Benign Prostatic Hyperplasia (BPH)

By Dr. Ali Ahmed Jourieh

Benign Prostatic Hyperplasia (BPH) is a common condition among men as they age, characterized by a non-cancerous increase in the size of the prostate gland. Although it is benign and does not turn into cancer, it can cause bothersome urinary symptoms that affect the quality of life.

Causes and Risk Factors

The exact cause remains unclear, but the most significant factors include:

• Aging: The most important factor.

• Hormonal Changes: Specifically, the increased effect of Dihydrotestosterone (DHT).

• Genetic Predisposition: Family history of the condition.

Symptoms

Symptoms are categorized into storage and voiding symptoms:

1. Storage Symptoms:

• Frequent urination.

• Nocturia (waking up at night to urinate).

• Urinary urgency.

2. Voiding Symptoms:

• Difficulty starting urination (hesitancy).

• Weak or interrupted urinary stream.

• Sensation of incomplete bladder emptying.

• Post-void dribbling.

Complications

• Acute urinary retention.

• Recurrent urinary tract infections (UTIs).

• Bladder stones.

• Bladder weakness.

• Kidney damage and renal failure in advanced cases.

Diagnosis

Diagnosis is based on:

• Clinical history and physical examination (including a Digital Rectal Examination - DRE).

• Urinalysis.

• PSA (Prostate-Specific Antigen) test to rule out cancer.

• Additional tests when necessary, such as: uroflowmetry, ultrasound (Echo), or cystoscopy.

Treatment

1) Watchful Waiting (Observation)

For mild cases without a significant impact on daily life.

2) Lifestyle Modification

• Reducing fluid intake at night.

• Reducing caffeine consumption.

• Avoiding medications that worsen symptoms.

3) Medical Treatment

• Alpha-blockers: Such as Tamsulosin, which significantly improve symptoms.

• 5-Alpha Reductase Inhibitors: These reduce the size of the prostate over time.

4) Surgical Treatment

For severe or non-responsive cases:

• Transurethral Resection of the Prostate (TURP): The most common procedure.

• Laser Techniques or Vaporization.

• Open Prostatectomy: In selected cases.

Summary

Benign Prostatic Hyperplasia is a common age-related condition. It is non-cancerous but can cause distressing urinary symptoms. Treatment usually begins conservatively and scales according to severity, with good outcomes in most cases.

Urology Clinic Dr. Ali Ahmed Jourieh Syria - Damascus