Benign Prostatic Hyperplasia

Symptoms

BPH is a common condition, affecting up to 90% of men older than 80. While not life-threatening, BPH can cause bothersome symptoms, including:

• Frequent urination, including at night (nocturia)
• Urgent need to urinate (urgency)
• Difficulty starting urination (hesitation)
• Weak urine stream
• Dribbling urine after urination
• Feeling like the bladder isn’t completely emptied (incomplete emptying)

Causes

The exact cause of BPH is unknown, but it’s thought to be linked to hormonal changes that occur with age. As men age, testosterone levels decrease, while estrogen levels may stay the same. This imbalance may stimulate prostate cell growth.

Diagnosis

Diagnosis of BPH typically involves a physical exam, a discussion of symptoms, and possibly some tests such as:

• Urinalysis: To check for signs of infection or blood in the urine
• Urine flow test: To measure the strength and volume of urine flow
• Post-void residual (PVR) test: To measure the amount of urine remaining in the bladder after urination
• Prostate-specific antigen (PSA) test: To check for prostate cancer (although a high PSA doesn’t necessarily mean cancer)
• Biopsy: In some cases, a small tissue sample may be needed to rule out prostate cancer

Treatment

Treatment for BPH depends on the severity of symptoms.

• For mild cases, lifestyle changes may be recommended, such as limiting caffeine and alcohol intake, double voiding, and pelvic floor muscle exercises.
• If medications are necessary, alpha-blockers and 5-alpha reductase inhibitors can be effective. Alpha-blockers relax muscles in the prostate and bladder neck to improve urine flow, while 5-alpha reductase inhibitors shrink the prostate by reducing hormone levels.
• For moderate to severe symptoms, minimally invasive procedures may be considered. These treatments use heat, lasers, or electrical energy to shrink or destroy prostate tissue. In certain cases, prostate artery embolization can be a minimally invasive option to reduce prostate size by blocking blood flow (Click here to read more on Prostate artery embolization for benign prostatic hyperplasia)
• Surgery is typically reserved for severe cases that haven’t responded to other treatments. Various surgical techniques are available, each with associated risks and benefits.