Almost half of men over the age of 65 have either early symptoms of urinary tract infection or have noticed decreased urine flow due to benign prostatic hyperplasia (BPH). BPH is characterised by benign (non-carcinogenic) prostate cancer enlargement, thus the central part of the prostate is progressively increased. The result is that a part of the urethra surrounded by the prostate becomes narrowed. This reduces the flow of urinary bladder and men experience blood in the urine and find urine flow weaker and often difficult to empty the bladder. These symptoms can significantly impact on quality of life.
In response to an increasing obstruction, the muscular wall of the bladder is solidified and strengthened. Consequently, the pressure within the bladder required for urinary production must be increased to overcome the effect of obstruction. This high pressure causes the creation of a bag or “diverticula”, resulting in what is referred to as “back pressure” on the kidneys, creating kidney problems.
If BPH is not treated, a chronic retention of urine (characterised by excessive urinary bladder) or acute urinary retention (urge abnormal urination, with painful excessive urinary bladder circulation) may develop. If suffering from BPH, most men are admitted into hospital for catheterization and in some instances prostate surgery.
Risk of being affected by the disease
Recent studies have clarified the risk factors associated with the likelihood of developing BPH. The higher the prostate (which is estimated by digital rectal examination and ultrasound), the greater the risk of illness. Similarly, risk increases for men with a PSA level above 1.4 ng / mL, in fact, the higher the PSA (provided that prostate cancer is not present), the higher risk of retention. Risk increases for me who’s urine flow is slower and for those who have a relatively large amount of urine in the bladder even after the urinating. Though not all suffer from progressive deterioration, in most cases the symptoms gradually become worse over time and eventually complications develop.
How is BPH Diagnosed?
The spectrum of symptoms associated with BPH are commonly known as lower urinary tract symptoms (LUTS, short) and those symptoms of BPH overlap, therefore it is not uncommon to be told that you have either or, the initial and subsequent medical examinations need to be extremely thorough in order for a right diagnosis to be determined.
Your doctor will examine you and will talk to you about your general health, well-being and recent symptom experiences. To systematically assess the symptoms, educate yourself on the scoring system and ask questions relating to it. It is not uncommon for your doctor to discuss diseases and illnesses with you during this assessment, having clear information regarding diabetes and history of hypertension can assist in future treatment and medication recommendation.
Physical Examination and Digital Rectal Exam
Your physician will conduct a digital rectal examination to get accurate information on the size and consistency of your prostate, they will also examine the belly to check if your bladder is enlarged which can be checked by pressing the stomach and if enlarged can be an indication of urine retention. Your doctor may also evaluate your nervous system, such as muscle and sensory testing in the eye area and between the scrotum and anus, as some disorders of the nervous system such as Parkinson’s disease or spinal cord problems may resemble symptoms similar to BPH.
Because of its frequent high blood pressure (hypertension), blood pressure is usually measured as part of a general health examination.
As urinary tract infections can cause symptoms such as increased need for urination, urine samples are checked for signs of bacterial infection or blood. Urine can also be routinely tested for the presence of sugar, a sign of diabetes and for malignant cells caused by urinary bladder, ureter or kidney cancer.
Very few males have kidney problems as a result of BPH, however by calculating the amount creatinine in the blood, your doctor will be able to check if your kidneys are affected by back pressure.
Blood sugar levels can also be tested to make sure you have no diabetes, as this may also be the cause of frequent urination.
The amount of PSA can also be measured. PSA is a marker that indicates prostate damage, often resulting from prostate cancer, but sometimes as a result of BPH. In fact, the larger the prostate, the greater your PSA. If your PSA level is increased, your doctor may recommend prostate biopsies so that prostate cancer can be ruled out. As mentioned, your PSA level also gives a rough indication of your prostate size, which may affect the risk of developing urine retention and provides vital information relating to treatment options.
Urine Flow Test
Urine flow rate measurement can also provide your urologist with useful information. You will be taken into the procedure area and told how to use a specialised piece of medical equipment known as a flow meter.
Less Common Tests
Depending on the results of the various tests, your urologist may want to perform further examinations. Urodynamic measurements are made using a small catheter that is inserted through the urethra through the penis into the urinary bladder. By measuring the pressure inside the urinary bladder, your urologist can determine if the symptoms are a consequence of BPH obstruction or are the result of the bladder itself not working properly. This test is uncomfortable, but not painful, and lasts about 20 minutes. You need to drink extra fluid after testing to reduce the risk of later urinary tract infections.
Transrectal ultrasonography (TRUS) is used to view the prostate, measure the proportion, and help guide the biopsy needle when prostate cancer is present.
Treatment of BPH
BPH is most often treated with medication or surgery. Some men with mild symptoms are closely monitored by their general practitioners and urologists and are prescribed medication to keep symptoms at by and prevent further and more digressive developments.
Surgery – Certain BPH complications, such as kidney problems, retention of bladder or stones inside the bladder, make the surgery more appropriate.
Medication– Is recommended for men experiencing low to moderate symptoms, although, medication can be used even for symptoms assessed to be high.
There are two main groups of medicines prescribed for BPH:
- 5-alpha-reductase inhibitors
Alpha-blockers work in principle to help relieve muscle at the tip of the bladder and prostate. By reducing pressure on the urinary tube, they help overcome obstruction and thus increase urine flow.
Studies indicate that up to 60% of men feel that their symptoms are significantly improved in the first 2-3 weeks of treatment with the alpha-blocker. This type of medicine does not treat BPH, they do however help alleviate some of the symptoms.
The most common side effects of alpha-blockers are fatigue, dizziness and headache, which is reported to be affecting 1 in 10 men who are taking the medication.
5-alpha reductase inhibitors act to block the conversion of testosterone to another substance, DHT (dihydrotestosterone), which is known to play a key role in prostate growth.
The 5-alpha reductase inhibitors Proscar and Avodart, have been tested and unlike the alpha blocker, Proscar and Avodart appear to be able to reverse the condition, especially if the prostate is significantly increased, essentially their use can reduce the likelihood of developing acute urinary retention and might assist in avoiding surgery.
These medications seem to work better in patients with larger prostate glands, but may take up to six (6) months to be effective. It is important to reduce the PSA value by about 50%, so this should be taken into account when monitoring prostate cancer. One way to do this is to double the PSA values obtained when the patient is taking Avodart or Proscar.
The main negative effects of these medications is the reduction in sex drive and difficulties in maintaining/achieving erection; it seems to affect about 3 to 5 men in every 100 cases. It is also reported that about 1% (or less) of men can experience tenderness and swelling around the nipple, and generally disappear if and when treatment ceases.