An old age problem

Symptoms of BPH also can be caused by other conditions, including prostate or bladder cancer, kidney stones, and overactive bladder. Overactive bladder causes a strong, frequent, uncomfortable need to urinate immediately…
By Dr Abhinav Veerwal

As man gets older his prostate gets larger and this condition is known as Benign Prostatic Hyperplasia (BPH(, 50% men at age 50 have enlarged prostate & 80% at age of 80. Prostate is chestnut shaped gland and is part of male reproductive system. BPH isn’t a cancer, but it can cause health problem such as:

Common Symptoms of Prostate Disorders:
Increased frequency of urination especially at night, which reduces quality of sleep, Sudden or urgent need to urinate
Painful or difficult urination
Slow flow of urine and difficulty in stopping Terminal dribbling or leaking
Incomplete emptying of the bladder If you get any of the symptoms you should contact your Urologist.

These symptoms tend to appear over time and may gradually worsen over the years. However, some men have an enlarged prostate that causes few or no symptoms, while other men have symptoms of BPH that later improve or stay the same. Some men are not bothered by their symptoms, while others are bothered a great deal. In a small percentage of men, untreated BPH can cause urinary retention, meaning that the man is unable to empty the bladder. The risks of urinary retention increases with age and as symptoms worsen.

Prevention
Since it’s a ageing phenomenon which is till date irreversible. But it may be delayed by adopting certain life style modifications such as
Eat healthy
Reduce Stress
Regular physical activity
Quit Smoke

How to Assess Your Prostate Health:
Begin regular prostate exams at age 50 (or sooner if you are experiencing symptoms or have high-risk factors)
Know your urology numbers

-AUASS is the American Urological Association Symptom Score demonstrates symptom severity of BPH

-Prostate Specific Antigen (PSA) indicates issues with the prostate including cancer, its screening in appropriately selected patients helps detect cancer of prostate at early stages.

Evaluation
In addition to above two, Digital Rectal Examination, Urinalysis, Uroflowmetry, Rectal Ultra sound, Post void Residual Volume may be needed, tests which are readily available at Urology clinics

Potential Medical Consequences of BPH:
Urinary retention
Urinary tract
infections
Bladder stones
Blood in the urine
Incontinence
Decreased kidney function

BPH TREATMENT:
Treatments for BPH can help to reduce urinary symptoms. Treatment options include medicines and surgery. Men with mild BPH might not need treatment. In this case, most experts recommend a “wait and watch” approach. This means that you will watch your symptoms over time. In some cases, BPH symptoms improve without treatment. However, men with moderate to severe symptoms usually require treatment

Lifestyle changes — Behavioral modifications and therapies may be helpful, particularly as an adjunct to medication. Lifestyle changes include avoiding fluids prior to bedtime or before going out as well as reducing consumption of mild diuretics such as caffeine and alcohol. Pelvic floor muscle training, including the use of biofeedback, may be particularly helpful for patients with urgency symptoms.

All men with BPH should avoid medicines that can worsen symptoms or cause urinary retention. These include certain antihistamines (such as diphenhydramine [Benadryl]) and decongestants (eg, pseudoephedrine [found in some cold medicines]).

Lifestyle changes are recommended if you are bothered by having to go to the bathroom frequently. This includes:
Stop drinking fluids a few hours before bedtime or going out.
Avoid or drink less fluids that can make you go more often, like caffeine and alcohol.
Double void. This means that after you empty your bladder, you wait a moment and try to go again. Do not strain or push to empty

Medications : The types of medicine used to treat BPH include alpha blockers, phosphodiesterase inhibitors, and alpha-reductase inhibitors. Men who also have erectile dysfunction may consider a phosphodiesterase inhibitor over the other options. Most men with BPH who start taking a medicine will need to take it forever to relieve symptoms unless they have some type of prostate surgery.

Combination treatment — A combination of an alpha blocker and an alpha-reductase inhibitor might be recommended for certain men. This may benefit men:
With severe symptoms
With a large prostate
Who do not improve with the highest dose of an alpha blocker

Transurethral procedures — If medicines do not relieve your symptoms of BPH, a treatment to remove or destroy some of the prostate tissue around the urethra may be recommended. Most procedures are performed through the urethra using a special scope. Each treatment has advantages and disadvantages, and the best treatment depends upon the size and location of the excess prostate tissue, your surgeon’s expertise, and your preferences. Your doctor can help you choose the best course of treatment.

Surgery is more effective in properly selected patients and long track record of success after treatment:
Go home shortly after treatment Urinary catheter may be required for a day Can resume to normal activities within 24-48 hrs Symptoms improvement generally seen within 8 to 10 weeks of treatment

CONCLUSION:
General population today should be well aware of the sign & symptoms of BPH. Detecting the symptoms early can prevent many unwanted complications. Both medical and surgical managements of BPH are effective and results of TURP, which is now the gold standard, are excellent in properly selected cases.

(The author is Urologist with interest in lower tract diseases practising in Noida)