Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) or benign enlargement of the prostate (ICD-10 code – N40) is a chronic, progressive disease of the prostate, closely associated with the aging factor. It involves the enlargement of the gland primarily due to the increase in glandular or stromal components of the organ.

The disease is very common among elderly men and has an unfortunate trend of "becoming younger": it occurs in 10-20% of men under 40 years old and nearly 90% by the age of 80. On average, 20 out of 1000 men will consult a specialist about the symptoms of this disorder by the end of the year, although the actual prevalence of the disease is much higher.

Unfortunately, about two-thirds of men with symptoms of urinary disorders or erectile dysfunction will not visit a doctor due to stigma and feelings of embarrassment. Therefore, even with such a diagnosis, not all patients understand what benign prostatic hyperplasia is.

The specific cause of the pathology remains unidentified to this day, with most experts leaning towards a multifactorial theory of etiology. Among the possible aspects influencing the formation of the disease are:

• Age-related changes – with age, men have an increased concentration of estradiol and dihydrotestosterone, which stimulate the receptors of the prostate and lead to its growth;
• Genetic predisposition – particular sensitivity of the prostate gland receptors, increased concentration of certain hormones in the body;
• Diabetes mellitus – against a background of increased glucose concentration, the growth of many benign and malignant tumors is accelerated;
• Excessive body weight – obesity leads to an increase in estrogen levels and a decrease in testosterone levels, which accelerates prostate growth (as with age-related changes);
• Improper diet – fatty, smoked, fried food in large quantities, first, increases the risk of obesity, and second, can itself affect the hormonal balance for the worse.

There are also certain risk factors for the development of benign prostatic hyperplasia, in the presence of which the disease may appear more likely or progress more rapidly:

• Age – the older a man gets, the higher his risk of developing the disease;
• Increased concentration of prostate-specific antigen (PSA);
• Increased size of the prostate gland;
• Symptoms of urinary disorders.

The manifestations of the pathology significantly worsen the quality of life of the patient, so it is necessary to visit a doctor at the very early stages of manifestation to prevent their progression. Among the symptoms of BPH are:

• Increased frequency of urination and decreased volume;
• Inability to hold back the urge, urine leakage;
• Decreased urine stream pressure, intermittency, spraying;
• The need to strain the abdominal wall muscles to start urination;
• Sensation of residual urine in the bladder;
• The need to wake up at night to empty the bladder.

Symptoms of benign prostatic hyperplasia are not very specific and can resemble various urogenital infections, kidney stone disease, and other pathologies of the urinary and reproductive systems. The manifestations of disturbed urination are classified using the IPSS (International Prostate Symptom Score) test.

Initially, during a consultation, the doctor collects the patient's history and the most troubling complaints, offers various questionnaires (e.g., IPSS) for more accurate classification. After that, additional physical, laboratory, and instrumental examinations are conducted to diagnose the disease and exclude other pathologies (e.g., oncology):

• Digital rectal examination – for direct palpation of the prostate;
• General urine and blood analysis;
• Biochemical urine analysis – evaluation of creatinine levels;
• Biochemical blood analysis – evaluation of PSA levels;
• Ultrasound of the prostate gland (preferably transrectal) and bladder with determination of residual urine volume;
• Uroflowmetry – evaluation of dynamic characteristics of the urine flow.

Without timely medical intervention, ignoring the specialist's recommendations, or incorrect, self-administered medication, BPH can lead to the following disorders:

• Chronic infectious process in the urogenital system;
• Kidney stone disease;
• Acute urinary retention;
• Appearance of blood in the urine;
• Kidney dysfunction.

Depending on the severity of the disease, the presence or absence of comorbidities, the patient's age, and other criteria, the doctor chooses conservative or surgical therapy for BPH. In mild cases with a slight enlargement of the prostate, behavioral and medication assistance is sufficient:

• It is not recommended to drink a lot of water and diuretic products at night;
• It is essential to empty the bladder before going to bed;
• Control the intake of diuretics before bedtime;
• Alpha-blockers – are the first-line therapy, which can reduce the symptoms by almost half;
• 5-alpha-reductase inhibitors – for a sufficiently large gland or when PSA is elevated;
• Herbal remedies – there is no proven efficacy, but phytotherapy is quite popular in many countries;
• Vasopressin analogs – to eliminate nighttime awakening.

If conservative options do not yield results or the patient's initial condition is severe, surgical treatment of benign prostatic hyperplasia is recommended. The following surgical options are used:

• TURP (transurethral resection of the prostate) – the most common and effective operation for BPH;
• Open adenomectomy – used for a large volume of the prostate;
• Transurethral incision of the prostate – applied to patients with a small gland;
• Modern laser technologies;
• Interstitial laser coagulation – used for patients with coagulation disorders (e.g., due to anticoagulant therapy).