Prostate Enlargement (BPH)

Causes

1. Aging: The most significant risk factor, as BPH is common in men over 50.

2. Hormonal Changes: Changes in the balance of sex hormones as men age.

3. Genetic Factors: Family history of BPH may increase the risk.

4. Lifestyle Factors: Obesity, lack of physical activity, and certain dietary factors may contribute to BPH.

Symptoms

• Frequent urination, especially at night (nocturia).

• Urgent need to urinate.

• Difficulty starting urination.

• Weak or interrupted urine stream.

• Dribbling at the end of urination.

• Inability to completely empty the bladder.

• Urinary retention (in severe cases).

Diagnosis

1. Medical History and Physical Examination:

   • Discuss symptoms and medical history.

   • Digital Rectal Exam (DRE) to feel the size and shape of the prostate.

2. Urinalysis:

   • Check for infection, blood, or other abnormalities in the urine.

3. Prostate-Specific Antigen (PSA) Test:

   • Measures PSA levels in the blood. Elevated levels can indicate BPH or prostate cancer.

4. Uroflowmetry:

   • Measures the strength and amount of urine flow.

5. Post-Void Residual Measurement:

   • Measures the amount of urine left in the bladder after urination using ultrasound.

6. Imaging Tests:

   • Ultrasound or MRI to assess the size of the prostate and rule out other conditions.

7. Cystoscopy:

   • A thin tube with a camera (cystoscope) is inserted into the urethra to visualize the prostate and bladder.

Treatment Options

The choice of treatment depends on the severity of symptoms, prostate size, patient’s age, and overall health.

1. Lifestyle Changes and Home Remedies:

   • Reducing fluid intake before bedtime.

   • Limiting caffeine and alcohol.

   • Regular physical activity.

   • Bladder training exercises.

2. Medications:

   • Alpha Blockers: Relax the muscles of the prostate and bladder neck to improve urine flow (e.g., tamsulosin, alfuzosin).

   • 5-Alpha Reductase Inhibitors: Shrink the prostate by blocking the hormone that causes prostate growth (e.g., finasteride, dutasteride).

   • Combination Therapy: Use of both alpha blockers and 5-alpha reductase inhibitors for more effective symptom relief.

3. Minimally Invasive Procedures:

   • Transurethral Microwave Thermotherapy (TUMT): Uses microwave energy to destroy excess prostate tissue.

   • Transurethral Needle Ablation (TUNA): Uses radiofrequency energy to destroy excess prostate tissue.

   • Prostatic Urethral Lift (PUL): Implants are used to lift and hold the enlarged prostate tissue away from the urethra.

4. Surgical Options:

   • Transurethral Resection of the Prostate (TURP): The most common surgery for BPH, involving the removal of part of the prostate.

   • Laser Surgery: Uses high-energy lasers to remove or vaporize excess prostate tissue (e.g., Holmium Laser Enucleation of the Prostate, or HoLEP).

   • Open or Robot-Assisted Prostatectomy: Removal of the prostate through an abdominal incision. Used for extremely large prostates or other complicating factors.

Post-Treatment Care

• Regular follow-up to monitor symptoms and prostate size.

• Managing and preventing complications such as infections or urinary retention.

• Medications may be prescribed to maintain symptom relief.

Complications

• Urinary retention.

• Bladder stones.

• Bladder damage.

• Kidney damage.

• Urinary tract infections.

• Blood in the urine after surgery.

Conclusion

Benign Prostatic Hyperplasia (BPH) is a common condition that can significantly impact the quality of life. Early diagnosis and appropriate treatment are essential for managing symptoms and preventing complications.

Dr. Saurabh Mishra and his team provide comprehensive care for patients with BPH, offering a range of treatment options tailored to individual needs to ensure the best possible outcomes.