Benign Prostatic Hyperplasia (BPH)

The prostate is an organ found in males that has an essential function in human reproduction. It is a gland of the male reproductive system that produces some of the fluid for semen, which is used to transport sperm during the male orgasm. The prostate is made up of various cell types that have complex interactions which science still does not fully understand.

The prostate is located just below the bladder, in front of the rectum. It wraps around the urethra which is the tube that carries urine from the bladder out through the tip of the penis. The prostate is normally very small, about the size of a walnut and is made up of muscular and glandular tissue.
As men age, it is possible for their prostate to increase in size. By age 70, over 40% of men will have an enlargement of the prostate. If the prostate becomes large enough it will press against the urethra, decreasing the flow of urine, making it weaker and slower. This is the condition known as Benign Prostatic Hyperplasia (BPH).

When Does This Happen?

The prostate gland goes through two different growth periods. When a male hits puberty the prostate will double in size. It will then remain the same throughout puberty, until the male reaches about age 25. The prostate will then go through a second growth period which will make it larger, but will not cause any significant problems until later in life. Men rarely have prostate problems until they reach their 40’s. However, by the time men reach their 60’s, more than 50% are affected, and over 90% are affected by the time they are in their 70’s and 80’s.

Causes?

Throughout their lives, men produce testosterone, which is an important male hormone that aids in reproduction, as well as small amounts of estrogen, which is a female hormone. As men age, their production of testosterone decreases which results in a higher proportion of estrogen in the blood. Studies have shown that higher levels of estrogen within the gland may increase the activity of substances that promote cell growth. This suggests that elevated levels of estrogen could promote the onset of Benign Prostatic Hyperplasia.

Another supposition focuses on dihydrotestosterone (DHT), or a substance that originates from testosterone within the prostate. This substance is believed to help control its growth. Studies have shown that as most animal’s age, they lose their ability to produce DHT, but in humans, even one drop will cause men to continue to produce high levels of DHT in the prostate. This production could encourage the growth of cells and promote BPH.

Symptoms:

There is a layer of tissue that surrounds the prostate, and as it enlarges, this layer prevents it from expanding. This causes the gland to press against the urethra which causes the bladder wall to become thick and irritable. When this happens, the bladder will begin to contract even when it only contains small amounts of urine, ultimately leading to more frequent urination. Over time, the bladder will weaken and eventually lose the ability to empty itself. The urethra narrowing and the bladder only empting partially, are two of the causes for many of the problems associated with BPH.

There are three common symptoms, mostly dealing with problems or changes in urination that most men endure when they have BPH. These are more frequent urination (particularly at night), an interrupted, weak stream and leaking or dribbling. The size of the prostate will not always run in conjunction with the severity of the symptoms. Often, men with greatly enlarged prostates will have very minor symptoms.

Treatments:

When BPH is caught early, many doctors will wait to treat the problem. If symptoms are not severe, many times they clear themselves up. Routine checkups can help keep tract of the progression of the prostate. If the problem persists, there are several ways to treat BPH. It can be treated with medications, non-surgical procedures or surgery.

Doctors have the option of using several different medications to try and relax the muscle tissue in the prostate and the bladder neck. This will relieve the pressure against the urethra which will hopefully restore normal urine flow and reduce bladder obstruction. Medications can also be used to inhibit the production of dihydrotestosterone (DHT) which can lead to prostate enlargement. This will hopefully hinder any excess growth that could be damaging.

Non-surgical procedures use heat to destroy excess tissue of the prostate. This procedure is known as transurethral microwave thermotherapy (TUMT). TUMT sends microwaves of heat through a catheter to selected parts of the prostate. A cooling device is used to protect the bladder while this procedure is being performed. The heat effectively destroys excessive tissue in the prostate. This procedure is not a cure for BPH. It does reduce symptoms associated with the prostate, but Benign Prostatic Hyperplasia can return.

Most doctors recommend surgery as the best long-term solution for patients with BPH. With surgery, the excessive, enlarged tissue that is pressing against the urethra is removed and the rest of the prostate tissue as well as the outside capsule are left unharmed. Removal of the enlarged part of the prostate is the most effective way to rid the body of BPH. Transurethral surgery, Open surgery and Laser surgery are the three procedures used to treat BPH. Discussing each with your doctor will enable you to decide which surgery will be the most effective for you.

Recovery:

After the surgery, some bleeding may show in the urine. The blood is from blood clots that have formed to heal the wound. Drinking lots of water will help to flush the clots out of the bladder. Once home it is good to take it easy for a few weeks. Strenuous activity could cause damage to the wound. It will probably be a few months before you are completely back to normal.

The most common problems that occur once patients return home are bleeding and excessive urination. Both problems should remedy themselves as you recover, but if they persist, your doctor should be notified. BPH is a real problem that older men face, but, like any problem, it has a solution. Getting checked early for prostate problems is the best way to discover abnormalities. Also, after treatment, yearly checkups will ensure that the BPH is no longer affecting your prostate.