Benign Prostatic Hyperplasia: Know more about the condition of an enlarged prostate

Dr. Vinay MH, Consultant – Urology, Manipal Hospital, Hebbal says, Benign Prostatic Hyperplasia (BPH) is a common condition among aging men, typically manifesting after 60 years of age, characterized by the enlargement of the walnut-shaped prostate gland which is present just below the bladder encircling the urine passage tube. This enlargement leads to various urinary symptoms, including slow or obstructed urine flow, dribbling, sensation of incomplete emptying, frequent urination day and night, intermittent flow, difficulty initiating urination, urgency, and in severe cases, lower abdominal pain accompanied by the inability to urinate, necessitating immediate intervention such as catheterization. Neglecting these symptoms may lead to recurrent urinary tract infections, bladder stone formation, and ultimately bladder and kidney weakness, potentially culminating in renal failure.

Factors exacerbating urinary symptoms include diuretic use for heart failure and hypertension, neurological conditions such as Parkinson’s disease or stroke, spinal cord disorders, and poorly controlled diabetes, which increases urine formation and may impair bladder sensation and contractility.

Diagnosis involves a digital rectal examination, uroflowmetry, abdominal ultrasound for prostate size evaluation, and possibly urodynamic study if neurological conditions are present, while treatment options vary.

Medical therapy primarily comprises:

·         Alpha blockers (Tamsulosin, Siladosin, Alfuzosin) – it relaxes the bladder neck muscle and prostate which helps in improving urinary flow.  Side effects include dizziness, retrograde ejaculation, exhaustion.

·         5 alpha reductase inhibitor – helps to shrink the prostate in large glands by about 15 %. Side effects include sexual dysfunction, breast soreness, and an increased risk of high-grade prostate cancer

·         Beta 2 agonist like mirabegron – helps to reduce urgency by relaxing the bladder

·         anticolinergics – solifenacin and others – relax the bladder and reduce urgency. Common side effects – dry mouth, constipation

·         combination therapy based on symptoms of patients

Surgical management is indicated for patients who do not respond to or cannot tolerate medical therapy, those with bladder stones, recurrent hematuria unresponsive to medical treatment, recurrent urinary retention, recurrent UTIs, and renal failure due to obstruction.

Advancements in Minimally Invasive Techniques for BPH

Recent interventions for BPH are primarily endoscopic and minimally invasive, including Transurethral Resection of the Prostate (TURP), Transurethral Incision of the Prostate, various types of Prostate Enucleation using laser technologies such as holmium, diode, or thulium. Holmium Laser Enucleation of the Prostate (HoLEP) is notable for its applicability to large prostates and safety in patients on blood thinners. Other minimally invasive methods include Prostate Artery Embolization, Urolift, or prostate stent placement, Water Vapor Thermal Infusion (Rezum), and Transurethral Microwave Thermotherapy.

 

Dr. Shrinivas R P, Consultant – Urology, Manipal Hospital Whitefield says

The prostate is a normal gland present in all men from birth. However, the gland begins to enlarge as we reach around the age of 50, similar to the graying of hair or the development of cataracts in the eyes. This enlargement is typically age-related and is a natural part of the aging process.

Generally, this enlargement is not life-threatening or organ-threatening. This common condition is called to as benign prostatic hyperplasia, which is a noncancerous age-related enlargement. Despite being age-related, it can sometimes obstruct urinary flow as it is part of the urinary and genital system. This can also lead to various problems such as infections, blood in the urine, complete blockage of urination, urinary bladder stones, kidney dysfunction, and bladder abnormalities such as an overactive bladder, frequent urination, or urinary leakage.

These conditions are detected during routine health check-ups, and treatment is initiated accordingly. The first line of treatment involves drug therapy, which provides long-lasting relief. In some cases, surgery may be required. Various surgical options are available, with endoscopic surgery, one of which is TURP (Transurethral resection of the prostate), which is being performed routinely. Advances in surgical techniques have made this procedure relatively easier for older men. We should be aware that prostate enlargement is a part of aging, which can be easily managed if detected and treated.