Benign Prostatic Hyperplasia: A Pressing Issue

Benign Prostate Hyperplasia (BPH) or Benign Prostatic Enlargement (BPE) are prostatic diseases that arise with age.

The prostate gland is a part of the male reproductive system and it secretes nutrients for the sperm for reproduction. It naturally starts to grow from around the age of 35, however, it is not until later in life when it starts to pose as an issue.

The pressing issue of an enlarge prostate gland bears are its obstructive and/or irritative tendencies when it compresses on the urethra. These tendencies are symptoms known as Lower Urinary Tract Symptoms (LUTS).

These symptoms can be - hesitancy during urination, intermittent flow, greater frequency of urination, urgency and nocturia (the need to urinate 2 of more times at night).

If the causative disease is left untreated, complications will arise – often worsening the symptoms and quality of life. Ultimately, these complications can result in urinary tract infection, renal failure and urinary stone formation.

There are many social hinderances a man presenting with LUTS encounter. To name a few – avoiding visits to the cinema, places without toilets, outdoor sports, long drives (>2 hours) and the interruption of sleep and limited fluid intake before travel. The social impact of BPH should not be overlooked as the isolation of the man could lead to depression.

Beyond LUTS, a man with BPH may also encounter a very painful condition known as acute retention of urine (ARU) or simply the inability to urinate. Amongst younger patients, it may be due to urinary stone in the urethra, urethra trauma, stricture or prostatitis (prostatic infection). Whereas amongst older patients, it is often BPH aggravated by prostatitis, constipation, consumption of cough mixture or any other conditions that may paralyze the bladder. If presented with this condition, a patient will need to be catheterized alongside medication. If the condition is unresolved, surgery may be needed if it is due to an obstructing prostate.

The treatment provided for BPH is dependent on four clinical parameters: International Prostate Symptoms Score (IPSS), Quality of Life (QoL), Maximum Flowrate (QMax) and Residual Urine (RU). The former 2 tests can be done here, while the latter 2 require a physical Uroflow RU test.

From the parameters, a patient can be classified to have: mild, moderate or severe BPH.

Mild – High IPSS, low QoL and/or low Qmax scores with low RU.
Moderate – High QoL, regardless of IPSS and Qmax scores with low RU.
Severe – High RU, regardless of the other scores. Or presented with any BPH complications.

If you have a mild BPH, you will be observed and provided medication to control its growth. If you have a moderate or severe BPH, you have the option to undergo a Trans-Urethral Resection of the Prostate (TURP) procedure where your prostatic gland will be resected.

(updated : December, 2019)

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