BENIGN PROSTATIC HYPERPLASIA
Benign Prostatic Hyperplasia (BPH) – Detailed Overview
A nonmalignant growth of the prostate tissue, benign prostatic hyperplasia (BPH), is known to cause a variety of symptoms in the lower urinary tract in men.
In a similar fashion to many other health conditions in men, BPH becomes increasingly common as men age.
Roughly 50% to 60% of males in their 60s encounter BPH, and this figure goes to 90% to 90% of men that are 70 or older.
There are various terms to describe BPH, but it’s characterized by the proliferation of epithelial and stromal cells in the prostate transition zone. This health complication leads to compression in the urethra and bladder outlet obstruction.
BPH can be rather complex, and this article will highlight causes, symptoms, and everything men should know about the health condition to help preserve their health as they age.
Learning the Basics of BPH
Some of the primary health concerns related to BPH include lower urinary tract issues, increased risk for bladder infections, and complications with urinary retention. When left untreated, BPH can develop chronic high-pressure retention.
This also includes long-term issues with the function of the bladder detrusor.
Common treatment routes for benign prostatic hyperplasia include:
- Medical interventions
- Surgical interventions
- Watchful waiting in some cases
These are a handful of the common risks factors associated with BPH:
To get a thorough understanding of what’s required when trying to manage BPH, it’s important to look at etiology, recognition, interprofessional collaboration, and many other factors.
The next section will provide a more thorough look at the causes and risk factors that come with BPH.
Understanding the Causes and Potential Risks
Primary causes of BPH tend to come from the hormonal effects of testosterone, but this is far from the only potential cause.
Testicular androgens play an essential role in the development of BPH. This is possible through interacting with prostatic stroma and epithelium.
The occurrence of BPH happens due to an imbalance between cell death and cellular proliferation.
When this happens within the body, it generates increased numbers of stromal and epithelial cells in the periurethral area of the prostate.
Aside from that, genetic factors can play a part in increased risks, in addition to metabolic syndrome, hypertension, and obesity.
Below, you can find a brief highlight on how genetic predisposition, metabolic syndrome, and obesity can affect the development of BPH.
When it comes to first-degree relatives, research shows these individuals can have a four-fold increase in the risk of developing BPH. This research also holds up in twin studies.
Although it may not pose a guarantee for the development of BPH, it’s something that should be considered if patients have a close relative with BPH.
This topic covers multiple factors, such as glucose intolerance, dyslipidemia, and hypertension. Individuals who deal with metabolic syndrome have been shown to encounter much higher prostate volumes.
Although further studies are needed to understand this correlation in more detail, there is a known link between those with metabolic syndrome and the prevalence of BPH.
Considering obesity makes up an aspect of metabolic syndrome, experts have determined that obesity can lead to BPH.
It should also be highlighted that obesity is multifactorial in nature and comes with a variety of unique health concerns.
Nevertheless, increased levels of systemic inflammation and levels of estrogens can pose a risk for the development of benign prostatic hyperplasia.
The examination and treatment of BPH are pretty complex, but thankfully, numerous solutions can provide substantial aid in the short and long term.
What each patient goes through regarding this process is likely to be unique and structured around the current state of their health condition.
Evaluating and Treating BPH
A general approach for examining BPH includes looking at external genitalia, an abdominal exam, and a digital rectal exam.
The rectal exam is to determine the shape, size, and consistency of the prostate.
Patients can also expect to encounter a urine dipstick test, which helps to rule out other causes, such as assessing bladder emptying and infection. This also includes checking the International Prostate Symptom Score (IPSS) and a chart to quantify symptoms centered around frequency volume.
Other evaluations included when checking for BPH include:
- Metabolic disorders
- Various blood tests
- Prostate-specific antigen testing
Ultrasound is also commonly used, and this assessment is used to search for urinary tract stones and hydronephrosis and investigate hematuria. In regard to urodynamic studies, this is used to determine the filling and emptying of the bladder.
Doctors will look toward this test if they suspect a neurogenic or overactive bladder in the patient.
One or more of these evaluation methods may be considered to help determine an accurate diagnosis. The findings will lead to the treatment options available to the patient, which can be pretty vast in their own right.
What Diagnosis Can Look Like
There are several diagnoses that can act as a direct cause or even precursor to BPH. Below is a general list of common diagnoses that are a part of benign prostatic hyperplasia in many different patients.
Conditions that pose a cause for immediate concern include:
- Cauda equina
- High-pressure chronic retention
- Bladder and/or prostate cancer
Here are a few other conditions that could be related to BPH:
- Urinary tract stones
- Urethral stricture
- Urinary tract infections
- Neurogenic bladder
If any of these conditions are part of a patient’s diagnosis, the doctor will likely move forward with determining the existence of BPH. At this point, various treatment and management options will be explored for the patient to take a proactive stance on the health condition.
Treatment Options for BPH
More than one solution may need to be utilized to help manage the existence and symptoms related to BPH. Medical aspects such as observation, surgical interventions, and medical therapy may be required.
Observation may sound vague, but this solution includes a plethora of lifestyle advice.
Changes such as weight loss, water intake, avoiding constipation, and reducing caffeine intake are all primary examples. In more extreme cases, surgical intervention can be explored from multiple angles.
Some examples of surgical intervention include:
- Recurrent infections
- Refractory urinary retention
- Eliminating bladder stones
- Renal insufficiency
- And more
Benefits that arise from surgical intervention can include a reduction in post-void residual, improved flow rate, and overall improvement in BPH symptoms.
Medical therapy is an option that many doctors and patients prefer due to its bioavailability, efficacy, and relatively simple application.
Through administering tolterodine or solifenacin, patients can alleviate symptoms of an overactive bladder. This can be accomplished by reducing smooth muscle tone and is a decent solution for short or long-term treatment.
5 Alpha-Reductase Inhibitors
Some common inhibitors used for this particular health condition are dutasteride and finasteride. After administration, these inhibitors can reduce the prostate, but it can take weeks for any noticeable improvement to be seen.
It’s also common for doctors to look into combination therapy which utilizes multiple solutions to tackle the symptoms of BPH. Patients can expect doctors to take the path of least resistance, but numerous health factors play into which treatment is utilized.
Although surgery may be needed, some people may not be candidates for such treatment options.
What are the Most Common Surgical Options?
In more serious cases, surgical treatment might be the only effective path available. Thanks to modern medicine, patients and doctors have multiple surgical solutions to discuss regarding the treatment and management of BPH.
Holmium Laser Enucleation of the Prostate
Laser enucleation of the prostate comes with a few benefits. Lower transfusion rate, improved flow rate, and reduction in post-void residual are common. The limitations regarding this surgery may include very specialized equipment, which might not be available everywhere.
Transurethral resection surgery (TURP) focuses on a debulking of the prostate. This process helps to create a sufficient channel for urine to flow successfully and without obstruction.
It should be mentioned that this particular surgery will likely only be used if a patient is dealing with a prostate obstruction.
This is a great alternative surgery to more invasive procedures. Aurolift includes compressing the lobes of the prostate, which widens the channels in the prostatic urethra.
Overall, the surgery ends up improving lower urinary tract symptoms and helps to preserve sexual function. It’s an effective treatment solution for individuals dealing with an enlarged prostate, which is correlated to symptoms stemming from BPH.
BPH is a pretty convoluted health condition that can lead to many mild and serious health concerns. It’s no secret that speaking with a doctor should be the first step, but it could come with a drawn-out journey to healing the body.
Although this is true, it’s a medical condition that can be treated successfully and comes with multiple routes that are equally or more effective than the next.