BENIGN PROSTATIC HYPERPLASIA (BPH)

BACKGROUND

Benign prostatic hyperplasia is the medical term for an enlarged prostate. The prostate is a gland that surrounds the urethra (the tube that carries urine from the bladder out through the penis). This gland often gets bigger in men as they get older.

Benign prostatic hyperplasia, also called “BPH,” is a common problem. It has nothing to do with prostate cancer. In fact, the word “benign” means “not cancer.”

DISEASE OCCURRENCE IN POPULATION:

There is a paucity regarding clinical prevalence of BPH in Pakistan. health experts during a press briefing to mark international BPH awareness week in Karachi said BPH (Benign Prostatic Hyperplasia) affects 50% of men aged 40 to 50 and if untreated, can cause complications including acute urinary retention (AUR) and surgery’.

Pakistan with as many as 50% of the 2 million men older than 65 year are at risk of bladder outlet obstruction from BPH.

RISK FACTORS:

Risk factors for prostate gland enlargement include:

• Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
• Family history: Having a blood relative, such as a father or brother, with prostate problems means you're more likely to have problems.
• Ethnic background: Prostate enlargement is less common in Asian men than in white and black men. Black men might experience symptoms at a younger age than white men.
• Diabetes and heart disease: Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
• Obesity increases the risk of BPH, while exercise can lower your risk.

SIGN AND SYMPTOMS:

Many men with BPH have no symptoms at all. When symptoms do occur, they can include:

• Needing to urinate often, especially at night
• Having trouble starting to urinate (this means that you might have to wait or strain before urine will come out)
• Having a weak urine stream
• Leaking or dribbling urine
• Feeling as though your bladder is not empty even after you urinate

DIAGNOSTIC TEST:

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:

• Digital rectal exam: The doctor inserts a finger into the rectum to check your prostate for enlargement.
• Urine test: Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
• Blood test: The results can indicate kidney problems.
• Prostate-specific antigen (PSA) blood test: PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
• Neurological exam: This brief evaluation of your mental functioning and nervous system can help identify causes of urinary problems other than enlarged prostate.

After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These additional tests might include:

• Urinary flow test: You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
• Post void residual volume test: This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
• 24-hour voiding diary: Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.

If your condition is more complex, your doctor may recommend:

• Transrectal ultrasound: An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
• Prostate biopsy: Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
• Urodynamic and pressure flow studies: A catheter is threaded through your urethra into your bladder. Water or, less commonly, air is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working.
• A lighted, flexible cystoscope is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.
• Intravenous pyelogram or CT urogram: A tracer is injected into a vein. X-rays or CT scans are then taken of your kidneys, bladder and the tubes that connect your kidneys to your bladder (ureters). These tests can help detect urinary tract stones, tumors or blockages above the bladder.

TREATMENT OPTIONS:

Treatments options include:

• Watchful waiting– Watchful waiting means that you wait to see if your symptoms change, but you don't have treatment right away. Men who choose this option can decide to try treatment later if their symptoms get worse, or if their symptoms start to bother them more.
• Medicines– There are medicines to treat BPH. Two types are often used. One type relaxes the muscles that surround the urethra. The other type keeps the prostate from growing more or even helps the prostate shrink. In some cases, doctors suggest taking both types of medicine at the same time. Depending on your symptoms, your doctor might also suggest other medicines.
• Surgery– Surgery to treat BPH works by removing some of the prostate, or by causing the prostate to shrink. There are several surgeries to choose from.

PRECAUTIONS:

To help control the symptoms of an enlarged prostate, try to:

• Limit beverages in the evening: Don't drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
• Limit caffeine and alcohol: They can increase urine production, irritate the bladder and worsen symptoms.
• Limit decongestants or antihistamines: These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
• Go when you first feel the urge: Waiting too long might overstretch the bladder muscle and cause damage.
• Schedule bathroom visits: Try to urinate at regular times — such as every four to six hours during the day — to "retrain" the bladder. This can be especially useful if you have severe frequency and urgency.
• Follow a healthy diet: Obesity is associated with enlarged prostate.
• Stay active: Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
• Urinate — and then urinate again a few moments later:  This practice is known as double voiding.
• Keep warm: Colder temperatures can cause urine retention and increase the urgency to urinate.

REFERENCES:

• Condie JD Jr., Cutherell L, Mian A. Suprapubic prostatectomy for benign prostatic hyperplasia in rural Asia: 200 consecutive cases. Urology. 1999;54:1012-6.
• https://www.uptodate.com/contents/benign-prostatic-hyperplasia-enlarged-prostate-the-basics?source=see_link
• http://ppinewsagency.com/%EF%BB%BFdelay-in-bph-treatment-can-cause-serious-complications/
• http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/risk-factors/con-20030812
• http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/lifestyle-home-remedies/con-20030812