What is Benign prostatic enlargement?

Benign Prostatic Hyperplasia (BPH), also known as benign prostatic enlargement, is a non-cancerous enlargement of the prostate gland. It is a common condition, particularly in older men, as the prostate tends to grow with age. This growth can lead to the compression of the urethra, the tube through which urine exits the bladder, causing urinary symptoms.

Benign prostatic enlargement condition is very common in men over the age of 50 years. It’s not a serious threat to health but it affects your quality of life more frequently.

The prostate gland is found only in men and it is located below the bladder and the urethra (urinary passage) runs through the prostate. It’s an important gland in the male reproductive system. It basically involves in the production of semen.

The prostate producers prosthetic fluid which is a thick white fluid. This fluid mixes with the sperm to create the semen.

It often enlarges after the age of 40 years. The enlarged prostate progressively squeezes the urethra and make urine flow difficult. This sometimes lead to weak or intermittent stream. It also leads to the bladder taking longer to empty the urine or not emptying completely. The continued growth of prostate could lead to loss of normal bladder function leading to acute urinary retention (AUR). Therefore common symptoms are difficulty starting urination, frequent need to pass urine and feeling of incomplete emptying of the bladder.

The symptoms may vary from individual to individual. Some men may require treatment but some with mild symptoms can be managed conservatively.

Enlarged prostate does not increase the risk of you developing prostate cancer.

What causes BPH?

While the exact cause of BPH is not fully understood, it is believed to be linked to hormonal changes that occur as men age. Two main factors that may contribute to the development of BPH include:

Dihydrotestosterone (DHT) Accumulation: DHT is a hormone derived from testosterone that plays a role in prostate growth. Some research suggests that an accumulation of DHT in the prostate could contribute to its enlargement over time.

Hormonal Changes: As men age, their levels of testosterone decrease while the levels of estrogen may remain the same or increase. This hormonal imbalance might lead to the enlargement of prostate cells.

Other common symptoms of benign prostatic enlargement

Benign prostatic enlargement (BPE) is a common condition affecting men, particularly as they age. While some individuals may remain asymptomatic, discovering the condition only during routine medical check-ups, others may experience noticeable symptoms. In more severe cases, men may even require emergency care due to acute urinary retention. Recognizing the early signs and symptoms of BPE is crucial for timely intervention. Here are some of the common symptoms associated with benign prostatic enlargement:

1. Difficulty Starting Urination

One of the hallmark symptoms of BPE is difficulty initiating the flow of urine. The enlarged prostate can press against the urethra, causing a blockage that makes it challenging for urine to pass. This symptom, often referred to as "hesitancy," can lead to prolonged periods of straining before urination begins.

2. Frequent Toilet Visits

Men with benign prostatic enlargement often experience increased urinary frequency. The enlarged prostate can interfere with the bladder's ability to empty completely, resulting in the need to urinate more often, including during the day and at night. This increased frequency can be both inconvenient and disruptive to daily activities, affecting overall quality of life.

3. Waking Up at Night to Urinate (Nocturia)

Nocturia, or waking up at night to urinate, is another common symptom of BPE. This occurs due to the incomplete emptying of the bladder, which leads to a build-up of urine that needs to be expelled, even during sleep. In severe cases, this frequent nighttime urination can cause sleep disturbances and fatigue. While nocturia is often associated with benign prostatic enlargement, it is important to consult a healthcare professional for proper evaluation.

4. Urgency

Men with BPE may experience a sudden, strong urge to urinate, often accompanied by the sensation of being unable to delay urination. This urgency can be distressing and lead to anxiety, particularly in situations where access to a bathroom is not immediately available. The cause of this urgency is the pressure exerted by the enlarged prostate on the bladder, which affects its normal function.

5. Terminal Dribbling and Incontinence

Terminal dribbling, or the leakage of small amounts of urine after completing urination, is another symptom commonly reported by those with benign prostatic enlargement. In some cases, this may progress to urinary incontinence, where individuals are unable to control the release of urine. This occurs because the enlarged prostate can obstruct the flow of urine, preventing the bladder from emptying completely and leading to residual urine leakage.

6. Weak Urine Stream

A weak urine stream is another characteristic symptom of BPE. The enlarged prostate can narrow the urethra, reducing the force of the urine stream. Men may notice a significant decrease in the speed and strength of urination, which can be frustrating and time-consuming. Addressing this symptom early can help manage the condition more effectively.

Why should BPH be treated?

