The benign prostatic hyperplasia (BPH) is the benign enlargement of the prostate. Older men are particularly affected. With increasing prostate enlargement, there are usually unpleasant symptoms when urinating. Lighter stages of benign prostatic hyperplasia are first treated with medication, and if there are pronounced symptoms or complications, surgery is performed.
Benign prostatic hyperplasia: description
Benign prostatic hyperplasia (BPH) describes a benign enlargement of the prostate. “Benign” means that although there is an increase in the number of cells in the prostate , it is not as aggressive and uncontrolled as with malignant growth (cancer). The increasing tissue in benign prostatic hyperplasia does not grow into other structures and does not spread. So there are no metastasis (daughter tumors) as in prostate cancer.
Benign prostatic hyperplasia is therefore neither a form of cancer nor a precursor to it. Nevertheless, the increase in volume of the organ results in increasing complaints for those affected.
Location and anatomy of the prostate
The prostate (prostate gland) resembles a chestnut in shape and size. It is located just below the urinary bladder and in front of the rectum. In the normal state it weighs between 20 and 25 grams, in contrast, in the case of pronounced benign prostatic hyperplasia, it weighs up to 150 grams.
The uppermost section of the urethra runs through the prostate . In addition, the vas deferens (transports the sperm from the testes ) and the excretory duct of the vesicle gland (produces secretion for the ejaculate) unite in the prostate to form the so-called injection tubules. This also flows into the urethra within the prostate. The spermatic duct, vesicle gland and tubules are paired.
The prostate can be divided into three zones from the inside out:
The innermost zone (periurethral mantle zone or transition zone) directly surrounds the urethra. There are small secretory glands in it. The next layer is the “inner zone”. It makes up about a quarter of the total mass of the prostate. The two small spray ducts run in it. The outermost layer (outer zone or peripheral zone) also contains secretion-producing glands. They account for almost three quarters of the weight of the prostate. The prostate is surrounded by a tough layer of connective tissue (capsule) on the very outside.
Function of the prostate
The prostate gland consists of many smaller glands that produce a secretion that protects the sperm and stimulates movement. It makes up 30 percent of the ejaculate and is released into the urethra. In addition, the so-called prostate-specific antigen (PSA) is formed in the prostate – an enzyme that makes the sperm liquid.
Layers of connective tissue and smooth muscles lie between the glands of the prostate. With the help of the muscle cells, the prostate can rhythmically contract during orgasm and thus expel the ejaculate.
What happens with benign prostatic hyperplasia?
In medicine, the term “hyperplasia” describes the excessive increase in the number of cells in a tissue. In the case of prostatic hyperplasia, this primarily affects the cells of the connective and muscle tissue located between the glands, but also the gland cells themselves.
According to the current state of research, the increase in the number of cells is due to the fact that natural cell death (apoptosis) slows down (and not through an increased cell proliferation).
The increase in the number of cells in benign prostatic hyperplasia can only be seen in the periurethral mantle zone. The outer zone of the prostate gets more and more distressed by the growing transition zone until it only appears as a thin layer.
The fact that there are many glands in the outer zone also explains why the prostate’s secretory capacity decreases somewhat in the case of benign prostatic hyperplasia, although there are more cells overall.
In contrast to benign prostate enlargement, prostate cancer has uncontrolled growth in the outer zone, while the transition zone is not affected.
As described above, the term benign prostatic hyperplasia (BPH) only describes the pure increase in size or volume of the prostate, but not associated symptoms. Some terms that often appear in connection with benign prostate enlargement and should be briefly explained here therefore seem a bit confusing.
Benign prostate obstruction (BPO): Benign prostatic hyperplasia can cause the so-called bladder outlet resistance to increase. This term describes the resistance that the urinary bladder has to overcome in order to expel the urine that has collected in it out of the body via the urethra.
A certain amount of resistance is normal and necessary to prevent the constant, uncontrolled dripping of urine. In the case of prostatic hyperplasia, the resistance can be abnormally increased because the urethra is narrowed by the enlarged prostate gland.
