BPH (Benign Prostatic Hyperplasia), i.e. benign prostate enlargement, is a urological disorder that should be treated. It negatively affects the patient's quality of life.
The condition where the volume and weight of the prostate gland increase are called benign prostate enlargement (benign prostatic hyperplasia). In benign prostate enlargement, prostate cells do not grow abnormally and do not metastasize to other parts of the body as in prostate cancer.
If the cells on the prostate have grown in an uncontrolled manner and spread to the surrounding tissues, the condition is called malignant prostate enlargement, i.e. prostate cancer.
A variety of treatment options are available for the treatment of prostate enlargement, including drug therapies, minimally invasive treatment procedures, and surgical procedures.
The most appropriate treatment is selected under the influence of various factors. These factors are;
- The size of the prostate
- Patient’s age
- General health condition
Benign Prostate Enlargement (Prostatic Hyperplasia)
While prostate enlargement rarely causes complaints in men under 40, it causes complaints in 50% of patients over 50, and in 90% of patients in their 80s.
The risk factors known to be most effective in the development of benign prostate enlargement are as follows:
Aging: The appearance of benign prostate enlargement symptoms before the age of 40 is a rare condition. As age progresses, symptoms related to prostate enlargement become much more common.
Family History: An individual, who has a close relative (such as his father) with prostate problems, is more likely to develop benign prostate enlargement compared to other individuals.
Diabetes and Heart Disease: Diabetes, heart disease, and certain blood pressure medications raise the risk of developing benign prostate disease.
LifeStyle: Obesity increases the risk of prostate enlargement. In addition, experts think that factors such as smoking, socioeconomic status, and diet play a role in benign prostate enlargement as well.
Race: Prostate enlargement and other prostate diseases are more common in black men than in white men.
Geography: This disease is seen with different incidence rates in different parts of the world. For example; it is quite common in the USA, Australia, and northern Europe, while it is rare in southern and eastern Asia, Africa, and South America. It is highly difficult to explain how geography affects this condition.
Genetic Features: In some people, cancers or some chronic diseases develop due to a variety of disorders in genes. In some cases, there is no disease gene from any of the parents. However, when a person is exposed to certain environments, chemicals, or harmful rays, disorders occur in his genes and consequently, the disease develops. These types of genetic disorders are not passed on to children.
Signs and Symptoms
Complaints due to stimulation of the urinary bladder (Irritative):
- Frequent urination (day and night)
- Sudden urge to urinate
- Urinary incontinence when feeling the urge to urinate
- Burning and stinging sensation while urinating
Problems due to occlusion (Obstructive):
- Decrease in urine strength and thickness
- Difficulty in starting urination
- Intermittent urination
- Dripping after urination
- The feeling of incomplete urination
- Blood in the urine
Treatment Options for Benign Prostate Enlargement
Prostate enlargement is a curable disease. It is possible to get rid of this disease with appropriate treatment planning based on the condition of the patient.
Drug therapy is the most common way of treatment for mild to moderate BPH symptoms. Drug therapy options include:
- Alpha-blockers: These medications relax the bladder neck muscles to make it easier to urinate. Alpha-blockers including Alfuzosin (Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and Silodosin (Rapaflo) often work fast in men who have relatively small prostates. Side effects may include dizziness and a harmless condition in which semen goes back instead of getting out the tip of the penis (retrograde ejaculation).
- 5-alpha reductase inhibitors: These drugs shrink your prostate by preventing hormonal changes that lead to prostate enlargement. It may take about six months for these medications including Finasteride (Proscar) and Dutasteride (Avodart) to show their effects. Side effects include retrograde ejaculation.
- Combination drug therapy: If any medication alone is not effective, your physician may recommend taking an alpha-blocker plus a 5 alpha-reductase inhibitor
- Tadalafil (Cialis): Research shows that this drug commonly used to treat erectile dysfunction can also treat prostate enlargement.
Minimally Invasive or Surgical Treatment
Minimally invasive or surgical treatment procedures can be recommended for patients with kidney problems and those who have moderate symptoms that could not be treated with medications.
However, minimally invasive or surgical treatment is not recommended for those with untreated urinary tract infection, those with urethral stricture, those with Parkinson’s disease, and those who have had radiation therapy for their prostate.
There are several types of minimally invasive or surgical treatment.
- Transurethral resection of the prostate (TURP)
- Transurethral incision of the prostate (TUIP)
- Transurethral microwave thermotherapy (TUMT)
- Transurethral needle ablation (TUNA)
- Laser treatment (HoLEP or ThuLEP)
- Prostatic urethral lift (PUL)
- Open or robot-assisted prostatectomy
Any type of treatment procedure intended for the prostate can cause side effects. Depending on the treatment procedure you choose, complications can include:
- Semen flows back into the bladder instead of getting out of the penis during ejaculation (retrograde ejaculation)
- Temporary difficulty with urination
- Urinary tract infections
- Erectile dysfunction
- Despite being rare, loss of bladder control (incontinence)
Frequently Asked Questions (FAQ)
Does Frequent Sexual Intercourse Cause Prostate Gland Enlargement?
