Benign Prostatic Hyperplasia

The prostate is a small gland located just below the bladder, in front of the rectum, that produces certain components of semen. This gland, which is very small at birth, grows until the male reaches puberty. At adulthood however, the gland should cease to grow. Nevertheless, around 40 years of age, it is not uncommon for the gland to begin growing again and to become enlarged. When the prostate becomes too large, it becomes a condition referred to as benign prostatic hyperplasia. It is not a disease; it is simply a fact of aging that affects countless men. More than 50% of men in their 50s have symptoms and that percentage only increases with age. By age 80, more than 80% of men are affected.

Causes

The causes of benign prostatic hyperplasia are not well understood. There are however, risk factors that predispose certain men to benign prostatic hyperplasia. These risk factors include being Black, diet, alcohol, liver cirrhosis, hypertension and diabetes.

Symptoms

Given that the prostate is located directly below the bladder, the effects of its growth are particularly felt when one must urinate:

  • Decreased force of the urinary stream
  • Need to strain to urinate
  • Sensation of incomplete evacuation of urine from bladder
  • Increased risk of urinary infections
  • Need to urinate more frequently
  • Interrupted sleep to urinate at night
  • Sudden urgent need to urinate, sometimes accompanied by leaks

Over time, the symptoms can intensify or lead to complications (in less than 10% of cases) such as:

  • incontinence
  • renal insufficiency (due to increased pressure in the urinary system and in the kidneys)
  • urinary retention (obstruction of the urethra; a catheter is then required to drain the bladder)

Diagnostic

You must consult with a physician for a proper diagnostic. The physician will then be able to conduct an examination and/or refer you to a urologist. The diagnosis for benign prostatic hyperplasia is made in stages. Firstly, the physician will ask questions about the symptoms you are experiencing. Secondly, the physician will perform a rectal examination that will allow him to assess the size and consistency to the prostate (this test is conducted yearly in men over 50 years of age and also serves to screen for prostate cancer).

And finally, he will run some tests to make sure that you are not suffering from prostate cancer. (Do not be alarmed. Even though these two separate conditions involve the same gland, they are unrelated).

Once this has been ruled out, the physician will need to assess what stage you are at and what the best course of action is. He will most likely ask you to submit to a urine test to check for infections or blood. He may also want to evaluate your urine flow (uroflowmetry) and finish up with a bladder, prostate and kidney ultrasound.

Treatment

There are medications available on the market to help to reduce the symptoms of benign prostatic hyperplasia.

They may prove useful for a certain time but they are mainly intended to improve quality of life and slow progression.

Surgery aimed at partially or totally removing the prostate is only reserved for very serious cases where symptoms substantially affect daily life or where the risk of complication is very high.

Surgery known TURP is widely used to treat benign prostatic hyperplasia. The procedure is conducted under general anaesthesia and has an excellent success rate. The most common adverse effects associated with the procedure is retrograde ejaculation (70-75%). Impotence, although less frequent (5-10%) and urinary incontinence (2-4%) can also occur. Partial surgery (or TUIP), has a much lower risk of complications but does not permanently do away with the need for TURP surgery in the future.

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