Benign prostatic hyperplasia (BPH)
Reviewed by Mr John Macfarlane, consultant urological surgeon
What is benign prostatic hyperplasia? (BPH)
The prostate is a gland the size of a chestnut. It is only present in men, and it is situated under the bladder surrounding the urethra, the passageway that takes the urine to the outside. The gland produces seminal fluid, which is mixed with sperm to make semen.
With age, the gland may begin to grow - this happens to most men. The growth may eventually cause problems with urination, because the gland pinches off the urethra as it increases its size.
The growth in itself is harmless and so the condition is called benign prostate hyperplasia (BPH). It occurs most often in men over the age of 60. Up to 30 per cent of men in their 70s have BPH that causes them symptoms.
What kinds of problems can an enlarged prostate cause?
The enlargement of the prostate gland stretches and distorts the urethra and so obstructs the urine flow. Symptoms include:
Can other problems arise?
There are further complications with this disease.
How does the doctor diagnose the disease?
A GP can often make the diagnosis on the following grounds.
How is benign prostate hyperplasia treated?
There are a variety of treatment strategies for this condition and the following factors should be considered:
What kinds of medicines are used?
There are two types of medication for this problem.
There are also different kinds of over-the-counter herbal medicine on the market. However, these preparations are not generally recommended because their effect has not been completely documented. Those which do have some supporting evidence are saw palmetto and beta-sitosterol plant extracts and rye grass pollen extract.
What kind of surgery is available?
An operation on the prostate will involve the removal of parts of the enlarged tissue.
The most common operation is an endoscopic surgical procedure where parts of the enlarged tissue are peeled off. This is called transurethral resection of the prostate (TURP).
If the prostate is only slightly enlarged, it may be enough to make a little cut in the prostate, without removing tissue, to reduce the constriction of the urethra. This is called transurethral incision (TUI).
If the prostate is considerably enlarged, it may be necessary to make an incision in the lower abdomen and to carry out an open operation. But this procedure is rarely carried out.
Surgery carries more risk than medical treatment and there are possible complications including retrograde ejaculation. In retrograde ejaculation, the sperm enters the bladder during ejaculation instead of being expelled through the penis. Later it is flushed out with urine.
Studies estimate that 74 per cent of men will experience retrograde ejaculation after transurethral resection of the prostate (TURP).
Surgery has also been linked with side effects of erectile dysfunction (in 14 per cent of men after TURP) and urinary incontinence (5 per cent). But studies are inconclusive as to whether the same rates of these problems would have occurred anyway in men not undergoing surgery.
The benefits of surgery are long lasting, but because only part of the prostate is removed, some men may eventually need another operation.
Are there other more gentle surgical treatments?
Newer treatments for benign prostate hyperplasia already exist and are continually being developed. These techniques are minimally invasive. Some need only local anaesthesia and the risk of complications is smaller.
A couple of general points about these new techniques:
In this treatment, the prostate tissue is heated to around 45ºC by means of microwaves. This reduces the size of the prostate by causing cells in the centre of the prostate to die. This treatment is carried out through the urethra.
In this procedure, part of the prostate tissue is removed by evaporation by means of electrical current. The treatment is performed with an endoscope.
Another endoscopic treatment, in which part of the prostate tissue is removed with laser energy. For this treatment, a passage is created by inserting a tube made of metal or plastic - which remains in place where the prostate gland obstructs the urethra.
This procedure is used only on rare occasions, for those patients who are unable to be considered for other forms of treatment.
Some patients with urine retention who cannot endure an operation, may have to have a permanent catheter. This can be placed through the urethra or through the lower abdomen into the bladder. But with a permanent catheter, the patient is at greater risk of cystitis (infection of the bladder).
An alternative, is for the patient to learn to empty the bladder himself with a catheter. This way the catheter is removed after each use and the danger of infection is reduced.
NHS Centre for Reviews and Dissemination. Benign Prostatic Hyperplasia. Effective Healthcare Bulletin, December 1995.
McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: diagnosis and treatment. Clinical Practice Guideline, Number 8. US Agency for Health Care Policy and Research, Pub. No. 94-0582: US Department of Health and Human Services, February 1994.
Barry MJ, Roehrborn CG. Benign prostatic hyperplasia. In Clinical Evidence, Issue 5. BMJ June 2001.
Based on a text by Dr Bettina Norby and Dr Ejnar Kuur
Last updated 02.03.2005
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