Benign Prostate Hyperplasia
Overview
Benign prostate hyperplasia (BPH) is a common non-cancerous condition found in aging men. It commonly causes lower urinary tract symptoms, and it is associated with bladder obstruction (poor and slow urine flow). The prevalence of the disease increases as men advance in age. In fact, the histological prevalence of BPH is as high as 50% to 60% for men in their 60’s, increasing to 80% to 90% of those over 70 years old.
A wide variety of risk factors can cause BPH in addition to the effect testosterone has on the prostate. Although testosterone does not cause BPH, it is essential for BPH to develop. Other risk factors include obesity, a family history of BPH, and metabolic syndromes including hypertension, dyslipidemia (high cholesterol), and glucose intolerance / insulin resistance.
Diagnosis
Symptoms of an enlarged prostate include:
- Finding it difficult to start peeing.
- Straining to pee.
- Having a weak flow of urine.
- “Stop-start” peeing.
- Needing to pee urgently and / or frequently.
- Needing to get up frequently in the night to pee.
- Accidentally leaking urine (urinary incontinence).
If you’re experiencing any of these symptoms, consult one of our specialists who can advise you on what should be done next.
When diagnosing BPH, it’s important to rule out any other underlying causes of your symptoms. This process may include:
- Blood tests, including kidney function tests, which are used to establish your baseline renal function.
- Urine tests, which can detect infection, non-visible haematuria, or metabolic disorders (increased sugar levels in the urine).
- Ultrasound scans, which are used to look for evidence of dilated kidneys (hydronephrosis). Urine flow studies are used to determine the volume of urine passed over time. An ultrasound can help determine whether there is anything causing the obstruction.
- Urodynamics studies can also be performed in cases that warrant further investigation.
- Flexible cystoscopy should be used to investigate symptoms of poor urine flow which might be caused by an enlarged prostatic gland or by urethral strictures.
- The prostate-specific antigen (PSA) blood test should not be done routinely when investigating an enlarged prostate. Levels may be raised from a large range of conditions (large prostate, infection, catheterization, prostate cancer) and can cause undue anxiety or lead to further unnecessary investigations.
Treatment
Men with BPH may present with urinary retention, meaning the inability to urinate. This requires urgent medical attention.
If you’re experiencing bothersome symptoms, there are various treatment options ranging from watchful waiting to medical and surgical intervention. The treatment you and your medical team decide on will depend on how much BPH is influencing your day-to-day life. This is assessed through questionnaires such as the IPSS.
Observation: Watchful waiting involves managing or improving your symptoms through lifestyle changes. These may include weight loss, reducing caffeine intake or reducing fluid intake in the evening, and avoiding constipation by maintaining a healthy diet. This also involves intermittent checkups with your medical team to monitor your condition.
Medical Therapy: This involves treating your symptoms through medication. Your medical team will share information about the different options, their effects, and side-effects, and will recommend medication if they feel it is appropriate for your case. They will then continue to monitor your condition and evaluate how effective the specific medication is. If it isn’t working, or causes undesirable side-effects, they may recommend changes in type, frequency or dosage.
Surgery: Surgical management of BPH has broadened significantly over the years, with the development of further minimally invasive techniques (Urolift, Rezum). If surgical intervention is appropriate for your case, your medical team will discuss your options in detail.
TURP: Transurethral resection surgery focuses on debulking the prostate to allow enough urine to flow freely through the urethra. This is achieved using diathermy, which produces a high-frequency current that allows tissue to be cut. By resecting all obstructing prostatic tissue, an adequate channel is created through which urine can flow. Bipolar diathermy (TURis) has largely replaced monopolar diathermy techniques for TURP.
HoLEP: Previously, open prostatectomy allowed any adenoma to be removed or enucleated off its capsule. This can now be achieved through laser enucleation, referred to as HoLEP (Holmium laser enucleation of the prostate).
Urolift: Tissue-sparing approaches, such as Urolift, have also been developed recently. These can help minimize the risk of bleeding in patients with co-morbidities and decrease the associated risks of more invasive surgery (such as risks from anesthesia, prolonged surgery time, etc.). By compressing the prostate lobes, the channel can be widened in the prostatic urethra, improving symptoms.
Rezum: This new technology “boils” the prostate from within the urethra securing the formation of a channel through which the bladder can be emptied within a few days to weeks.
Green light LASER vaporization: Green light laser surgery destroys the obstructive part of the prostate by vaporizing it (turning it into smoke) and leaving an empty cavity, which allows the bladder to be emptied normally.
Why GMI
At the GMI, we have a state-of-the-art facility for patients affected by prostate diseases, which includes our Prostate Cancer Center. At the GMI Prostate Cancer Center the departments of Radiology, Nuclear Medicine and Pathology apply the most modern diagnostic procedures to ensure an optimal diagnostic work-up.
Our team of internationally recognized specialist will guide you through the whole process, from your diagnostic work-up to your treatment and post-treatment care. We are committed to providing the best treatment options to each of our patients. The GMI team will never offer a simple “one size fits all” approach to any patient. We believe each patient’s case is as individual as they are and strive to find the best solution for each of our patients, taking their specific case and diagnosis, their lifestyle, and choices into account.
We believe each of our patients is more than their diagnosis. That’s why our dedicated paramedics team supports patients with benign prostate hyperplasia by offering more than just expert medical care. We offer specialized physiotherapy, integrative medical services (including yoga classes, and acupuncture), occupational therapy, psychological help, and rehabilitation services, and have a GMI Patient Advocacy Program.
Adhering to our passion for innovation, and desire to progress the medical field, the GMI Prostate Cancer Center both initiates and participates in several clinical trials in which the most modern and advanced treatment concepts are tested.
