BPH (Enlarged Prostate): Diagnosis and Treatment

BPH – Benign prostatic hyperplasia (BPH) causes the prostate to grow in size. It is the most prevalent prostate condition in males and persons born male, and it affects practically everyone as they become older. Symptoms include difficulties urinating and an urgent desire to urinate. Medication, surgery, & minimally invasive techniques are all used to treat the condition.

What is an enlarged prostate (BPH)?

The prostate is a gland found in the male reproductive system. It lies immediately under the bladder. It produces fluid which is a part of sperm. An enlarged prostate occurs when your prostate gland grows bigger than usual. It is also known as benign prostatic hyperplasia or BPH for abbreviation. Benign means not cancerous. And hyperplasia denotes excessive cell growth. BPH is not cancer, and it does not raise the chance of developing prostate cancer.

The prostate is a gland that normally continues to expand throughout life. This development frequently enlarges the prostate sufficiently to induce discomfort or prevent urine flow. It is unclear what causes the prostate to grow. It might be linked to alterations in the balance of sex hormones as you get older.

How BPH is Diagnosed?

Prior to anything else, your doctor will discuss with you the medical history of you and your family. Another option is to complete a survey by providing information about your symptoms and how they impact your day-to-day life.

Following that, your doctor will perform a physical examination. This may involve a digital rectal examination. In order to assess the size and form of your prostate, they will put on a glove and carefully enter one finger into your rectum.

Basic tests: The following are some basic tests that can help to diagnose.

Blood testing to detect kidney issues
Urine testing to search for infections or other disorders that may be causing your symptoms.
PSA (Prostate-specific Antigen) blood test. High PSA readings may indicate a larger-than-usual prostate. A doctor can also order it to check for prostate cancer.

Advanced testing: Depending on the findings of those tests, your doctor may request more tests to rule out other issues or to better understand what is going on. These may include:

Different forms of ultrasonography are used to assess your prostate and determine if it is healthy.
A bladder ultrasonography to assess your level of bladder emptying.
A biopsy is performed to rule out cancer.
Urine flow test to determine the strength of your stream and the amount of urine you produce.
Urodynamics testing to assess bladder function.
Cystourethroscopy is a camera-based technique that examines the prostate, urethra, and bladder.

They could also inquire about any drugs you are taking that could have an impact on your urinary system, like:

antidepressants
diuretics
antihistamines
sedatives

Your healthcare provider can alter your medication as needed. Do not attempt to modify your medications or dosages on your own.

Management and Treatment of BPH

There is no cure for BPH. However, there are therapy alternatives available to assist you manage your symptoms. If your symptoms are minimal, you may not need any therapy. Your doctor may propose a “watchful waiting” strategy, in which you arrange regular checkups to ensure that your BPH does not worsen. The following are the treatment options for BPH.

Medications

The most typically recommended drugs relax the muscle of the prostate, relieving stress on your urethra. The following are the same:

Tamsulosin (Flomax)
Terazosin (Hytrin)
Doxazosin (Cardura)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)

Some drugs reduce DHT production, slowing prostate gland development. These drugs are most effective for persons with bigger prostates. Here are several examples:

Finasteride (Proscar)
Dutasteride (Avodart)

Your healthcare practitioner may recommend a combination of drugs to address your symptoms and enhance your urine flow.

Surgery

Prostate tissue that is blocking your urethra can be removed using a variety of surgical procedures. This includes:

Transurethral resection of the prostate (TURP): With the use of a specialized tool called a resectoscope, a urologist can see into and remove prostate tissue via the urethra.
Transurethral incision of the prostate (TUIP): To enlarge your urethra and enhance urine flow, your urologist makes two tiny incisions in your prostate and the bladder neck, which is where your urethra and bladder join.
Transurethral electrovaporization: Your urologist will heat the tissue in your prostate using an electrode. This produces steam from the tissue cells in the prostate’s swollen regions.
GreenLight laser treatment: Your urologist will use a special laser to remove the tissue surrounding your enlarged prostate. Prostate photovaporization as well as photoselective vaporization of the prostate (PVP) are other terms for GreenLight laser therapy.
Aquablation: Prostate tissue is removed by your urologist using precision, high-pressure water jets.