Prostate gland enlargement has definitely nothing to do with the frequency of sexual intercourse. This enlargement can be seen not only in those who have frequent sexual intercourse but also in those who do not. Contrary to popular belief, prostate enlargement has nothing to do with such things as libido.
What Kinds of Complaints Does Benign Prostate Enlargement Cause?
The complaints include frequent urination, sudden urge to urinate, need to strain to start urination, intermittent or thin urination, inability to empty the bladder completely, and dripping after urination.
Is waking up at night to urinate a sign of prostate disease?
No. If the patient wakes up and goes to the toilet more often at night than during the day, especially by waking up from sleep, the condition is more likely to be associated with heart failure, nocturnal polyuria, diabetes, and medications used. Of course, this condition should be investigated by an experienced urologist.
Does Benign Prostate Enlargement Always Cause Difficulty with Urination?
No, it doesn’t. Benign prostate enlargement starts in the tissues around the urinary canals. If the prostate enlargement is towards the urinary canals, patients begin to have complaints about urination.
If the prostate enlargement is towards regions away from the urinary canals, then the patient does not have urinary complaints, despite the test results showing a prostate enlargement.
Is There a Relationship Between Prostate Sizes and Complaints about Urination?
No. If the prostate enlargement is directly towards the urinary canals, the patient may have serious complaints about urination, even if the prostate is not found to be too large in the ultrasound results. Despite that, if the prostate enlargement is towards regions away from the urinary canals and outside the prostate, urinary complaints may not occur in the patient, even if the ultrasound result shows that the prostate has enlarged to a considerable extent.
Which Diseases Beside Benign Prostate Enlargement Cause Difficulty with Urination?
When complaints about urination start in a man over 50, and when tests show an increase in prostate size, the complaints about urination are thought to be due to prostate enlargement. This is one of the biggest mistakes.
Besides prostate enlargement, overactive bladder, neurogenic bladder, urinary tract infection, prostatitis, urethral strictures, bladder cancer, distal ureteral stones, and foreign bodies in the urinary bladder can also lead to similar complaints about urination. If you are mistakenly diagnosed with an enlarged prostate, you cannot benefit from the treatment applied to you and may even have unnecessary surgery.
When Should a Patient with Benign Prostatic Enlargement be Treated Surgically?
If the patient’s complaints about urination do not go away despite drug treatments and if the complaints have been found to be due to prostate enlargement, the patient should be treated with surgery. Surgery should also be recommended for those with recurrent urinary tract infections due to prostate enlargement, those with recurrent hematuria, and those with kidney disorders due to the inability to urinate. In addition to these, surgery is also recommended for those who have stones in their bladder due to prostate enlargement or those who cannot completely empty their bladder.
What Happens if a Patient with Benign Prostate Enlargement Stays Away from Surgery Even if It is Necessary?
There are 2 factors affecting the urination function; adequate contraction of the urinary bladder and an open urinary canal. Benign prostate enlargement can cause obstruction in the urinary canal.
When the urinary canals are blocked due to benign prostate enlargement, the urinary bladder starts contracting more strongly to overcome this obstruction. At this stage, the patient does not have considerable complaints. In the course of time, the bladder muscles begin to get tired, and then the bladder cannot contract adequately.
If left untreated, the bladder gets damaged permanently. Once the urinary bladder gets damaged, the patient can no longer have a chance to urinate normally. In case of prolongation of the period without treatment, the kidney functions of the patient are also permanently impaired.
Are there any Drugs that Can Save the Patient from Surgery by Stopping the Progression of Prostate Enlargement?
Benign prostate enlargement is a progressive disease. As the patient gets older, his prostate keeps growing. Most of the drugs used in the treatment of benign prostate enlargement are intended to improve the patient's complaints.
Only 5 alpha-reductase group drugs have the effect of stopping the progression of the disease by 15-20% and saving the patients from surgery.
Recommendations for a Comfortable Life in Case of Prostate Enlargement
If you do not have serious complaints about urination (this should be determined by your physician), it is possible for you to make your life more comfortable by making some adjustments in your life. These regulations can be listed as taking precautions against constipation, regulating daily fluid intake, avoiding caffeinated and alcoholic beverages, re-regulating the use of diuretic drugs, increasing the capacity of the urinary bladder with bladder exercises, stroking the penis to prevent dripping after urination, and using double voiding techniques.
Does Prostate Enlargement Become Cancerous?
Prostate enlargement and prostate cancer are two diseases differing from each other. There is no relationship between prostate enlargement and the development of prostate cancer. However, prostate enlargement and prostate cancer can develop simultaneously. Therefore, prostate cancer screening should definitely be performed on patients with benign prostate enlargement. This should not be neglected.
Distinguishing between prostate enlargement and cancer is a job that a urologist can do. The urologist will reveal this condition with both a physical examination based on the sensations taken from the prostate through the finger and a simple blood test called PSA.
It should be remembered that prostate enlargement and prostate cancer can coexist. Therefore, every patient who develops symptoms of prostate enlargement should be screened for prostate cancer.