

Symptoms

Common signs and symptoms of BPH include:

•      Frequent or urgent need to urinate.

•      Increased frequency of urination at night (nocturia).

•      Difficulty in starting urination.

•      Weak urine stream or a stream that stops and starts.

•      Dribbling at the end of urination.

•      Inability to completely empty the bladder.

The size of prostate doesn't necessarily determine the severity of symptoms.

Causes

The Prostate gland is located beneath the Urinary Bladder. The tube that transports urine from the bladder out of the penis (urethra) passes through the Prostate. When the Prostate enlarges, it begins to block urine flow.

 Prostatic enlargement in old age is attributed to imbalance in sex hormones and growth factors.

Risk factors

Risk factors for prostate gland enlargement include:

•      Aging

•      Family history

•       Sedentary Lifestyle and Obesity 

•      Smoking.

Complications

Complications of an enlarged prostate can include:

•      Sudden inability to urinate (urinary retention). 

•      Urinary tract infections (UTIs). 

•      Bladder stones.

•      Bladder dysfunction (damage due to long standing obstruction)

•      Kidney damage 

Having an enlarged prostate is not believed to increase the risk of developing prostate cancer.

 Diagnosis

Detailed history is taken about symptoms and a physical examination including digital rectal examination is performed by the Urologist. The other tests that a Urologist may recommend are:

•      Urine test.

•      Blood tests 

•      Prostate-specific antigen (PSA) 

•      Urinary flow test

•      Ultrasound KUB with Post-void residual volume 

•      Urodynamic and pressure flow studies and  Cystoscopy (In special circumstances)

 Treatment

A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. 

Medical Treatment

Medical Treatment is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:

•      Alpha blockers (Alfuzosin, Tamsulosin and Silodosin). These are the most commonly used drugs. Side effects of these might include dizziness and retrograde ejaculation.

•      5-alpha reductase inhibitors (finasteride and dutasteride) 

•      5-Phosphodiesterase inhibitor (Tadalafil)

•      Anticholinergic drugs (Tolterodine, salifenacin ,Darifenacin).Used with other drugs for irritative symptoms

•      Combination drug therapy. 

Minimally invasive or surgical therapy

Minimally invasive or surgical therapy might be recommended if:

•      Symptoms are moderate to severe

•      Medication hasn't relieved  symptoms

•      Urinary tract obstruction, bladder stones, blood in urine or kidney problems

•      Patient preference

 There are several types of minimally invasive or surgical therapies.

•      Transurethral resection of the prostate (TURP)

This is the commonest procedure done. A resectoscope is inserted into the urethra and the obstructing prostate tissue is removed to make a wide channel. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP, temporary need of catheter to drain bladder is required.

•      Transurethral incision of the prostate (TUIP)

•      Transurethral microwave thermotherapy (TUMT)

•      Transurethral needle ablation (TUNA)

•      Laser therapy (Holmium laser enucleation of the prostate (HoLEP),

•      Open or robot-assisted prostatectomy

•      Newer Procedures like Prostatic urethral lift (PUL),Embolization

  Prostate procedures can cause side effects. Depending on the procedure done, complications might include:

•      Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation)

•      Temporary difficulty with urination

•      Urinary tract infection

•      Bleeding

•      Very rarely, loss of bladder control (incontinence)

•      Narrowing of urinary passage ( stricture urethra /Bladder neck contracture)

Surgery for BPH does not reduce the risk of Prostatic cancer 

 Life style modifications in BPH/BPE

•      Limit fluids intake in the evenings.

•      Limit intake tea, coffee, alcohol.

•      Limit drugs like decongestants, antihistaminics ( for cold, allergy) 

•      Have a healthy diet (diet rich in fresh fruits and vegetables)

•      Exercise regularly.

•      Pass urine when there is an urge (do not postpone).

•      Regular interval voiding (timed voiding)

•      Avoid cold exposure ( may aggravate symptoms/ retention of urine)