The possible consequence is problems urinating. In this case, doctors speak of benign prostate obstruction, or BPO for short.
Lower urinary tract symptoms (LUTS): Many symptoms of benign prostatic hyperplasia (such as frequent urination or a weakened urine stream) affect the lower urinary tract, i.e. the bladder and urethra.
This is why these complaints are grouped under the term “lower urinary tract symptoms”. In English usage one says “Lower Urinary Tract Symptoms”, the abbreviation for this is LUTS.
Benign prostate syndrome (BPS): If there is benign prostatic hyperplasia and there is also an obstruction (BPO) and symptoms in the lower urinary tract (LUTS), this overall complex is referred to as “benign prostatic hyperplasia” (BPS).
In the case of BPH in need of treatment, it is ultimately always BPS, since the symptoms are decisive for a therapy and not the mere enlargement of the prostate.
Prostate adenoma: Prostate adenoma terms is sometimes used synonymously for BPH (benign prostatic hyperplasia), however this is actually incorrect. In medicine, an adenoma describes an excessive benign growth of cells in the mucous membrane or glandular tissue.
In benign prostatic hyperplasia, it is not only the gland cells that are affected by the increase in the number of cells, but also connective tissue and muscle cells. Nevertheless, the term prostate adenoma is often used as a synonym for benign prostatic hyperplasia.
Benign prostatic hyperplasia: frequency
Benign prostatic hyperplasia is the most common urological disease in men. It is also a typical phenomenon of old age. While young men generally have no problems with their prostate gland, men over the age of 50 in particular see a urologist because they have difficulty urinating.
The enlargement of the prostate, which is pathological in the medical sense, can occasionally be detected earlier (from around the age of 35), but then usually has no disease value because symptoms do not appear at first.
Benign prostatic hyperplasia is relatively common from a certain age, but only some of those affected experience the typical symptoms. About every second man between 50 and 60 has an enlarged prostate.
However, only 10 to 20 percent of men in this age group show clinically relevant symptoms. In the 60 to 69 year olds, on the other hand, around 70 percent have an enlarged prostate and 25 to 35 percent have noticeable symptoms.
Benign prostatic hyperplasia: symptoms
When BPH (benign prostatic hyperplasia) causes symptoms, the main sign are urination, as the urethra runs through the prostate (prostate gland). An enlarged prostate can trigger symptoms such as a weakened urine stream, nocturnal urge to urinate, dribbling and residual urine sensation. Read more about the symptoms of benign prostate enlargement here!
Prostate enlargement: general symptoms
As the prostate gland increases in size, it narrows the upper portion of the urethra that runs through the prostate . In technical terms, this phenomenon is called subvesical obstruction (“subvesical” = located below the bladder; “obstruction” = occlusion of a hollow organ).
By narrowing the urethra, benign prostate enlargement causes symptoms, almost all of which are related to urination. They can be divided into two symptom complexes (obstructive and irritative micturition problems). In addition, benign prostatic hyperplasia (BPH) can disrupt sexual function.
Obstructive micturition problems
In medicine, the term micturition refers to the emptying of the urinary bladder . Micturition problems are therefore disturbances in emptying the bladder. One speaks of obstructive micturition problems when they are caused by a narrowing of the urethra, which is typical for benign prostate enlargement. Symptoms that are grouped under this collective term are as follows:
- weak urine stream or even complete urinary retention
- interrupted urine stream
- delayed start of micturition
- Clenching during micturition
- Trickle down
- Residual urine sensation
These symptoms come about as follows:
Due to the narrowing of the urethra in benign prostatic hyperplasia, the urine stream is weakened and possibly partially interrupted. Urination is then repeatedly withheld for a period of time because the pressure that the urinary bladder builds up is temporarily insufficient to overcome the resistance caused by the subvesical obstruction. As a result, the men affected often try to help by pressing.
The narrowing often results in the start of micturition being delayed : Although the “command” to urinate is given purely voluntarily, so to speak, with BPH it takes a certain time before micturition actually begins.
