What is Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) also called prostate gland enlargement is a common condition; seen in men as they get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine from the urinary bladder. It can also cause urinary bladder, urinary tract or kidney problems.

Symptoms:

The severity of symptoms in people who have BPH varies; but the symptoms tend to gradually worsen over time.

Common signs & symptoms of BPH include:

• Frequent or urgent need to urinate
• Increased frequency of urination at night (nocturia)
• Difficulty starting urination
• Weak urine stream or a stream that stops & starts
• Dribbling (dripping) at the end of urination
• Inability to completely empty the bladder

Less common signs & symptoms include:

• Urinary tract infection
• Inability to urinate
• Blood in the urine

Causes:

The prostate gland is located beneath the urinary bladder. The tube that transports urine from the urinary bladder out of the penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout their life. In many men, this continued growth enlarges the prostate; enough to cause urinary symptoms or to significantly block urine flow. It isn't entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones; as men grow older.

Risk Factors:

Risk factors for BPH include:

• Aging: BPH rarely causes signs & symptoms in men younger than age 40. It ranges in prevalence from over 50% at 60 years of age to as high as 90% by 85 years of age.
• Family History: Having a blood relative with prostate problems makes one more likely to have similar problems in future.
• Diabetes & Heart Disease: Studies have shown that diabetes as well as heart disease & the use of beta blockers; might increase the risk of BPH.
• Lifestyle: Obesity increases the risk of BPH while exercise can lower its risk.

Complications:

Complications of an enlarged prostate can include:

• Sudden inability to urinate (urinary retention): One might need to have a tube (catheter) inserted into his bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
• Lower Urinary Tract Symptoms/ Infections (LUTS): Inability to fully empty the bladder can increase the risk of infection in the urinary tract. If UTIs occur frequently, one might need surgery to remove part of the prostate.
• Bladder Stones: These are generally caused by an inability to completely empty the urinary bladder.
• Bladder stones can cause infection, bladder irritation, blood in the urine & obstruction of urine flow.
• Bladder Damage: A bladder that hasn't emptied completely can stretch & weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty it.
• Kidney Damage: Pressure in the urinary bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys. Elderly people with nocturia (increased frequency of urination at night) are at great risk for bone fracture & mortality. Although BPH is not a life threatening disease; it significantly affects in different ways the quality of life of patients suffering from it. The impairment in quality of life of BPH patients is mainly because of sleep disturbance due to nocturia, disruption of social life due to urinary frequency, psychological burden due to urgency & fear of prostate cancer. Thus, prevention & treatment of BPH is expected to improve the quality of life.

Pathogenesis of BPH:

Two enzymes are involved in the overgrowth of prostate tissue. One of these enzymes is called aromatase, which converts testosterone to estradiol. Men with the greater estradiol concentration have 1.78 times higher incidence of urinary tract symptoms. The other enzyme is called 5-alpha reductase which converts testosterone to dihydrotestosterone.

By inhibiting the production of dihydrotestosterone (DHT) locally within the prostate gland; 5 alpha-reductase inhibitors have the effect of reducing prostate volume. Thereby, , improving lower urinary tract symptoms, increasing peak urinary flow & decreasing the risk of acute urinary retention and need for surgical intervention.