Urolift benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia is a medical condition that comes with the enlargement of the prostate gland and surrounding tissue, often causing problems in the urination process for men. The prostate is a small gland located just below the bladder and in front of the rectum; it helps males in the reproductive system by secreting fluid into semen. Throughout a man's lifespan, the prostate grows once more, and two significant growth spurts happen. The first one occurs upon early pubescence where the prostate gets to increase twice its size, and finally, the second significant growth phase occurs approximately at age 25 and continues through a man's lifespan gradually. BPH usually becomes of clinical significance after the prostate has grown large enough to cause visible symptoms, more so when men get older

How the Prostate Works

The prostate surrounds the urethra, a tubular structure that conveys urine from the bladder out through the penis. Enlargement of the prostate can compress the urethra and result in urinary symptoms. The bladder wall thickens, and its contraction becomes less stretchy, which makes the bladder less efficient at emptying and leaves residual urine in the bladder; these changes can result in a variety of LUTS related to BPH.

Who Is at Risk for BPH?

Several risk factors make getting BPH more likely, including:

• Age: The chance of having BPH is greater for men aged 50 years or older.
• Family history: Researchers believe that some conditions—like BPH—might be inherited .
• Obesity: Men who are overweight or obese are more likely to get BPH.
• Inactivity: A man who is less physically active is more likely to get BPH.
• Erectile dysfunction: Some men who suffer from erectile dysfunction may discover that they develop BPH.

Signs and Symptoms of BPH

• Frequent urination: The urge to urinate every one to two hours, particularly at night.
• Incompletely emptying: that patients did not empty their bladder completely
• Frequency: The urge to urinate often
• Intermittency: Stopping and starting several times while urinating
• Urgency: A strong, sudden urge to urinate
• Weak stream: The urine flow is weak
• Straining: Trouble starting a urine stream or weak flow, and/or having to push or strain to urinate.

The true origin of the cause of BPH is not comprehensive, although it is more attributed to aging and hormonal changes. This theory examines the fluctuations of hormones, such as fluctuations of testosterone and constant levels of oestrogen, might be responsible for triggering the growth of cells surrounding the prostate. Other theories attribute the effects associated with dihydrotestosterone, which is said to support development in the prostate. Proportionally, the levels of DHT in older men are greater, despite levels of testosterone being lower, and that may be responsible for BPH.

Diagnosis of BPH

Diagnosis of BPH involves several tests and examinations:

Symptom Score Index

The BPH Symptom Score Index is clinically formulated by the American Urological Association (AUA) for the evaluation of the symptom of the patient's problem. This scale gauges the severity of the symptoms, include in the plan of treatment.

Physical Examination

A digital rectal examination is usually done. In a DRE, a health care provider inserts a lubricated, gloved finger into the rectum and feels the prostate to check for its enlargement and presence of any lumps or thinness.

U

Serial urine studies to evaluate the adequacy of the bladder emptying and evidence of infection or blood or any other anomalies. These studies include

• Urinalysis: Analysis of the urine for presence of blood, infection, glucose, and protein.
• PVR: Postvoid residual volume or the volume of urine in the bladder after micturition
• Uroflowmetry: Urine flow rate
• Urodynamic pressure flow study: to document the pressure in the bladder when the patient voids

Scans

Scans, including ultrasound, cystoscopy, MRI, and CT, visualize the exact size and shape of the prostate, assisting in determining the degree of enlargement, and preparing for the possibility of operation.

Blood Tests

Prostate cancer screening can be done with a blood test that gives an amount of the PSA present in the blood, commonly referred to as prostate-specific antigens. An increase in PSA in the blood, therefore referred to as PSA, is an indication of benign prostate enlargement, prostatitis, or prostate cancer.

BPH Treatment

Treatment for BPH depends on the severity of symptoms and personal wishes. It may comprise the following measures:

Watchful waiting

This is applied in cases of mild BPH. A patient is observed for significant changes in symptoms without instituting any treatment. Further, lifestyle changes, such as exercise and lifestyle, can be recommended.

Alpha- Blockers

The drugs are prescribed as management of BPH symptoms. They work to relax the muscles of the prostate and the bladder. Shearing or urine liking can be promoted. Alpha-blockers exist in multiple varieties.

5-Alpha reductase inhibitors: These act by inhibiting the action of DHT to make the prostate gland smaller. Eg, dutasteride, finasteride

Combined therapy: These medications are given together as combination therapy to get better results. They are both alpha blockers and 5-alpha reductase inhibitors

Antimuscarinics: These are used for symptoms of an overactive bladder.

Less Invasive Surgery

Minimally Invasive Surgical treatments (MIST) aim to give relief of symptoms but with a quicker return to activity. These include:

• Prostatic urethral lift (PUL): It involves the placement.
• Temporary Implantable Prostatic Devices (TIPD): Temporarily reshape the urethra.
• Prostate Artery Embolization (PAE): It blocks the blood supply to reduce the size of the prostate.
• Catheterization: It allows the urine to drain out of the body with a tube known as a catheter.

More Invasive Surgery

For critical cases and non-successful treatments of the above methods, the surgeon might recommend the following more invasive procedures:

• Transurethral incision of the prostate (TUIP): It makes small non-cuts in the prostate.
• Transurethral resection of the prostate (TURP): Removes prostate tissue with a resectoscope.
• Holmium laser enucleation of the prostate (HoLEP): Uses a laser experience to remove the excess tissue.
• Thulium laser enucleation of the prostate (ThuLEP): Uses the same principle as that of Holmium, but it uses a different kind of laser.
• Transurethral vaporization of the prostate (TUVP): I involves removing the tissue by killing it through electrical current.
• Transurethral water–jet ablation (TWJA): Removes the tissue via water jets.
• Simple prostatectomy: An operation that involves removing the entire gland of the prostate

Most men experience a reduction of symptoms with treatment. The time to complete recovery is variable depending on the procedure done, and many often have short-term complications like infection, bleeding, incontinence, or scarring. However, in the long term, most men achieve excellent outcomes, with the majority experiencing a great reduction in the symptoms associated with an enlarged prostate.

PREVENTION AND LONG-TERM CARE

While it does not ensure that BPH will be prevented, much can be done toward the goal of increasing a person's chances of longevity by maintaining a healthful weight, enjoying a balanced diet with plenty of fruits and vegetables, and staying active. In established cases, medications can be continued, and lifestyle changes can be effected for treating residual or recurring symptoms.

In summary, BPH is a common health condition that affects many men as they age. Understanding the symptoms, risk factors, and available treatments can help manage this condition effectively and improve quality of life.