Benign Prostate Hyperplasia

Benign Prostate Hyperplasia (BPH) is a common pathological finding in men after age 40. BPH contributes to lower urinary tract symptoms that affect quality of life. It is estimated that more than half of men in their 50s and 70% of men in their 70s suffer voiding symptoms due to BPH. Untreated, BPH may lead to urinary retention, bladder stone formation, or deterioration of kidney function.

Every year, more than two million men are treated for BPH. The treatment goal is to resolve bladder outlet obstruction and ranges from non-invasive medical therapy to open surgery. In the last decade many new less invasive and non-invasive therapies for BPH have been introduced.  Search for optimum therapy for BPH continues.

The prostate is a small, usually chestnut-sized (20-25 g) organ that sits directly below the bladder in men.  The urethra and the seminal ducts pass through it, and it is composed of epithelial and stromal cells.  As men grow older, many develop benign prostate hyperplasia (BPH), a condition in which the epithelial cells of the prostate accumulate and cause the prostate to expand.  BPH is not a type of cancer nor does it lead to cancer.  A patient with BPH can, however, have serious urological problems if his enlarged prostate constricts the urethra.  BPH causes increased resistance to urination, and as the muscles around the bladder attempt to compensate by becoming stronger, the compliancy of the bladder decreases, leading to increased frequency, feelings of urgency, and nighttime urination.  In severe cases, BPH can lead to urinary tract infections, bladder stones, blood in the urine, acute urine retention, and even kidney failure.  Physicians estimate that about 50 percent of men over 50 and around 70 percent of men over 70 have BPH.  The majority of patients with BPH do not seek treatment.  These people often fear the costs of treatment and/or the potential side effects.  Many are unaware that medication and open surgery are not their only options.  BPH is a disease that can drastically reduce a patient’s quality of life, so the goal of therapy is to relieve symptoms while preserving bladder and kidney function.  Treatment options include watchful waiting, medication, minimally invasive surgical procedures, and major surgery.  

Medications for BPH

Medical therapy is often the first treatment that patients with mild to moderate symptoms receive.  Drugs to treat BPH fall into two major classes, alpha-blockers and 5-alpha-reductase inhibitors.  Alpha-blockers inhibit alpha-adrenergic receptors and cause smooth muscles cells in the prostrate stroma to relax.  Alpha-blockers are usually used to treat men with relatively small (35 g or smaller) prostate glands.  For patients with larger prostates, doctors often choose 5-alpha-reductase inhibitors, which block an enzyme that normally transforms testosterone into dihydroxytestosterone (DHT), a hormone that causes prostate growth.  In some cases, alpha-blockers and 5-alpha-reductase inhibitors are used in combination.  Most patients respond well to one or both types of drug, but each class is imperfect.  Alpha-blockers can cause hypotension, and 5-alpha-reductase inhibitors take three to six months to work. 

Many researchers are actively seeking better medications for BPH.  Some studies have recently found that drugs developed for other purposes, such as statins and drugs to treat erectile dysfunction, may be effective against BPH.  In the future, doctors hope to develop long-acting drugs that won’t need to be taken daily and drugs capable of helping them distinguish BPH from prostate cancer.  Doctors also hope that genomic advances will soon allow them to tailor therapies to individuals and that safe, preemptive treatments will become available. 

Minimally Invasive Therapy

For the ten to twenty percent of patients who do not respond to medication, many other treatment options that fall short of open surgery are now available.  These procedures require little or no anesthesia; and they have fewer adverse effects and shorter recovery times than major surgery.   

Transurethral needle ablation (TUNA) of the prostate is one outpatient technique used today.  With the patient under local anesthesia, two small needles in a catheter are inserted into the urethra, and low-energy radio pulses between the two needles destroy excess prostate tissue.  The technique causes improvements in most patients, but 40 percent of patients have urinary retention problems within the first 24 hours.  The long-term effects of the relatively new procedure have not been well studied.

Transurethral microwave therapy (TUMT) is another method used to treat BPH.  In this procedure, a special catheter releases microwaves into the prostate, causing some tissue coagulation but not much.  The procedure usually relieves symptoms, but doctors do not understand exactly how it works.  Patients who respond well to medication usually respond well to TUMT, but it does not work for everyone.

Surgical Options

A more invasive means of treating BPH is transurethral resection of the prostate (TURP).  This technique, which has changed little over the last decades, uses an electrocauterizing loop to remove excess prostate tissue.  Its success rate is higher than those of less invasive procedures, but it also poses greater risks.  Some patients experience significant bleeding, and others develop hyponatremia from the irrigation fluid used during the surgery.  The technique is not considered safe for patients with cardiac problems.

Lasers can also be used to resect prostate tissue.  The lasers used today vaporize some tissue and leave coagulated tissue around the vaporized area.   Lasers don’t cause hyponatremia, and technological advances are reducing the amount of coagulation that they produce.    

Wikipedia

Start or edit a Benign Prostate Hyperplasia encyclopedia article on Wikipedia.

You can link to this page from the article using the following URL:

http://www.cimit.org/forum/forum-mis-02.12.08.panel.html

Learn more about Wikipedia.

Forum Blog

Post a comment / start a discussion on the Forum Blog regarding this Forum.