Benign Prostatic Hyperplasia (BPH) is a common condition in older men, characterized by the enlargement of the prostate gland. This enlargement can lead to urinary symptoms due to its location around the urethra.
Causes of BPH
- Aging: Most significant risk factor; prevalence increases with age.
- Hormonal Changes: Imbalances in hormones like testosterone and dihydrotestosterone (DHT) are implicated.
- Genetic Factors: Family history of BPH increases risk.
Diagnosis of BPH
- History
- Urinary Symptoms: Frequency, urgency, nocturia, weak stream, difficulty starting urination, dribbling at the end of urination, incomplete emptying of the bladder.
- Medical History: Previous urinary issues, surgeries, medication history, and presence of comorbid conditions like diabetes.
- International Prostate Symptom Score (IPSS): Questionnaire to assess the severity of symptoms.
- Physical Examination
- Digital Rectal Exam (DRE): Assess the size, texture, and symmetry of the prostate gland.
- Abdominal Examination: To check for bladder distention.
- Investigations
- Urinalysis: To rule out infection or hematuria.
- Serum Creatinine: To assess kidney function.
- Prostate-Specific Antigen (PSA): Elevated levels can be associated with BPH but also with prostate cancer.
- Uroflowmetry: Measures the volume and speed of urination.
- Postvoid Residual Volume Assessment: Using ultrasound to determine the amount of urine left in the bladder after urination.
Differential Diagnosis (DDx)
- Prostate Cancer: Can present with similar urinary symptoms.
- Urinary Tract Infection (UTI): Especially in cases presenting with dysuria.
- Overactive Bladder: Characterized by urinary urgency and frequency without prostate enlargement.
- Urethral Stricture: Narrowing of the urethra, leading to obstructive symptoms.
- Bladder Stones or Cancer: Can present with hematuria and irritative urinary symptoms.
- Neurological Disorders: Conditions like Parkinson’s disease or stroke can affect bladder function.
Management of BPH
- Lifestyle Modifications
- Fluid Management: Reducing fluid intake before bedtime.
- Dietary Changes: Avoiding caffeine and alcohol, which can worsen symptoms.
- Bladder Training: Timed voiding schedules to manage urgency.
- Medications
- Alpha-Blockers: Such as tamsulosin, to relax the muscles of the prostate and bladder neck, improving urine flow.
- 5-Alpha Reductase Inhibitors: Like finasteride and dutasteride, to reduce prostate size.
- Phosphodiesterase-5 Inhibitors: Such as tadalafil, for both BPH and erectile dysfunction.
- Combination Therapy: Alpha-blocker and 5-alpha reductase inhibitor for more severe cases.
- Surgical Treatments
- Transurethral Resection of the Prostate (TURP): Removal of a portion of the prostate through the urethra.
- Laser Therapy: To remove or shrink prostate tissue.
- Transurethral Incision of the Prostate (TUIP): Small cuts in the prostate to relieve pressure.
- Open or Robotic Prostatectomy: For very large prostates.
- Follow-Up and Monitoring
- Regular Follow-Up: To monitor symptoms and adjust treatment as needed.
- PSA Monitoring: Note that those on 5-alpha reductase inhibitors need to have their values multiplied by 2 for comparative level purposes
Conclusion
BPH management is personalized based on symptom severity, patient preference, and overall health status. It often starts with lifestyle modifications and medications, progressing to surgery if symptoms are severe or if there is evidence of complications like urinary retention or kidney damage. Coordination of care with a urologist is essential for optimal management.