BPH (benign prostatic hyperplasia) / Prostate enlargement

• The prostate is a small gland deep in the pelvis, found only in males
• It is situated below the bladder and the urethra (urine tube) passes through it and as a result some prostate conditions may result in urinary symptoms
• It produces the semen fluid which is necessary for healthy sperm

• The exact cause of BPH remains unclear however there appears to be a genetic link (family history and racial background) and may be associated with a change in the balance of sex hormones as men age. There may also be an association with dietary and lifestyle factors
• BPH is benign (non-cancerous) prostate enlargement; most men have continued prostate enlargement throughout life
• It affects 50% of 50 year-olds and the incidence increases with age
• It may cause obstruction of the urethra (urine tube) which passes though the prostate, leading to bothersome urinary symptoms
• The symptoms often develop slowly; it is not uncommon for patients to have advanced disease by the time they seek help

They symptoms of BPH or benign prostate enlargement can vary in their nature and severity and often include:

• Straining or difficulty in beginning urination
• Weak stream/flow of urine
• Stop and start urine flow
• Incomplete emptying of the bladder
• Frequent urination including overnight, causing sleep disruption
• Sudden urge to urinate and dribbling

Less common symptoms may include (you should seek immediate attention):

• Blood in the urine*
• Complete inability to urinate (urinary retention)
• Urinary tract infection (may lead to septicaemia/blood poisoning)
• Painful urination*

To diagnose BPH, the Urologists at Melbourne Urology Centre will take a thorough history to assess the nature and severity of your symptoms. Your Urologist will perform an examination and arrange further investigations as necessary which may include:

• Questionnaire (IPSS*) which will assist in making the diagnosis as well as monitoring your response to treatment
• Mid stream urine test – to exclude infection or blood in urine
• PSA blood test*
• Renal tract ultrasound – to assess prostate size, bladder emptying and kidney health
• Flow rate – to measure your urine flow and bladder emptying
• Flexible cystoscopy*

There is no one-size-fits-all when it comes to treatment of benign prostatic hyperplasia (BPH). Your Urologist will make an individualized assessment of your case and discuss the most appropriate treatment options for you. The Urologists at the Melbourne Urology Centre offer the full range of world-class medical and surgical treatment options available for enlarged prostate (BPH):
Medical therapy

• Alpha Blockers (Prazosin, Tamsulosin, Silodosin)
  • May provide symptom relief – doesn’t treat underlying cause
  • Works by relaxing the bladder neck and prostate
  • Does not change the natural progress of the disease
  • Side effects may include: dizziness/low blood pressure, fatigue or retrograde ejaculation (sexual dysfunction)
• 5A-reductase inhibitors (Dutasteride, Finasteride)
  • Up to 25% reduction in prostate size over 6-9 months by altering sex hormones
  • May improve symptoms and possibly reduce need for surgery
  • Up to 10% of men will have decreased libido (sex drive) and erectile dysfunction* (sexual dysfunction); this may be permanent
• Combination therapy (Duodart)
  • Tamsulosin + Dutasteride
  • More effective than either medication alone
  • Maximal effect in 6-9 months
  • Combined side-effect profile of both medications

Minimally invasive procedures

• Rezum Therapy
• UroLift System

Surgery

• Transurethral Resection of Prostate (TURP)
• Holmium Laser Enucleation of the Prostate (HoLEP)
• Green light laser ablation of Prostate
• Robotic Simple Prostatecomy (Da Vinci Robot)

• Lifestyle factors such as a healthy balanced diet high in fresh vegetables, fruit, nuts, minimal red meat and refined sugars, along with daily exercise, moderate alcohol and intake may assist with improving urinary tract health
• Measures such as reducing alcohol and caffeine as well as reducing evening fluids may improve symptoms
• Optimizing other health conditions such as diabetes, sleep apnoea and heart disease with the assistance of your family doctor may improve symptoms

• Urinary tract infection* – in men always needs evaluation
• Sepsis (blood poisoning) due to urinary tract infection
• Haematuria* – blood in urine
• Kidney failure due to high pressure retention of urine
• Bladder stones
• Permanent bladder damage

Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa

Edwards, J. L., (2008), Diagnosis and management of benign prostatic hyperplasia, American Family Physician, 77(10), [https://www.aafp.org/afp/2008/0515/p1403.html], accessed 15/2/21.

National Institute of Diabetes and Digestive and Kidney Diseases, (2014), Prostate Enlargement (Benign Prostatic Hyperplasia), [https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia], accessed 15/2/21.