If the obstruction is particularly pronounced, it can even lead to complete urinary retention : then no more urine can be excreted at all. It increasingly accumulates in the urinary bladder or backs up to the kidneys. You can read more about this in the “Complications” section below.
Because the urinary bladder can often no longer be completely emptied due to the narrowing of the urethra, those affected by prostatic hyperplasia often experience an uncomfortable “ residual urine sensation” after micturition . In addition, it often happens that a small amount of urine involuntarily drips after urination, which is then referred to as ” dribbling “.
Irritant micturition problems
In addition to obstructive micturition problems, BPH (benign prostate enlargement) causes symptoms that are summarized under the term “irritative micturition problems”. These are complaints caused by irritation of the bladder and the bladder outlet.
The bladder outlet (bladder neck) is the area in which the bladder tapers downwards in a funnel shape and opens into the urethra.
The entire bladder is surrounded by a muscle called the detrusor vesicae muscle, or detrusor for short. When it contracts, it builds up pressure which, when large enough, induces urination.
However, due to the increased resistance that the bladder has to overcome in BPH to enable urination, the detrusor is increasingly stressed, which can lead to a change in its structure and irritation. Put simply, it reacts increasingly over-sensitive and thus triggers the following symptoms:
- frequent urination in small amounts (pollakiuria)
- urinating multiple times at night ( nocturia )
- strong urge to urinate that cannot be held back (imperative urge to urinate)
- Painful urination (dysuria)
Pain when urinating does not have to occur with all BPH, it is often absent.
Basically, the severity of the complaints varies greatly from person to person. In addition, it does not depend directly on the extent of the prostate enlargement. So it happens that some patients with only mildly benign prostatic hyperplasia experience more intense symptoms than men whose prostate gland is already larger.
Benign prostatic hyperplasia: sexual disorders
Micturition problems are typical of an enlarged prostate. Symptoms in the area of sexual function are also not uncommon. Erectile dysfunction (inability to get an erection ; impotence ) is a major problem for some men with BPH. Furthermore, there may be a reduced ejaculation and pain during ejaculation.
Benign prostatic hyperplasia: complications
The main problem that causes benign prostatic hyperplasia with pronounced subvesical obstruction is the increased accumulation of urine in the urinary bladder. As a result, urinary tract infections and bladder stones are not only more common, but if left untreated, they can lead to even more serious complications.
Remodeling of the bladder wall
The constant increased bladder filling and the increased pressure during micturition lead to a reactive growth of the muscle cells of the detrusor (detrusor hypertrophy) after a certain time.
The body wants to ensure that a sufficiently high pressure can be built up to overcome the greater resistance during bladder emptying. However, as the muscles grow, the bladder wall loses its elasticity. It also stores more collagen. There may even be small bulges in the wall of the bladder, known as pseudodiverticula.
The changes in the bladder wall in turn encourage the build-up of residual urine. The final state of this pathological remodeling is called the “bar bladder” because the detrusor is then thickened like a bar. If the benign prostatic hyperplasia is treated, a barbed bladder can in principle be reversed.
Complete urinary retention and overflow bladder
If the constriction of the urethra caused by the enlarged prostate does not allow emptying of the bladder, then complete urinary retention occurs. The urine then collects in large quantities in the urinary bladder, causing it to become massively overstretched. The result is a noticeable and visible bulging of the lower abdomen and severe pain.
Sudden complete urinary retention is an emergency and needs to be treated quickly! It should be noted that certain risk factors can further promote this complication. These include, for example, alcohol consumption, prolonged bed rest, certain medications, and sexual activity.
In some cases, when there is complete urinary retention, the enormous increase in pressure in the bladder leads to what is known as an overflow bladder. In doing so, the pressure in the urethra is finally overcome, albeit only slightly, so that there is a constant, slight dripping of urine, but not a regular micturition. This phenomenon is also known as “Ischuria paradoxa”.
