So, what is BPH? Benign prostatic hyperplasia, or BPH, is the medical term used to describe an enlarged prostate. The dictionary defines benign as “not harmful” and hyperplasia as “the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells.” Therefore, benign prostatic hyperplasia is the non-harmful, non-cancerous enlargement of prostate tissue in men due to aging and the increased rate of prostatic cell reproduction. Of course, “non-harmful” is a relative term if a person is suffering severe lower urinary tract symptoms or LUTS and their bladder is completely blocked by a continually-growing prostate. BPH symptoms are typically mild to moderate but can sometimes become severe. The main cause of prostatic hyperplasia is unknown, but it is highly suspected that it is linked to hormonal changes in men as they age.
Determining whether an enlarged prostate is the result of BPH, prostatitis (inflammatory disorder), cancer, or something else, is an important first step toward diagnosing and evaluating benign prostatic hyperplasia. Each condition can include overlapping symptoms, so it can be challenging to definitively determine which one is presenting problems. One, several, or all of the above conditions could be present concurrently, but a urologist will be able to run some tests or order a few procedures to pinpoint the exact issue. Science has progressed to the point that when urologists are asked the question “What is BPH?”, they can now give the history, likely causes, and a long list of possible solutions for the condition that affects so many men.
There is a big difference between benign prostatic hyperplasia and prostate cancer. As mentioned above, BPH is not cancer. And BPH doesn’t cause cancer or increase one’s risk for cancer. BPH is simply the benign overgrowth of prostate tissue. Prostate cancer tends to grow from the periphery of the prostate outward and can affect other surrounding tissues. It can grow undetected for months or years because it may not cause any symptoms. That’s why after age 40, and especially if African-American, speaking with a doctor about any family history of prostate cancer would be appropriate for determining if a prostate-specific antigen (PSA) test, together with a digital rectal exam (DRE) would be prudent. BPH, on the other hand, grows inward and the enlarged prostate starts affecting the urethra, bladder, or both and bothersome BPH symptoms begin to arise fairly soon thereafter.
Even though doctors and scientists can now answer the question “What is BPH?”, they haven’t yet pinpointed an exact cause of BPH. They do, however, have strong suspicions and have devised many strategies, medications, and highly effective surgical procedures to address benign prostatic hyperplasia which will eventually affect nearly all men if they live long enough. Some men experience BPH symptoms earlier and more impactfully than others, but luckily, most men will never experience BPH as an emergency.
The Anatomy of BPH
The prostate gland is an important component of the male reproductive system. It makes prostatic fluid that combines with sperm and fluid from the seminal vesicles to create semen that nourishes and protects sperm as the fluids are released from a man’s reproductive tract.
The prostate grows to a walnut-sized, and shaped, gland by the time a man is in his 20s, but will progressively grow larger as most men age. When a man reaches his 40s, the prostate will, in many men, have grown to the size of a plum or apricot. By the time a man reaches his 60s, his prostate will likely grow to the size of a lemon. Due to benign prostatic hyperplasia, some prostates grow quicker and will reach even greater sizes.
Since the prostate straddles the urethra (the duct or tube that transports urine from the bladder out of the body), any increase in prostate size can begin pinching or blocking the urethra and partially cutting off urine flow. That’s when BPH symptoms such as dribbling, starting and stopping, hesitancy, and incomplete emptying start becoming noticeable. Benign prostatic hyperplasia can start becoming a minor inconvenience in one’s 30s but usually doesn’t start displaying more prominent symptoms until a man is in his 40s, 50s, or beyond.
The prostate consists of 3 lobes – two lateral (outside) lobes and an interior median lobe. For most men who experience BPH symptoms, the larger lateral lobes are to blame for squeezing the urethra and curbing the flow of urine. However, some unlucky men will have their median lobe grow out of control as well. Not only will their lateral lobes take up more real estate and crowd the urethra, but their median lobe will likely grow up into their bladder and act as a stopper – keeping urine at times from exiting the bladder at all. Unfortunately, the prostate is nature’s way of letting men know they are but mere mortals.
BPH as a Nuisance
For some men, benign prostatic hyperplasia is a nuisance more than a serious issue. Watchful waiting or simply monitoring an enlarged prostate without significant action is often the first line of defense against nuisance BPH. Minor lifestyle changes such as getting up to use the restroom once or twice a night or relieving oneself more often during the day may be necessary as BPH symptoms increase. A weaker urine stream, starting and stopping, dribbling, or hesitancy may become more common during this time. These symptoms are typically not overly impactful and many men can adjust their schedules or behaviors accordingly when BPH symptoms are in this mild or nuisance stage.
BPH as a Problem
Each year a man ages past 40, the incidence of benign prostatic hyperplasia increases. According to Yale Medicine, approximately half of men aged 51 to 60 will experience BPH symptoms.1 Research published by the National Institutes of Health (NIH) states that “BPH affects 70% of US men 60–69 years of age and 80% of those 70 years of age or older”2 If one lives long enough, BPH, represented by lower urinary tract symptoms (LUTS), will find most men. It is estimated that one-quarter of men diagnosed with prostatic hyperplasia will require treatment for the problem, and some will require re-treatment.
When BPH symptoms grow beyond the nuisance stage and begin to become more problematic, watchful waiting will have run its course. It’s then appropriate to consider medication or surgery to alleviate lower urinary tract symptoms brought on by BPH.
Medications such as alpha-blockers, which relax urinary muscles, or 5-alpha reductase inhibitors, which work to shrink the prostate, are often prescribed. A combination of the two may even be warranted. However, medication won’t necessarily help all men. Men with median lobe growth may not respond as well to medications and might be candidates for prostate surgery sooner. Other men whose symptoms arise from lateral lobe growth may benefit more from BPH medications.
Eventually, many men find that medication no longer helps their ever-growing enlarged prostate and they find themselves good candidates for BPH surgery. Some men who have waited too long to seek treatment for BPH will need to consider surgery as their first line of defense. Fortunately, there are numerous surgical procedures available that can address any size, shape, and prostate issue.
What is BPH, and how can it impact me? These are important questions for men to ask their doctors. As covered above, BPH is prostatic hyperplasia that is benign and non-cancerous. It is believed to be hormone-driven as men age. Contributing factors to benign prostatic hyperplasia include age, family history, medical conditions such as obesity and diabetes, a lack of physical exercise, and erectile dysfunction. Nuisance BPH can be treated with watchful waiting and some minor lifestyle adaptations, but moderate and severe BPH often require medication or surgery. Whichever methods are utilized to address symptoms of BPH, the solution that works the best depends on the individual, their expectations, and their desire to live with or without BPH symptoms.
References
1. https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph
2. Parsons, J.K. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Curr Bladder Dysfunct Rep5, 212–218 (2010). https://doi.org/10.1007/s11884-010-0067-2
All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.
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