All about Benign Prostatic Hyperplasia (BPH)

The most common benign tumor that is found in men is characterized by the term Benign Prostatic Hyperplasia. To describe in simple words, it is an enlargement of the prostate cancer that is non-cancerous in nature. It tends to grow in Eastern countries more than the West. 

What is BPH (Benign Prostatic Hyperplasia)?

This condition is most commonly found in older men that are characterized by uncomfortable urinary symptoms like a blockage in the flow of urine, kidney, and urinary tract problems. Men who are younger than 65 years can also develop this condition. A recent study determined that there can be a genetic link to this. To be precise, there is a six-fold increase in risk under such circumstances.

Common symptoms are:

• Difficulty in urinating despite applying force

• Weak or interrupted urine stream

• Frequent urination 

• Not being able to empty the bladder fully

• Nocturia 

Treatment of Benign Prostatic Hyperplasia 

Proper screening and diagnosis will take place to determine the condition at first. The doctor will observe your urination and detect the abnormalities in the stream. The lower abdomen will also be checked to check for an enlarged bladder. With the help of the digital rectal exam, the size of the prostate gland will be determined. If any hard or firm areas are found on the gland, it can be taken as signs of prostate cancer. Apart from that, a urinalysis, urine culture, and PSA testing are also helpful. 

Different approaches to the treatment of BPH

• Watchful observation- Patients who have not yet developed severe BPH symptoms may opt for this form of therapy. Once a year, the patient needs to pay a visit to the doctor to check the progression of the disease. Avoid tranquilizers during this time. 

• Medication- Currently, there are two types of drug therapy for this condition- 5-alpha-reductase and alpha-adrenergic blockers. They have been seen to improve the symptoms in approximately 30-60% of patients. In the first case, the conversion of testosterone to dihydrotestosterone is blocked by the finasteride. It can also help to relieve symptoms. This therapy is continued at a stretch for 6 months.  In the alpha-adrenergic blockers drug therapy, high blood pressure is managed, the tension of smooth muscles in blood vessel walls is relieved, and the muscle tissues of the prostate gland are relaxed using medication. To name some of the most preferred drugs, we have Prazosin, Doxazosin, and Tamsulosin. Regularly using the drugs can alleviate symptoms and improve the urinary flow.  The patients can also be prescribed Phosphodiesterase-5 inhibitors in order to relax the smooth muscles of the prostate gland. 

• Surgery- In this case, the obstructing adenoma of the prostate is effectively removed or displaced. It is generally prescribed for men who have not shown improvements during medication therapy or have developed urinary retention over a certain span. The different options are monopolar and bipolar transurethral resection, simple robotic prostatectomy, bipolar transurethral vaporization and transurethral incision of the prostate, photoselective vaporization, thermal ablation, transurethral needle ablation, and so on. 

• Thermal Treatments: By utilizing convective heat transfer from a radiofrequency generator, the symptoms can be alleviated. TUNA or transurethral needle ablation of the prostate requires low energy radio waves from tiny needles at the tip of a catheter to heat up the prostatic tissue. You can also opt for a lesser invasive process called transurethral microwave therapy. Other than that, the water vapor thermal therapy is also proved to be quite effective that is used to convert thermal energy into water vapor to destroy the prostate cells. 

• Transurethral Incision- An instrument is passed through the urethra to perform this surgery. A couple of small cuts are made in the prostate with the help of an electrical knife that can ultimately relieve the pressure from the urethra. Note that it is only applicable to patients with a small prostate gland. Local anesthesia is preferred in this case. 

• Prostatic Urethral Lift- This procedure requires placing the UroLift implants into the prostate gland so that the prostate lobes are compressed, which would lead to the elimination of obstruction from the urethra. Doctors use a needle that passes through the prostate that helps to deliver the small metallic tab to the prostate capsule. After that, a suture is connected to the tab to perform the rest of the procedure. 

• Transurethral Prostatectomy- Also regarded as the "gold standard" of BPH treatment, this process has set the bar so high that all the other approaches are compared against this. The prostate's core is removed with a resectoscope that is passed through the urethra into the bladder. After removing the tissue, it also seals the blood vessels with an electric current. It is a painless procedure with very less recovery time, approximately 3 weeks. 

• Prostatectomy- A simple prostatectomy helps to remove the inner portion of the prostate. Medical professionals consider this to be the best way to treat this condition. It also offers the fastest recovery. However, it must be also be remembered that even though the obstruction can be removed, certain symptoms may prevail due to bladder abnormalities. 

• Open Prostatectomy- If the prostate is quite large and weighs around 80 grams or more, this process can be opted for. Note that it can lead to life-threatening complications, including cardiovascular conditions, excessive bleeding, pneumonia, blood clot in the lungs, etc. This form of surgery is considered to be way more extensive than TURP or TUIP. 

Conclusion 

It must be noted that the progression of this disease is highly unpredictable. Therefore, unless the patient experiences severely intolerable symptoms, the only form of treatment is watchful observation. Medication therapy is used to relieve the symptoms by decreasing the size of the prostate or relaxing the prostate muscle tissues, which would remove the urethral obstruction. 

Read:- Prostate cancer staging system