Kidney congestion and kidney failure
The increased pressure in the urinary bladder with simultaneous obstruction of the urethra and the slightly raised bladder floor can lead to urinary backlogs in the context of benign prostate enlargement. The urine passes through the ureters and back into the renal pelvis.
In the long run, the kidneys are damaged, in the worst case it can even lead to kidney failure. The backlog of urine is referred to in technical terms as “vesicouretral reflux”, the damage to the ureter and kidneys resulting from this as “hydroureter” or “hydronephrosis“.
Uremia
Certain metabolic breakdown products – such as urea, uric acid or creatinine – have to be excreted via the kidneys with the urine, otherwise they can cause damage to the body.
Such substances are referred to as “urinate”. If they are no longer adequately excreted, for example because the kidneys are damaged as a result of benign prostatic hyperplasia, they accumulate in the body.
Doctors then speak of uremia: It can lead to symptoms such as pronounced itching, nausea and vomiting and, if left untreated, can even be life-threatening.
Blood in the urine (hematuria)
There are veins at the bladder exit area that may be blocked by prostatic hyperplasia. Doctors then speak of bladder neck varices.
These congested veins are relatively sensitive and can tear under certain circumstances. As a result, larger amounts of blood get into the urine (macrohematuria), which can be recognized by a clear red color when urinating. But the phenomenon is less dangerous than it looks.
Prostate enlargement: Alken graduation
In the middle of the 20th century, the urologist Carl Erich Alken described a three-stage classification for benign prostatic hyperplasia, which is still in use today.
The decisive factor for the classification is how severe the symptoms and possible complications are in the case of benign prostate enlargement. This is particularly important for the choice of therapy.
Stage I of benign prostate enlargement
Stage I of benign prostatic hyperplasia is also known as the “irritation stage”. It describes the condition of BPH in which clinical symptoms are already present (such as a weakened urine stream, nocturnal urination or pollakiuria), but no residual urine has yet formed.
Stage II benign prostate enlargement
In stage II (“residual urine stage”) the symptoms continue to increase and there is already a residual urine volume of 50 to 150 milliliters.
Stage III benign prostate enlargement
If the residual urine exceeds a volume of 150 milliliters, the condition is defined as stage III. In this “backwater stage”, an overflow bladder and kidney damage can occur, whereby a residual urine volume of 500 milliliters usually has to be exceeded.
Benign prostatic hyperplasia: causes and risk factors
Ultimately, the causes of benign prostatic hyperplasia have not yet been adequately clarified. It is clear that certain factors play a role.
The exact relationships and processes that lead to benign prostate enlargement are still the subject of research.
Hormones
What is certain is that the male hormone balance plays an essential role in the development of benign prostatic hyperplasia. The presence of male sex hormones (androgens), especially testosterone , is necessary for BPH to develop at all.
Accordingly, castrated men cannot develop benign prostatic hyperplasia: because they no longer have any testicles (the main places where testosterone is produced), they only have very small amounts of the hormone.
Testosterone seems to cause the transition zone of the prostate to grow in men with increasing age. The exact processes behind it have not yet been finally clarified. The testosterone does not act directly on the prostate, but is first converted into a more effective form – the so-called dihydrotestosterone (DHT) – in the cells within the prostate gland.
The enzyme that enables this conversion is called 5α-reductase. Dihydrotestosterone is not only produced in the prostate and its effect is not limited to this organ, but it is essential for the development of benign prostatic hyperplasia.
It is assumed that not only testosterone (or dihydrotestosterone), but also female sex hormones (estrogens) play a certain role in the development of benign prostatic hyperplasia. You have to know that men also have estrogens, albeit in smaller amounts than women.
Conversely, women also have low levels of testosterone and other androgens in their blood . With increasing age, the testosterone level decreases in men, while the estrogen level remains about the same or even increases. This leads to a (relative) increase in estrogens, which can obviously promote BPH.
Because oestrogens are also partly formed in fat cells, being very overweight should be viewed as a risk factor for benign prostatic hyperplasia.
