Benign Prostatic Hyperplasia, also called BPH, is when a person's prostate gland enlarges with age. Though it affects all men above 40, roughly 50 % need treatment at some point in their lives. Situated just below the bladder, the prostate gland is where the urethra passes. Therefore, enlargement of the gland leads to obstruction of the urethra and results in urinary issues. These include difficulty passing urine, waiting to start urination (hesitancy), giving a thin stream of urination, and straining to pass urine. Other issues include:
Urinating frequently and urgently.
Leaking a few drops of urine before reaching the toilet (incontinence).
Waking up from sleep to pass urine (nocturia).
Dr Nagasubramanyan S, a Consultant - Urologist and Transplant Surgeon at Manipal Hospital Jayanagar, says that all these issues may lead to complete blockage of urine and require emergency medical help.
Effects on Daily Life
These symptoms affect your daily life in different ways like difficulty sitting through meetings or work, embarrassment, and sleep disturbances leading to functional inefficiency during the day. BPH can also lead to complications like urinary retention when urine gets blocked. This complication results in urinary infection, stone formation in the bladder, and blood in the urine. Also, it may lead to hernia formation due to straining while passing urine and kidney failure due to prolonged obstruction. Due to the above reasons, BPH needs to be treated early.
Treatment of BPH includes lifestyle modifications cutting down on caffeinated beverages and alcohol intake, avoiding some medications, reducing fluids in the late evenings, passing urine frequently, and avoiding delaying or postponing urination. In addition, co-morbidities like diabetes and sleep disorders need to be treated to reduce symptoms.
Treatment For BPH
Apart from lifestyle modifications, drugs are available to manage BPH. These medications function by unwinding muscles in the prostate, thus easing out urination or reducing prostate size. A combination of these drugs is often used to get the above effects.
Surgical intervention is advocated when symptoms are severe due to a complete blockage of urine requiring a catheter to be inserted, failure of medications, or other complications (bladder stones, infection, renal failure, etc.). The standard treatment is Transurethral Resection of the Prostate (TURP) insertion of a telescopic instrument through the urinary passage (urethra).
However, other modifications of the above procedure exist where lasers are used to achieve the same purpose. Occasionally, surgical prostate removal by an open surgical approach is also undertaken.
Many minimally invasive procedures are also available Rezum, Prostatic Lift, prostatic hyperthermia, Aquablation, and Prostatic artery embolization, to name a few. Unfortunately, most of these procedures are new, expensive, industry-driven, and, at best, produce a reduction in symptoms.
Only after long-term results are known can doctors advocate these procedures to the general public, especially in our country where money is scarce in the health care industry.
Can BPH Lead To Cancer?
Benign Prostatic Hyperplasia does not turn into cancer. Prostate cancer is a separate disease, but it co-exists with BPH. Since the symptoms are similar, it requires efforts to diagnose prostate cancer early.
A high suspicion is needed to diagnose cancer of the prostate. Since it is one of the most common cancers in men, efforts are made to diagnose it early so it can be cured.
Therefore, men over 50 are usually screened for prostate cancer as part of their annual health check, at contact points with Urologists when they are present for any urinary complaints.
Also, men with prostate cancer family history are screened regularly and earlier than 50. Screening tests include S. PSA (Prostate Specific Antigen), DRE (Digital Rectal Examination), and, if needed, TRUS (Trans Rectal Ultra Sonography).
If any of these shows suspicious results, further investigations are done to diagnose the disease MRI, biopsy, etc.