Everything you need to know about BPH (Enlarged Prostate)

What is BPH?

Benign Prostatic Hyperplasia, or BPH, is a condition associated with the enlargement of the prostate gland. The prostate gland in males is located below the urinary tract surrounding the urethra. The condition is referred to as benign, suggesting it is not cancerous. The term ‘prostatic’ is associated with the prostate gland, and ‘Hyperplasia’ refers to the enlargement of the gland.

The primary function of the prostate gland is to produce the fluid that nourishes and transports sperm (seminal fluid). However, people with an enlarged prostate find it difficult to empty their bladder properly due to the narrowing of the urethra. This results in the frequent urge to urinate, especially at night. It is estimated that more than 70% of men are likely to have an enlarged prostate over 50 years, out of which 25% require surgical procedures.

How does BPH occur?

The leading cause of BPH or enlarged prostate is still under debate. However, prostate gland enlargement mainly occurs due to hormone changes that trigger prostate cell growth. Some studies have revealed that high levels of dihydrotestosterone (DHT), which is found mostly in men older than 50 years supports prostate development. Other reasons for BPH can be lifestyle, eating disorders, obesity, heredity, etc.

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Prostate-Enlargement Causes & Symptoms

Enlarged Prostate Causes

• Aging

• Infection in the urinary tract

• Inflammation of the prostate

• Change in male sex hormones

• Damage or injury to the testicles

Enlarged Prostate Symptoms

• Increased frequency of urination at night (nocturia)

• Difficulty starting urination

• Inability to urinate (in severe cases)

• Weak urine stream

• Blood while urinating

• Dribbling at the end of urination

• Inability to completely empty the bladder

Prostate-Enlargement Diagnosis

Diagnostic Test for BPH:

The doctor will recommend the following tests to rule out the possibility of enlarged prostate due to other conditions. Some of the diagnostic tests include –

• Ultrasound – Doctors generally recommend an ultrasound of the prostate gland to detect any abnormal growth within the prostate using 3D imaging. This test helps determine the amount of enlargement around the prostate.
• Prostate-specific antigen (PSA) blood test – Doctors usually recommend a PSA blood test to check for any increased PSA levels in an enlarged prostate. This helps the urologists to detect signs of prostate cancer.
• Urinary flow test – This test is done to measure the strength and amount of your urine flow and determine if the condition is stable or getting worse with time.
• Postvoid residual volume test – Sometimes, when the patient is unable to empty the bladder completely, this test is recommended to measure the amount of urine left in your bladder after the urination. This is done via ultrasound or inserting a catheter into your bladder.
• 24-hour voiding diary – The doctors recommend this test to record the frequency and amount of urine expelled, especially if more than one-third of your daily urinary output occurs at night.
• Urine test – The doctor analyzes a sample of your urine to rule out any signs of infection or other conditions that can lead to similar symptoms.
• Blood tests – Blood tests indicate any infections in the kidneys and indicate abnormal functioning.

BPH Diagnosis by the doctor:

The diagnosis for enlarged prostate involves a combination of physical examination along with some tests to confirm BPH. Since heredity is a risk factor for BPH, the doctor analyzes your family history report. These diagnostic exams are recommended by the doctor in case of moderate as well as complex cases-

1. Digital rectal exam – The doctor inserts a finger into your rectum to check for any signs of prostate enlargement.
2. Cystoscopy – A light, flexible scope called a cystoscope is inserted into your urethra to allow the doctor to see inside your bladder.
3. Prostate biopsy – The doctor uses needles guided by a transrectal ultrasound to take a tissue sample of the prostate and analyze the tissue to rule out the chances of prostate cancer.
4. Urodynamic and pressure-flow studies – This test measures the bladder pressure and determines how well your bladder muscles work using a catheter that is inserted through your urethra.

Prostate-Enlargement SEVERITY

BPH SEVERITY

The severity of BPH is categorized into three grades based on the comprehensive review of the lower urinary tract symptoms, digital rectal examination, urinalysis, and PSA measurement. The scores are given with respect to AUA (American Urological Association) symptom index after careful observation.