Changes in the extracellular matrix
In addition to hormones, there is another aspect that is suspected of contributing to the development of benign prostate enlargement: an altered effect of the so-called extracellular matrix (ECM) of the prostate on the cells of the organ. The area between the cells of a tissue is generally referred to as the extracellular matrix.
If certain changes take place here, as a consequence, for example, more growth factors can be bound to the ECM and cause cells to multiply. Such growth factors can also be increasingly produced by the body and stimulate cell division in the prostate tissue or prevent the natural death of cells. This can promote benign prostatic hyperplasia.
Genetic factors
Genetic factors play a subordinate role in benign prostatic hyperplasia. The likelihood of a genetic component causing BPH is higher if the prostate enlargement becomes clinically relevant at a relatively young age.
If benign prostatic hyperplasia has to be operated on before the age of 60, for example, then 50 percent of the causes are familial, i.e. genetic. In men over the age of 60, on the other hand, only about 9 percent of cases with BPH requiring treatment are genetic.
Benign prostatic hyperplasia: examination and diagnosis
The different examination methods serve on the one hand to confirm the diagnosis of benign prostate enlargement. On the other hand, it is important to rule out other diseases that can cause symptoms (such as frequent urination or an interrupted urine stream) as benign prostatic hyperplasia.
In general, individual test results usually do not provide sufficient evidence of benign prostatic hyperplasia. The diagnosis can only be made when several findings are viewed together.
Collection of the medical history (anamnesis)
In a detailed discussion with the patient, the doctor asks about the exact symptoms. He also asks about any previous illnesses and previous interventions that could be the cause of the complaints.
For example, a narrowing of the urethra may not only be due to prostatic hyperplasia, but also to a previous inflammation or a catheter. Diseases such as diabetes mellitus, Parkinson ‘s disease or cardiac insufficiency (heart failure) can sometimes also resemble the symptoms of benign prostatic hyperplasia. In some cases, certain drugs (anticholinergics, antidepressants, neuroleptics) trigger the symptoms.
Assessment of the severity of the symptoms
In order to be able to evaluate the extent of the symptoms objectively, the doctor uses the “International Prostate Symptoms Score” (IPSS) as an aid. The patient is asked about a total of 7 typical symptoms of BPH (such as residual urine sensation, nocturnal urge to urinate, etc.): On a scale from 0 to 5, he should indicate how strongly he feels the personal grievances. The more pronounced a symptoms, the higher the number of score given. The total result can therefore be a maximum of 35.
It should be noted that the IPSS is not a method for diagnosing benign prostatic hyperplasia. It only serves to determine the intensity of certain symptoms that can occur both with benign prostate enlargement and with other diseases.
The digital rectal exam (DRE)
The most important physical examination to clarify prostatic hyperplasia is the so-called digital rectal examination, or DRU for short. The doctor inserts his finger (lat. Digitus) into the patient’s rectum and palpates the prostate, which is located directly in front of the rectum.
If there is benign prostatic hyperplasia, then this can be determined with the help of the DRE, provided that the prostate has already enlarged sufficiently. The prostate then usually feels plump, elastic and smooth. In contrast, if the prostate is enlarged due to cancer, it usually appears rock-hard and uneven.
The DRU is only used as a rough guide; its result always depends on the experience of the doctor. Under no circumstances can the diagnosis of benign prostatic hyperplasia be made based on the findings of DRE.
More physical exams
In addition to the DRU, certain reflexes, possible nerve failures and the function of the sphincter are also checked during the physical examination to clarify benign prostatic hyperplasia.
Urine and blood tests
Laboratory diagnostics can also provide important information for clarifying benign prostatic hyperplasia. On the one hand, the condition of the urine is checked: the urine is checked for possible infection.
On the other hand, some laboratory parameters are collected. This includes the prostate-specific antigen (PSA), which can often be elevated in prostate cancer and should therefore be determined to rule out malignant prostate enlargement.
In addition, the blood concentrations of urinary substances (retention parameters) are measured in order to identify kidney damage and uremia in good time.