Benign prostatic enlargement (BPE) is a condition that, if left untreated, can lead to various health complications. While some men may initially experience mild symptoms, the progressive nature of BPE can cause more severe issues over time. Here are some key reasons why early treatment is crucial:

1. Acute Urinary Retention Requiring Catheterization

One of the most immediate risks of untreated benign prostatic enlargement is acute urinary retention (AUR). AUR occurs when the prostate becomes so enlarged that it blocks the urethra, preventing urine from passing through. This blockage can cause sudden and painful difficulty in urinating, often requiring emergency intervention. In such cases, catheterization becomes necessary to drain the urine and relieve the pressure within the bladder.

2. Recurrent Urinary Tract Infections (UTIs)

An enlarged prostate can interfere with the bladder’s ability to empty fully. When urine remains stagnant in the bladder, it creates an environment conducive to bacterial growth, leading to recurrent urinary tract infections. These infections not only cause discomfort but can also affect overall health if they spread to the kidneys or bloodstream. Treating benign prostatic enlargement can reduce the risk of frequent UTIs and improve bladder function.

3. Formation of Bladder Stones

Chronic incomplete emptying of the bladder due to BPE can result in the formation of bladder stones. These stones develop from the minerals in stagnant urine, which crystallize over time. Bladder stones can cause additional symptoms, including pain during urination, blood in the urine, and frequent urination. In severe cases, they can exacerbate bladder dysfunction and further complicate urinary tract health.

4. Risk of Renal Failure

Untreated benign prostatic enlargement can eventually lead to serious kidney problems. Persistent urinary retention increases pressure within the urinary tract, affecting the kidneys' ability to function properly. Over time, this pressure can lead to hydronephrosis, a condition in which the kidneys become swollen due to urine accumulation. If left unaddressed, this can cause irreversible kidney damage and result in renal failure. Early treatment of BPE is essential to protect kidney health and prevent long-term complications.

How is BPH diagnosed?

During your visit to your urologist, there are certain test and questionnaire that might be done to confirm the diagnosis. Most often the diagnosis is confirmed by the history alone.

Your urologist might perform some urine tests and if required blood test. There might be a need to perform digital rectal examination to look for other associated pathology.

You might also need to use a uroflow meter to look at the flow rate. This results will be interpreted by your urologist. Click here to read a patient instruction sheet on uroflow in both Bahasa Malaysia and English.

Treatment options

Some individuals with very minimal symptoms can be managed conservatively, without any medication if your doctor feel so.

Most individuals require oral medication which is taken at night to relax the prostate and relieve the obstruction and improve symptoms. These medication has its own side-effects which will be explained to you by your urologist.

In certain individuals with enlarged glands there might be a need to start on dual medication, one to shrink the prostate and the other to relax the muscle.

Surgical options

Individuals who fail to respond to the medication or develop acute urinary retention, unable to tolerate the medication due to the side-effects, develop renal failure secondary to the obstruction, has recurrent urinary track infection, has a very high residual urine in the bladder require surgical intervention.

The surgical intervention basically involves enlarging the urinary passage within the prostate. The modality by which this is done varies from individual surgeons but the basic principle is the same.

Commonly done procedures are:

• TURP (transurethral resection of prostate) using monopolar or bipolar resectoscope
• Laser enucleation of prostate (HoLEP)
• Greenlight laser vaporisation

Side effects of alpha-blockers

• Dizziness (especially upon standing suddenly), vertigo, lightheadedness, fainting
• Heart palpitations
• Nasal congestion, stuffiness, sinusitis, runny nose, sore throat, cough, infection
• Headache, drowsiness, fatigue, weakness
• Fluid retention, edema, swollen hands or feet
• Urinary incontinence
• Back pain
• Digestive distress, heartburn, nausea, diarrhea
• Lower libido, abnormal ejaculation (reduced semen or retrograde ejaculation into the bladder)
• Prolonged and/or painful penile erections (priapism)
• Intraoperative Floppy Iris Syndrome (IFIS) [this can cause problems during cataract surgery!], blurred vision
• Rash, itching or hives [notify your doctor immediately!]

Conclusion

If you're experiencing symptoms of Benign Prostatic Hyperplasia (BPH), such as frequent urination, difficulty starting, or a weak urine stream, it's essential to consult a healthcare professional. Early diagnosis and treatment can help manage symptoms effectively and prevent potential complications. Don't wait – schedule an appointment with your doctor or a urology specialist today to discuss your concerns and find the right treatment plan for you. Taking action now can significantly improve your quality of life.