Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate Gland

Benign prostatic hyperplasia (BPH) or an enlarged prostate gland is a very common condition in older men with estimates indicating that up to one in every two men suffers with this condition. The prostate gland, which is normally about the size of a walnut, starts to enlarge quite often after the age of forty, but may produce symptoms of enlargement much later. Most symptoms are caused due to compression of the urethra by the enlarged prostate gland, such as difficulty in passing urine, weak flow and incomplete emptying of the bladder. Benign prostatic hypertrophy is a non-cancerous condition and does not increase the risk of developing prostate cancer.

Causes of Enlarged Prostate

The exact cause of prostate enlargement is not known but it has been suggested that changes in the ratio of male hormone (testosterone) to that of female hormone (estrogen) that occur with age may be a factor contributing to enlargement of the prostate. Another suggestion is that, with age, the prostate becomes more sensitive to normal levels of testosterone, resulting in hyperplasia of the gland.

Age is an important factor in developing benign prostatic hyperplasia and while symptoms are rare before the age of forty, the incidence of BPH increases with age. A family history of enlarged prostate may be present and there may be an ethnic basis as it is less common in Asian men. It has been noted that men who have had their testes removed before puberty do not develop hyperplasia of the prostate.

Symptoms of Enlarged Prostate

Although enlargement of the prostate is common in older men, the symptoms may not be severe enough to prompt treatment for BPH. However in many cases, the symptoms may cause significant discomfort and require prostate surgery. The symptoms of prostate enlargement include :

  • Hesitancy or difficulty in starting urination.
  • Weak urine stream.
  • Interruption in flow of urine, with frequent stopping and starting.
  • Straining during urination.
  • Dribbling at end of flow.
  • Urgency or immediate need to urinate once the urge is there.
  • Nocturia or increased frequency of urination at night.
  • Incomplete emptying of bladder.
  • Hematuria or blood in the urine.
  • Frequent urinary tract infections.
  • Overflow incontinence.

Diagnosis of Enlarged Prostate

Diagnosis depends on the case history, clinical findings upon physical examination and diagnostic investigation.

  • Digital rectal examination to estimate the size and condition of the prostate gland.
  • A urine test should be conducted to rule out infection or other genitourinary conditions with similar symptoms as those of BPH.
  • Prostate-specific antigen (PSA) blood test is a screening test to rule out prostate cancer.
  • Transrectal ultrasound (TRUS) is done to determine the size of the prostate gland and also to exclude prostate cancer.
  • Urodynamic pressure-flow studies to measure bladder pressure and function during urination.
  • Urinary flow test to measure the strength and amount of urine flow.
  • Postvoid residual volume test to determine if there is complete emptying of the bladder after urination.
  • Cystoscopy to visualize the inside of the bladder and urethra by means of a cystoscope and to diagnose any urethral compression by an enlarged prostate.
  • Imaging techniques such as computerized tomography (CT) scan, magnetic resonance imaging (MRI), or intravenous pyelogram (IVP) may be done to detect obstruction or abnormality of the urinary tract.

Complications of an Enlarged Prostate

  • Urinary tract infections (UTI’s) are more common due to pressure on the urethra by the enlarged prostate and stagnation of urine. The dangers of repeated infections may prompt prostate surgery may be necessary to relieve the urethral compression.
  • Acute retention of urine is a sudden painful inability to pass urine and the bladder can only be emptied by introducing a catheter. Surgery is often indicated in these cases if the acute attacks are recurrent and severe.
  • Damage to the bladder wall due to stretching of the muscular wall of the bladder occurs as a result of a chronic state of incomplete emptying of the bladder. This weakening of the bladder wall and inability to contract properly undermines the ability for normal urination and may require surgery to correct it.
  • Bladder calculus is the stone formation within the bladders as a result of retention of urine due to incomplete emptying. These bladder stones may cause infection, irritation of the bladder, hematuria (blood in the urine), or obstruction of the bladder.
  • Kidney damage may occur due to acute urinary retention and frequent urinary tract infections.

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