Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BHP) is a non malignant increase in the size of the prostate gland. This gland is found only in men and is situated under the bladder where it surrounds the urethra. Normally the prostrate is about the size of a chestnut. The prostate produces the seminal fluid in which the sperm are carried to form semen.

Most men will have some form of increase in the size of the prostate gland as they age. As the growth increases it can cause pressure on the urethra and impede the flow of urine. It is estimated that thirty percent of men over the age of seventy have symptoms associated with BHP.

There are a number of symptoms of BHP and men may experience any or all or none of them.

* The urine stream may be weak or interrupted so it takes a number of attempts to empty the bladder.

* Having finished urination the patient may still feel as if the bladder is full.

* The frequency of urination particularly at night is increased. This may be combined with urgency which is the need to urinate immediately.

* It is sometimes difficult for the patient to start urinating even if the bladder is full.

* The patient may find that a small amount of urine dribbles out after urination has finished.

* There may be pain or a burning feeling during urination.

These symptoms are not diagnostic of BHP as other medical conditions can cause the same symptoms. Men experiencing these symptoms should consult a doctor.

A doctor will have to take a medical history and complete a thorough examination combined with laboratory tests to confirm a diagnosis. This will require a digital rectal examination to assess the size of the prostate, a urine test to see if there is any infection and a blood test for kidney function and prostate specific antigen. Other tests such as X-rays or an ultrasound may also be required to confirm the diagnosis.

Once a diagnosis of BHP has been confirmed then treatment options may be discussed. If the symptoms are mild then often the best option is no treatment at all.

There are some drugs suitable for treating BHP but they do have some side effects. Drugs do not work in every case of BHP. They do not cure the condition but may alleviate the symptoms.

Alpha blockers can relax the muscle fibers within the prostate gland so allowing the free flow of urine. These can cause retrograde ejaculation, headaches, dizziness and drowsiness. Examples of alpha blockers used in BHP treatment are terazosin (Hytrin) and tamsulosin (Flomax MR).

Drugs such as finasteride (Proscar) are 5-alpha-reductase inhibitors. These will inhibit the growth of the prostate and decrease its size. Side effects are mild but they may adversely affect sexual function.

There are some over the counter herbal remedies that are sold to aid BHP. Of these there is some scientific evidence that saw palmetto and beta-sitosterol plant extracts or rye grass pollen extract may be useful in the condition. Again they may not be suitable for all cases. They may also cause unpleasant side effects.

Where drug treatment does not alleviate the symptoms surgery may be necessary. This carries a greater risk than medical intervention.

When the prostate is slightly enlarged an operation to slit the prostate may be sufficient. This is called a transurethral incision (TUI).

In more enlarged cases removal of some of the prostate tissue may be required. This is called a transurethral resection of the prostate (TURP).

Complications following such surgeries include retrograde ejaculation, erectile dysfunction and urinary incontinence. As some of the prostate gland is still present it continues to grow and repeat surgeries may be necessary.

There are some newer procedures that are still being evaluated. These procedures are microwave thermotherapy, electro-vaporization and laser resection.

Where drugs do not work and surgery is not an option then the patient may need catheterization.  Some patients will have a catheter permanently inserted either via the urethra or directly into the bladder via the abdominal wall. Others may be able to self catheterize as required. Catheters carry an increased risk of urinary tract infections.

There are some complications with BHP that some patients may experience.

Occasionally the prostate enlargement may cause acute retention where the man is unable to urinate at all. In such cases prompt medical intervention is required or kidney damage may result. Between one and two percent of BHP cases will have this type of complication.

Chronic retention is another complication which can arise this is cause by incomplete bladder emptying. This may give rise to urinary tract infections.

References:

Nutritional supplements health guide http://www.nutritional-supplements-health-guide.com/saw-palmetto-side-effects.html

Family doctor.org http://familydoctor.org/online/famdocen/home/men/prostate/148.html

NHS Centre for Reviews and Dissemination. Benign Prostatic Hyperplasia. Effective Healthcare Bulletin, December 1995.