Benign prostatic hyperplasia (BPH) is a common condition affecting older men and is characterised by the non-cancerous enlargement of the prostate gland. This enlargement can cause a variety of urinary symptoms, such as difficulty starting urination, a weak urine stream, frequent urination, and the sensation of incomplete bladder emptying. The diagnosis of BPH typically involves:
Medical history & physical examination: A detailed history includes questions about symptoms, their onset, and frequency, as well as a review of any medications and general health conditions. A digital rectal exam is usually performed to assess prostate size and detect abnormalities.
Symptom scoring: The International Prostate Symptom Score (IPSS) questionnaire is often used to evaluate symptom severity and impact on quality of life.
Laboratory tests: Tests may include urinalysis to rule out infections or other conditions, and prostate-specific antigen (PSA) testing to evaluate prostate health.
Imaging & urodynamic tests: In some cases, further tests like urodynamic studies, ultrasound, or cystoscopy may be recommended to assess the extent of prostate enlargement and its impact on the urinary tract.
Treatment options
Treatment for BPH varies depending on symptom severity and patient preference. The options include:
Medications
Alpha-blockers relax the muscles of the bladder neck and prostate to improve urine flow (e.g., tamsulosin).
Alpha Reductase Inhibitors: These shrink the prostate by inhibiting hormonal changes (e.g., finasteride, dutasteride).
Combination therapy: Sometimes, both alpha-blockers and 5-alpha reductase inhibitors are used together for better symptom control.
Tadalafil: Originally for erectile dysfunction, this medication also helps relieve symptoms of BPH.
Minimally invasive procedures
Transurethral Resection of the Prostate (TURP) removes parts of the prostate to relieve obstruction.
Transurethral Incision of the Prostate (TUIP) involves making small cuts in the prostate to ease urine flow, suitable for smaller prostates.
In laser therapy, high-energy lasers remove overgrown prostate tissue with fewer side effects.
Prostate lift and water vapour therapy offers a less invasive option that compresses or removes excess prostate tissue with minimal side effects.
Surgical options
Open or robotic prostatectomy: This involves removing the enlarged part of the prostate through abdominal surgery, typically reserved for very large prostates.
Embolisation: Blocks blood flow to the prostate, causing it to shrink, though more research is needed to establish its routine use.
Follow-up & management
Regular follow-up is crucial to monitor the effectiveness of the treatment and manage any side effects. Lifestyle changes, such as reducing fluid intake before bedtime and avoiding caffeine and alcohol, can also help alleviate symptoms.
(The author is a consultant urologist.)