Ultrasound (sonography)
The ultrasound examination is an important method to clarify relevant questions about BPH. With their help, statements can be made about the amount of residual urine and the size of the prostate.
In addition, the thickness of the detrusor can be determined using ultrasound and possible complications such as bladder stones or pseudodiverticula can be identified.
As a rule, the ultrasound examination is carried out transrectally, i.e. via an examination device (transrectal ultrasound, TRUS) inserted into the rectum. The remaining amount of urine can also be easily scanned through the abdomen (transabdominal ultrasound).
Urinary stream measurement (uroflowmetry)
The urine stream is determined with the help of so-called uroflowmetry. The patient urinates in a special funnel, which can use sensors to measure how much urine flows through it per unit of time. In order for this examination to be really meaningful, at least 150 milliliters should be urinated.
A normal flow of urine is approximately 20 milliliters per second (ml / s). Anything below 10 ml / s, on the other hand, is highly suspicious of a narrowing of the urethra, for example due to benign prostatic hyperplasia. Uroflowmetry is relatively easy and inexpensive to perform.
Other apparatus-based examination procedures
There are other apparatus-based methods that are not necessarily used as standard, but only in certain cases.
The urethrocystometry (urodynamics) allows, for example, statements about the pressure that exists during voiding the bladder. This helps to differentiate an obstruction caused by prostatic hyperplasia from a pure weakness of the bladder muscle (detrusor weakness).
In an excretory urogram (urography), the patient is given a contrast medium through a vein and then an X-ray of the lower abdomen is made. The kidney excretion and the urinary drainage can be assessed.
In contrast, with a urethrogram, the contrast agent is injected through the urethra into the urinary bladder, which allows an assessment of the urethra.
Occasionally, a is in the clarification of benign prostatic cystoscopy used.
In order to be able to reliably differentiate a benign prostate enlargement from a malignant one, a small tissue sample must be passed through the rectum from the prostate gland and then carefully examined.
Benign prostatic hyperplasia: treatment
Benign prostatic hyperplasia does not necessarily require treatment. As long as it does not cause any symptoms, it is often sufficient to wait and see how the disease is progressing.
With an IPSS above 7 or general distress in the patient, however, treatment of the benign prostate enlargement is usually started. “Treatment” usually means the use of medication. Surgical procedures are only considered if the symptoms increase or if there are complications from the enlarged prostate.
Drugs for benign prostatic hyperplasia
In the case of benign prostate enlargement in stage I and mild forms of BPH in stage II according to Alken (described in the Benign prostatic hyperplasia: symptoms), drug treatment is usually sufficient. Various drug groups are available, some of which can also be combined with one another.
Herbal preparations (phytopharmaceuticals): There are a number of herbal medicines that can be used to treat benign prostatic hyperplasia with mild symptoms. These include, for example, preparations based on saw palmetto , rye, nettle root, African plum and pumpkin seeds.
The way in which the various plant substances work is different: some inhibit the enzyme 5α-reductase or certain growth factors, for example, while others promote natural cell death. Many phytopharmaceuticals also contain so-called beta-sitosterones – substances that inhibit male sex hormones, i.e. have an anti-androgenic effect.
Herbal medicines are available without a prescription and are usually very low-risk. Many patients therefore prefer them to other drugs. The therapeutic effectiveness of pumpkin seeds and Co. has not yet been adequately proven by studies; especially the long-term effect is questionable.
In the United States, herbal medicines used to treat benign prostatic hyperplasia have been banned for many years because there were concerns that they would discourage patients from further investigations for BPH.
α-blockers: The α-blockers (more precisely: α1-adrenoceptor antagonists) ensure that the muscles in the prostate and urethra relax, which improves the flow of urine. This is possible because α-blockers prevent the accumulation of certain messenger substances on receptors in the muscles, which would otherwise trigger a contraction of the muscle cells. However, α-blockers have little influence on the size of the prostate, which is why the mechanical flow obstruction from the bladder is only slightly influenced.