It usually takes a few days or a week following surgery for you to get back to your regular activities.

Minimally invasive treatments

The new BPH therapies are less intrusive and harmful to healthy tissue than surgery. In general, most of these therapies are outpatient operations, which means you may return home the same day. They are also less expensive, have less side effects, and allow for quicker recovery. However, because these procedures are new, there is limited evidence on their long-term consequences or problems.

Prostatic urethral lift:
This treatment separates the enlarged prostate lobes, widening your urethra and making it simpler to urinate. Your urologist inserts a specialized device (UroLift®) into the urethra & up to the prostate gland. Your urethra is opened and your prostate lobes are pulled apart by tiny implants that the UroLift ejects when it hits the side wall of the prostate. As per the size of prostate, urologist may insert between 02 – 06 implants.

Rezūm therapy:
Your urologist puts a tool into your urethra and guides it to your prostate. After that, a needle is inserted into your prostate. The needle produces steam vapor, which eventually converts into water. The heat energy of water damages prostate cells. Your prostate contracts as a result of your body reabsorbing the dead cells.

The most typical negative effects of these therapies include increased urine production and pain or irritation as the prostate recovers.

A note from kamarth

A relatively frequent illness affecting those designated male at birth is benign prostatic hyperplasia (AMAB). BPH often appears at age 55. You and your doctor may decide to schedule routine checkups to track your symptoms if you have moderate BPH. Treatments can help reduce the size of your prostate if BPH is affecting your quality of life. If you feel that you may have BPH, consult your doctor. You may talk about the best course of action together.

Some Additional Doubts

Question: What’s the purpose of the prostate?
Answer: In males, the prostate is a tiny gland that lies immediately behind the bladder. Its major role is to create fluid to nourish and preserve sperm. The prostate gland also controls the flow of urine.

Question: How do you find your prostate to perform a self-exam?
Answer: After cleaning your hands, put a little quantity of water-based lubricant on your gloved index finger and feel comfortable. Only a maximum of 2 inches (5 cm) or your second knuckle should be inserted with your finger. A few inches within your rectum, towards your belly button, is where the prostate gland is situated. It should feel like a little, smooth, spherical lump around the size of a walnut.

Question: What are the early signs of an underlying prostate condition?
Answer: Changes in sexual and urinal behaviors are common early indications, however, they might vary based on the particular illness.

Question: Is BPH the same as prostate cancer?
Answer: BPH and prostate cancer do not have similar symptoms. Prostate cancer is nearly invariably asymptomatic and can be discovered by either an increased PSA level or a prostate nodule. It is also a more severe problem than BPH. Your healthcare expert can conduct tests to ensure that your symptoms are not caused by prostate cancer.

Question: What is the first test for BPH?
Answer: Urinalysis, IPSS or AUA symptom score, DRE, PVR measurement, and urine flow investigations to determine whether obstructive or irritative voiding is present are standard procedures for investigating BPH. Depending on the patient’s history and these findings, more testing could be necessary.

Reference Links:
https://medlineplus.gov/ency/article/000381.htm#
https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/enlarged-prostate-benign-prostatic-hyperplasia
https://www.researchgate.net/publication/272771547_BENIGN_PROSTATIC_HYPERPLASIA_UPDATED_REVIEW#
https://www.urologyhealth.org/documents/Product-Store/English/Benign-Prostatic-Hyperplasia-Patient-Guide.pdf
https://medlineplus.gov/enlargedprostatebph.html
https://www.webmd.com/men/prostate-enlargement-bph/what-is-bph
https://pubmed.ncbi.nlm.nih.gov/9628595/
https://www.healthline.com/health/enlarged-prostate
https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia

BPH (Enlarged Prostate): Diagnosis and Treatment

Table of Contents