Benign Prostatic Hyperplasia (BPH)

Definition:

• Non-malignant enlargement of the prostate gland due to proliferation of stromal and epithelial cells.

Etiology:

• Exact cause unknown, but related to ageing and the influence of androgens (testosterone).
• Common in men >50 years of age.

Clinical Presentation:

• LUTS (Lower Urinary Tract Symptoms):
  • Obstructive: weak stream, hesitancy, incomplete emptying, post-micturition dribble, straining.
  • Overactive/Irritative: urgency, frequency, nocturia.
• Recurrent UTIs.
• Bladder stones.
• Acute urinary retention.

Investigations:

• DRE (Digital Rectal Examination): Enlarged, smooth, firm prostate.
• PSA (Prostate-Specific Antigen): Elevated but non-specific, done to exclude prostate cancer.
• Urinalysis: Rule out UTI.
• Uroflowmetry: Measure urinary flow rate.
• Post-micturition bladder scan: Assess residual urine volume.
• Cystoscopy.

Management:

• Watchful waiting for mild symptoms.
• Alpha-blockers (e.g., tamsulosin): Relax the smooth muscle of the prostate and bladder neck.
• 5-alpha-reductase inhibitors (e.g., finasteride): Shrink the prostate by reducing dihydrotestosterone (DHT) levels.
• Minimally invasive therapies: TUMT (transurethral microwave thermotherapy), TUNA (transurethral needle ablation).
• Surgery: TURP (transurethral resection of the prostate) for those with significant symptoms or complications.

Complications:

• Urinary tract infections.
• Acute urinary retention.
• Chronic kidney disease due to chronic bladder outlet obstruction.

Prognosis:

• Most men experience progression of symptoms over time, but timely treatment can manage symptoms effectively.