Originally, α-blockers were not developed for the treatment of benign prostatic hyperplasia, but as antihypertensive drugs. This explains why they sometimes have cardiovascular side effects. In addition, dizziness , headaches , fatigue and swelling of the nasal mucosa sometimes occur . Classic active ingredients from the group of α-blockers are, for example, alfuzosin , doxazosin , tamsulosin and terazosin.
5-α-reductase inhibitors: The 5-α-reductase inhibitors block the function of the enzyme 5-α-reductase and thus the conversion of testosterone into dihydrotestosterone. In this way, the essential growth-stimulating factor in benign prostatic hyperplasia is inhibited – the prostate does not enlarge any further; it may even shrink again. However, it can take up to a year for the patient to notice a relevant improvement in symptoms.
The two active ingredients used with a blocking effect on 5-α-reductase are called finasteride and dutasteride. Their typical side effects include loss of libido , impotence, and a decrease in male body hair.
Phosphodiesterase inhibitors (PDE inhibitors): A blockade of the enzyme phosphodiesterase has a similar effect to the inhibition of α-reductase in benign porous hyperplasia: the muscles of the urinary bladder and urethra relax, which makes micturition easier. In addition, PDE inhibitors such as tadalafil have a positive influence on erectile dysfunction (impotence), which can occur as part of an enlarged prostate.
Anticholinergics: These active ingredients have a dampening effect on the bladder muscle (detrusor). They are used against the irritative symptoms of benign prostatic hyperplasia, such as the imperative to urinate. In the case of pronounced obstructive symptoms, the use of anticholinergics must be carefully considered, because a weak detrusor muscle can then even be counterproductive.
Surgical procedures for benign prostatic hyperplasia
Once the symptoms have reached a certain severity, the mere use of medication is no longer sufficient. Then surgery is the treatment of choice for benign prostate enlargement.
Not all operations are the same: There are many different surgical procedures that can be used for BPH. The most important are described below. Which method is ultimately used always depends on the condition of patient.
TURP : The standard procedure in the surgical treatment of benign prostatic hyperplasia is “transurethral resection of the prostate” (TURP). Similar to a cystoscopy, a small tube is inserted into the urethra.
It has a tiny camera and a metal loop through which electrical current flows. With the help of the loop, the enlarged prostate tissue is removed in layers. Thanks to recent developments in the field of TURP, side effects are very rare.
TUIP: A modification of TURP is the “transurethral incision of the prostate” (TUIP). The technique is the same, except that no prostate tissue is removed, just incised, at the transition between the bladder neck and the prostate.
This gives the urethra more space. The TUIP is mainly used in benign prostatic hyperplasia when the prostate gland is not yet too large.
TUMT: “Transurethral microwave therapy” (TUMT) also takes place via the urethra. Here microwaves heat the prostate tissue to 70 degrees Celsius and thereby destroy it. As a result, the organ shrinks. To prevent damage to the urethra, it is cooled by flushing in liquid during the TUMT.
Laser procedures: Another possibility to treat benign prostatic hyperplasia are laser procedures (ILC, HoLEP). The prostate tissue is destroyed or cut out and ablated by laser beams. Above all, the HoLEP process is considered to be on a par with TURP. However, it is difficult to learn and therefore requires a lot of experience.
Open surgery: If the prostate is already very large or there are certain complications, it sometimes makes sense to have open surgery on benign prostatic hyperplasia. One then speaks of a prostate enucleation. Your doctor (surgeon) opens the bladder and removes the prostate through it.
Benign prostatic hyperplasia: disease course and prognosis
Unless treated, benign prostatic hyperplasia usually progresses slowly. However, medication can often stop the process and in some cases even reduce the size of the prostate gland.
If the medication is not working well enough or if the prostate hyperplasia is too pronounced at the time of diagnosis, then surgery usually helps.
The biggest risk factors for benign prostate enlargement include being overweight and smoking. Regular exercise and sport, on the other hand, have a positive effect. A healthy lifestyle is the best way to prevent benign prostatic hyperplasia
