Benign Prostatic Hyperplasia :Symptoms and Treatment

Benign prostatic hyperplasia is a physical condition in which the infected, enlarged prostate interferes with the normal flow of urine. The result is urinary hesitancy, dysuria or frequent urination. The formation of nodules within the periurethral region increases the risk of urinary tract infection due to urine retention. The condition is treated by elevating the prostate-specific antigen levels, but the organ inflammation could result in a premalignant lesion, if neglected. Normally, adenomatous prostatic growth is observed in males over 30 years of age. More than 50% males develop benign prostatic hyperplasia by 60 years, with only 40% cases displaying clinically significant symptoms.

What Causes Benign Prostatic Hyperplasia?

Androgens play a major role in the onslaught of benign prostatic hyperplasia. They do not necessarily cause the condition directly, but do support its progression. Benign prostatic hyperplasia is observed less in castrated males than their 'intact' counterparts. A metabolite of testosterone, dihydrotestosterone, plays a critical role in prostatic growth, when synthesized in the region by the action of 5α-reductase, type 2 enzyme. The enzyme binds to nuclear androgen receptors and triggers epithelial and stromal cell growth factors. Estrogens also play a vital role in the benign prostatic hyperplasia etiology. Symptomatic benign prostatic hyperplasia varies greatly, depending on individual lifestyle.

Signs and Symptoms

Benign prostatic hyperplasia symptoms manifest within two clinically segmented categories: 'storage' or 'voiding'. Storage signs and symptoms include:

• Compelling need for frequent urination.
• Urgency incontinence.
• Nocturia.

The voiding symptoms include:

• Hesitancy prior to urination.
• Weak urinary stream.
• Intermittency or the stream starting and stopping intermittently.
• Need to strain while urinating.
• Dysuria or a burning sensation while urinating.
• Dribbling.

Medical intervention evaluates the storage and voiding symptoms to assess the severity and stage of benign prostatic hyperplasia. The infection can be progressive if left untreated. Retained urine results in stasis of bacteria within the bladder. This in turn increases the risk of urinary tract infection. Another development is the formation of urinary bladder stones due to residual urine being concentrated with crystallized salts. As acute and chronic urinary retention increases, the bladder distends. The condition, if neglected, could result in a complete renal failure or obstructive uropathy.

Treatment Options

Benign prostatic hyperplasia can be diagnosed with the help of microscopic examination of the prostate tissues. There are immunohistochemical techniques that help to categorize NNT or normal non-neoplastic prostatic tissue, benign prostatic hyperplasia or BPH, PIN or prostatic intraepithelial neoplasia and PCA or prostatic adenocarcinoma. The Hryntschak procedure or transvesical prostatectomy procedure involves the removal of the prostate tissue through the bladder, with the help of metal instrument. Rectal examination, ultrasound, ultrasonography and blood tests are also performed to identify benign prostatic hyperplasia. The treatment options for benign prostatic hyperplasia include:

• Decrease fluid intake before bedtime.
• Reduced or complete cessation of alcohol consumption.
• Complete cessation of caffeine consumption through coffee or colas.
• Timetabled voiding schedule.
• Medication such as alpha blockers or α1adrenergic receptor antagonists like doxazosin, tamsulosin, terazosin and alfuzosin; and 5α-reductase inhibitors.
• Saw palmetto fruit extract.
• Herbal medicines such as Hypoxis rooperi or African star grass, pygeum or the extract of Prunus africana, Cucurbita pepo or pumpkin seed and Urtica dioica or the root of the stinging nettle.

Patients who do not respond favorably to medical management are considered for surgery. The three common surgery types include:

Transurethral microwave thermotherapy or TUMT: In the transurethral microwave therapy surgery, a urethral catheter is inserted into the intraprostatic region of the urethra. The control box managed externally is used to energize and heat the prostate tissue via microwave radiation. The resultant necrosis takes around six weeks to reabsorb damaged tissue.

Transurethral needle ablation or TUNA: Transurethral needle ablation uses radio frequency energy to trigger necrosis of the prostatic tissue. The TUNA device is inserted to deliver the radiated energy through two needles, one inserted within the urethral wall and the other into the prostate.

Transurethral resection of prostate or TURP: This surgery involves removal of the infected prostate through the urethra.

Transurethral electrovaporization or TVP, laser TURP and VLAP or visual laser ablation are other benign prostatic hyperplasia treatment alternatives. All three surgery types are conducted under general anesthesia.