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Benign Prostatic Hyperplasia (BPH)

Urology

Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, is a common condition in men characterized by symptoms such as difficulty urinating and frequent urination. It requires attention to treatment and lifestyle improvements.

Symptoms

According to statistics, about half of patients with benign prostatic hyperplasia (BPH) may not have any symptoms. As for those with symptoms, common signs include:

Frequency: The need to urinate more often.
Urgency: The need to find a restroom immediately.
Nocturia: The need to urinate multiple times during the night.
Weak urine stream: Reduced force in the flow of urine.
Urinary retention: Difficulty in completely emptying the bladder.

In severe cases, the bladder may be unable to void, leading to lower abdominal swelling and pain.

Factors

The exact cause of benign prostatic hyperplasia (BPH) is not fully understood, but age and changes in male hormone levels are the main influencing factors. As men age, the levels of the male hormone testosterone increase, which may lead to the proliferation of prostate cells.

Risk factors include:

Age	As age increases, the risk of developing benign prostatic hyperplasia also increases. In Hong Kong, over half of men aged 60 or above are affected, and for men over 80, 90% are patients.
Family History	If there is a family history of benign prostatic hyperplasia, the risk of developing the condition may be higher.
Race	The risk of benign prostatic hyperplasia is relatively lower in Asian men, while it is higher in African-American men.
Lifestyle	Unhealthy lifestyle habits, such as lack of exercise and poor dietary habits, may also influence the risk of developing the condition.

International Prostate Symptom Score (IPSS)

The American Urological Association proposes the International Prostate Symptom Score (IPSS). It is used as a self-assessment to determine the presence of benign prostatic hyperplasia (BPH) and its severity.

Criterion		Not at all: 0 Very few: 1 Less than half: 2 About half: 3 More than half: 4 Almost always: 5	Score
Urination condition	Weak Stream	Slow and weak urine stream
	Straining	Requires abdominal force during urination
	Intermittency	Intermittent urine flow during urination
	Incomplete Emptying	A feeling of incomplete emptying of the bladder after urination

Symptoms of urinary retention	Frequency	Need to urinate again within two hours after urination
	Urgency	Intolerable urgency to urinate immediately
	Nocturia	Waking up several times to urinate during the night after falling asleep
			Total Score
🙂Mild：0-7 🥶Moderate：8-19 🤢Severe：20-35			Total Score

Diagnosis

The medical diagnosis of benign prostatic hyperplasia includes:

Medical History	This includes a detailed description of symptoms and other possible related conditions.
Digital Rectal Examination (DRE)	A preliminary diagnosis of prostate abnormalities is made as the doctor inserts a finger into the rectum to feel the prostate.
Blood Tests	Conditions like benign prostatic hyperplasia (BPH), prostatitis, urinary tract infection, or prostate inflammation can cause an elevated Prostate-Specific Antigen (PSA) level in the blood.
Uroflowmetry	This test examines the speed of urine flow during urination to understand the voiding function of the bladder and urethra.
Ultrasound	It assesses the size and shape of the prostate and the residual urine volume in the bladder to diagnose the presence of benign prostatic hyperplasia.

Treatment

The treatment methods for benign prostatic hyperplasia (BPH) include the following:

Watchful Waiting: Doctors may recommend regular observation and monitoring for patients with mild symptoms to ensure that symptoms do not worsen. It typically involves regular medical check-ups and assessments.

Medication Therapy: Doctors may prescribe medications such as α-1 receptor blockers, 5α-reductase inhibitors, or combination drugs to alleviate symptoms. These medications can slow down the enlargement of the prostate and relieve urinary symptoms.

Minimally Invasive Surgery: For moderate to severe cases of BPH, doctors may recommend minimally invasive surgical procedures. Standard surgical methods include:

Transurethral Resection of the Prostate (TURP): Removing a portion of the prostate tissue through an instrument inserted into the bladder.
Laser Therapy: Using laser energy to vaporize or cut prostate tissue.
- Holmium Laser Enucleation of the Prostate (HoLEP): A minimally invasive surgery used to treat obstructive benign prostatic hyperplasia (BPH), resulting in moderate to severe lower urinary tract symptoms. This procedure utilizes a holmium laser to remove enlarged prostate tissue precisely and is performed through the urethra, eliminating the need for external incisions.
Bladder Neck Incision: Enlarging the bladder neck passage to improve urine flow.

Prostate Artery Embolization (PAE): By blocking the prostate artery, the blood supply to the prostate is reduced, reducing size.

Open Surgery: For extremely severe cases, open surgery to remove the prostate may be necessary.