What is benign prostatic hyperplasia (BPH)?
The prostate is a walnut-sized gland that sits beneath the bladder. The urethra, the pipe allowing urine to exit the bladder via the penis, passes through the prostate. As men get older the prostate can enlarge, compressing the urethra and making it difficult to pass urine. These men may develop symptoms such as a weak urinary stream, waking up at night to urinate, or being unable to defer urination when the urge arises.
What are the complications of BPH?
If left untreated, benign prostatic hyperplasia (BPH) may lead to a number of complications, including infections in the urine, bladder stones, complete inability to pass urine and kidney failure.
Complete inability to pass urine is called urinary retention. This is called acute urinary retention if it occurs suddenly and causes worsening pain as the bladder fills. Chronic urinary retention occurs if a man carries around a large volume of urine in his bladder but does not experience pain. These men often leak urine at night without realising it, a phenomenon called overflow incontinence.
An enlarged prostate is not the only cause of bladder symptoms. Obstruction may occur due to narrowing of the urethra, blood clots or stones. Conditions that affect the nerves leading to bladder, such as spinal cord injury or multiple sclerosis, can also cause urinary retention.
How is BPH treated?
BPH can be treated initially with medications that either: 1) relax the muscles with the prostate or; 2) shrink the gland over time. These medications can be used alone or in combination, depending on the circumstances of each patient, with the combined approach yielding better results. Surgery will most likely be required for patients who do not respond to medication or develop complications like retention or recurrent infections.
Transurethral resection of the prostate (TURP) is an operation for treating enlargement of the prostate gland due to BPH. During TURP the part of the gland causing blockage is removed using instruments that are passed through a telescope down the urethra. Depending on the size of the prostate, the operation can take about 40 minutes to 1 hour.
A bladder neck incision is used for patients with small prostates or those who have obstruction caused by narrowing or scarring at the bladder neck. Instead of boring out the prostate as in a TURP, the gland is cut at strategic locations to allow it to spring open.
In laser ablation the obstructing prostate tissue is vaporised using a laser fibre passed down a telescope in the urethra. It is usually associated with less bleeding, and patients can usually remain on their blood thinning medication.
Some men with BPH develop stones in the bladder as a result of poor bladder emptying. These stones can be broken down and removed, often at the same time as TURP, using either a laser fibre or special instruments passed down the telescope.