What is Benign Prostatic Hyperplasia (BPH), Anyways?
Benign prostatic hyperplasia or BPH, also known as prostate gland enlargement, is a fairly common condition that affects men as they get older.
What is the prostate gland & what does it do?
The prostate is a gland that forms part of the male reproductive system. It is situated at the apex of the bladder and surrounds part of the urethra.
This hollow tube is responsible for producing and transporting seminal fluid that mixes with the sperm produced by the testes.
What is benign prostatic hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH), commonly referred to as prostate gland enlargement, is a very common condition in males. It is caused by enhanced proliferation or growth of the smooth muscle and epithelial cells of the prostate gland.
BPH is more likely to occur in men 50 and older and becomes more prevalent as one ages.
Prostate enlargement can cause lower urinary tract symptoms (LUTS) due to its close relationship with the urethra.
Is this growth a form of cancer?
BPH is a benign condition, meaning it is non-cancerous.
Despite what many people may think, having BPH does not increase the risk of developing prostate cancer. However, prior to treatment of BPH symptoms, men should receive prostate cancer screenings.
Is benign prostatic hyperplasia (BPH) hereditary?
There has been some evidence that the occurrence of BPH has a genetic component.
One study found that the relatives of men who had enlarged prostates below the age of 65 were four times more likely to require BPH surgery than those without, and their brothers had a six-fold increase increase in risk.
This conclusion suggests that benign prostatic hyperplasia could be, in the least partially, linked to hereditary factors.
However, there are several lifestyle factors that appear to increase the risk of BPH development including aging, heart disease, diabetes and obesity.
What are the major symptoms of prostate gland enlargement?
Symptoms of prostate gland enlargement can vary in severity depending on the prostate size and relationship of the growth to the urethra. The gland compresses the urethra and causes lower urinary tract symptoms or LUTS.
These symptoms include:
- Increased frequency of urination, particularly at night (nocturia)
- Difficulty initiating urination
- Weak urination stream
- Inability to completely empty the bladder
- Inability to urinate requiring a foley catheter
- Blood in the urine
What are the treatment options for BPH?
Those with mild symptoms may not require treatment; however, other more serious cases can be treated with medications.
Common medications prescribed for BPH include 5-alpha reductase inhibitors, such as Finasteride, and alpha blockers, such as Tamsulosin. The 5-alpha reductase inhibitors reduce the production of dihydrotestosterone (DHT) which helps reduce the growth of the prostate gland. The alpha blocker relaxes the muscles in the prostate, thereby reducing tension on the urethra.
The associated side effects of these treatments include dizziness, weakness, low blood pressure and retrograde ejaculation.
Those with severe benign prostatic hyperplasia symptoms, which don’t respond to medical therapy, may require surgery or a procedure called prostate artery embolization to shrink the prostate gland size.
What is prostate artery embolization?
Prostate artery embolization (PAE) is a minimally-invasive technique where a small catheter is inserted into an artery in the wrist or the upper thigh in the groin.
Under x-ray guidance, the catheter is advanced into the arteries supplying the prostate gland. Tiny beads are delivered within the arteries that bring blood to the prostate.
Thus, blood flow to the prostate is then slowed, causing the prostate to shrink over a period of weeks. The procedure can be performed under mild sedation or even general anesthesia.
What are the surgical options for benign prostatic hyperplasia?
Common surgical options for BPH include:
-
Transurethral resection of the prostate (shortened to TURP)
- Procedure: the tissue that is blocking the urethra is removed using a precise surgical instrument. TURP can lead to bleeding, potential infection, inability to control urination, inability to maintain erection, and retrograde ejaculation.
-
Transurethral incision of the prostate (shortened to TUIP)
- Procedure: this involves making two small cuts in the prostate and in the neck of the bladder, where the urethra and the bladder join. This is used to restore a good flow through the urethra once again.
-
Transurethral electrovaporization
- Procedure: this uses electrical energy to heat the prostate tissue. This converts the cells into steam, enabling the surgeon to remove the enlarged tissue and unblock the urethra. This can lead to similar side effects as those listed for TURP.
-
GreenLight Laser Therapy
- Procedure: this involves the use of a laser to cut through the enlarged prostate tissue so the surgeon can safely remove it.
-
Prostate ureteral lift and water vapor therapy
- Procedure: the prostate tissue is ablated using the thermal energy of radiofrequency-generated water vapor (~103°C)
Have any questions about benign prostatic hyperplasia or want to schedule an appointment? Contact us today to reach our team.
Edited by Dr. Raymond Melikian, MD.
References
https://pubmed.ncbi.nlm.nih.gov/7515446/
https://emedicine.medscape.com/article/437359-overview
https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-enlargement-bph
https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)
https://pubmed.ncbi.nlm.nih.gov/17509841/
Malling B, Røder MA, Brasso K, Forman J, Taudorf M, Lönn L. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol. 2019 Jan;29(1):287-298. doi: 10.1007/s00330-018-5564-2. Epub 2018 Jun 14. PMID: 29948079.