Benign prostate hyperplasia (BPH)

Etiology

Benign hyperplasia of the prostate develops within the ageing process in men. It is caused essentially by increased volume of the inner prostatic gland resulting from complex changes and interactions in the male hormonal milieu with age. In some men this leads to a compression of the urethra which passes through the prostate. This causes an increased bladder outflow resistance and in turn to increased bladder pressure and development of residual urine.

Incidence

As a rule, BPH usually becomes manifest after the age of 55. Approximately a third of all men are affected, of which one in ten will need surgical treatment during the course of disease.

Symptoms

The most important signs are decreasing urinary flow and the feeling of incomplete voiding. Further symptoms are initial waiting before voiding, repeated interruptions in urinary flow and having to get up at night to urinate. As a consequence of residual urine chronic urinary infections may develop, which can, among other things, cause disturbing urgency. An, as a rule, prolonged and significant obstruction can lead to acute urinary retention and even to renal damage.

Diagnosis

In general the family practitioner can diagnose BPH by the symptoms and digital rectal examination. The urologist evaluates the situation and determines the treatment needed.

Therapy

In early stage of disease it is recommended to wait. One may try phytotherapeutic (prescription free, plant based) drugs to alleviate symptoms. With increasing symptoms classical pharmaceutical medications may be prescribed. As a rule, these provide only mild alleviation of symptoms. At most, they are only a temporary solution and the cost may not be covered by health care insurance. The urologist recommends surgical therapy, the options are: conventional electroresection, laser resection and microwave therapy. Conventional electroresection in practiced hands remains the standard in BPH therapy and is especially recommended in more complex cases with concomitant infection of the prostate, relaxed overextended bladder muscle, or totally blocked urinary flow. Laser resection is efficient in small to medium prostates. Blood loss is minimal and the hospital stay shorter. Microwave therapy is recommended especially for medium to large prostates. This therapy can be performed under local anesthesia and therefore be offered even to patients in poor health and to patients under anticoagulation.

Prognosis

As a rule, the prognosis of benign prostate hyperplasia is good under the condition that the disease is recognized and treated in time before irreversible bladder and kidney damage develops.