Grade 1

score of 7 or less – Mild BPH

Grade 2

score of 8 to 19 – Moderate BPH

Grade 3

score of 20 to 35 – Severe BPH

Prostate-Enlargement Risks & Complications

During the surgery

The surgical procedures for BPH surgery are safe and efficient to treat enlarged prostate. However, like any other surgery, there are several risks involved with the procedure that can lead to several complications. It all depends on the medical condition of the patient and the surgical expertise of the surgeon.

Some of the risks associated with the different surgical procedures of BPH are as follows –

• Abnormal bleeding during the surgery that may require transfusion
• Improper fluid absorption
• Retrograde ejaculation; when semen flows into your bladder
• Erectile dysfunction
• Infection around the surgical site
• Urinary incontinence
• Urethral stricture that results in a ‘split-stream’ of urine
• Post TURP syndrome; symptoms include shortness of breath, seizures, and coma

Complications of an Open Prostatectomy

• Infertility
• Impotence
• Wound infection
• Overactive bladder
• Urine leakage when you feel the urge to urinate

If left untreated:

Enlarged prostate or prostatic hyperplasia is a serious medical condition that can lead to several health problems in men above 50 years of age. Some several risks and complications can result due to prolonged BPH. Therefore, it is important to consult your doctor as soon as you experience Enlarged Prostate Symptoms.

If left untreated, BPH can cause-

• Sudden inability to urinate
• Urinary tract infections
• Kidney stones
• Bladder damage
• Kidney damage

Prostate-Enlargement Prevention

There are several lifestyle changes that can help you prevent BPH and keep your prostate healthy. These include several lifestyle changes and dietary restrictions. Here are some measures that can prevent BPH –

• Avoid supplements
• Keep a healthy body weight
• Avoid red meat and processed meat
• Encourage consumption of fruits and vegetables

When to consult a Urologist for BPH treatment?

It is important to seek medical attention if you’re having issues related to the urinary tract. Patients who experience symptoms associated with an enlarged prostate, such as improper emptying of the bladder, nocturia, or any obstruction in the urinary tract, are at risk of BPH. Consult a urologist if you are experiencing the following symptoms –

• Nocturia
• Frequent urination
• Blood in urine
• Erectile dysfunction
• Having trouble urinating

Prostate-Enlargement Treatment overview

Non-surgical

Non-surgical methods for BPH include various medications, dietary changes, and lifestyle modifications. However, these medications mostly reduce symptoms associated with the enlarged prostate and do not cure the disease.

Surgical

The surgical procedures for an enlarged prostate include minimally invasive techniques and laser surgery. However, the choice of surgery depends on the size of your prostate, the severity of the condition, your medical health, and the age factor. Surgical procedure is usually recommended when medications are ineffective that can progress the condition.

Prostate-Enlargement Insurance coverage

The surgeries for BPH are done to reduce symptoms that cause great discomfort due to enlarged prostate. Lack of treatment can cause severe complications that may require surgical procedures. Therefore, a surgical procedure to treat BPH is deemed a medical necessity.

So, some medical insurance companies cover the cost of surgical procedures for BPH partially or entirely. However, the insurance claim will depend on the type of your insurance policy and the terms and conditions set by the insurance provider. There are also other payment options to pay for the BPH surgery. A few of the insurance providers that may cover the cost of enlarged prostate are as follows:

1. Star Health Insurance
2. New India Health Insurance
3. Bajaj Allianz
4. Religare
5. ICICI Lombard
6. Insurance coverage for Benign Prostatic Hyperplasia

Prostate-Enlargement Recovery rate

The recovery from enlarged prostate surgery can vary depending on the patient’s health condition and the surgical expertise of the surgeon. The post-recovery tips provided by the doctor also depend on the type of surgical technique used for the procedure. However, it is important to consult with your doctor regularly to avoid any complications and ensure a faster recovery. Some of the post-operative care after your BPH surgery are-

Do not lift heavy equipment for around a week after your surgical procedure.
Restrict heavy exercises for about 6 weeks after prostatectomy.
Drink plenty of fluid during the first 2 weeks after the surgery to flush any new bleeding from the bladder.
Avoid alcohol and coffee for the first few weeks after the procedure.
Avoid food that can cause constipation or force you to strain during bowel movements.