What men need to know about Benign Prostatic Hyperplasia
In men an expanding prostate gland is often associated with LUTS (Lower Urinary Tract Symptoms), although not all LUTS is caused by the prostate and some of the symptoms including urinary frequency (trips to the bathroom) and nocturia (getting up at night) requires medical treatment rather than surgical.
In his excellent article, BPH Specialist and clinical expert, Dr Nigel Hacking explains how BPH is the condition that occurs when the prostate gland is increasing in size without there being any malignant cause. As the prostate enlarges it leads to compression and then obstruction of the urethra, which in turn affects urinary flow.
The symptoms include the following:
- urinary frequency,
- urinary urgency,
- hesitancy in urination,
- poor stream and
- incomplete bladder emptying.
Partial obstruction of the urethra can ultimately become complete causing acute urinary retention and the urgent requirement for a bladder catheter. BPH is not however a pre-malignant condition.
Traditionally, BPH has been managed as follows:
To begin with; lifestyle changes and medication (drugs include alpha blockers and 5ɑ-reductase inhibitors)
If the symptoms progress or become severe; surgery may be required.
Treating BPH according to age
By middle age half of men will have BPH symptoms
The condition is age-related and so fitness and suitability for surgery is often an issue.
The process by which the prostate begins enlarging starts around the age of 30 and up to 50% of men will have changes within the BPH tissues by 50 years of age. By 80 years of age this rises to 75% although not all of these men will have symptoms. Symptomatic BPH occurs in up to 50% of men of middle age or older.
What are the treatment options for BPH?
Treatment options for BPH will vary according to the nature and severity of the symptoms. Options may include the following:
- Lifestyle changes and medication
- Surgery including Trans Urethral Prostatectomy (TURP) and various forms of Laser Prosatectomy (Green light and HoLEP).
- Urolift and Rezum have recently been approved for men with modest prostatic enlargement.
- Minimally invasive thermal ablation using microwave energy (TUMT), radiofrequency (RF) and Water Vapour have not yet gained widespread use.
- Non-surgical shrinking of the prostate by trans-arterial embolisation.
Trans-arterial embolisation
This is a non-surgical, two hour, minimally invasive procedure and patient can be discharged after 4 hours provided he is fit. Men needing to travel out of the area or those who are less fit may require an overnight stay in hospital.
Post-procedural pain is usually mild to moderate and this discomfort can be managed by simple anti- inflammatory and pain killing oral medications.
For further information see; Introduction to Benign Prostatic Hyperplasia
