Understanding Benign Prostate Hyperplasia in Men: Causes, Symptoms, and Treatment

A meta-analysis study published by Lee et al. illustrates that the prevalence of BPH (Benign Prostate Hyperplasia) in the world increases with age. The highest prevalence is in the age group of 70 years, with a median prevalence of 25.2% (19–37.9%). Until now, the incidence of BPH in Indonesia has never been studied, so the number cannot be known with certainty.

Although rarely life-threatening, BPH presents complaints that can interfere with daily activities. This condition is a result of obstruction of the bladder neck and urethra due to BPH. Furthermore, this obstruction can lead to changes in the structure of the bladder and kidney, causing complications in the upper and lower urinary tracts. BPH patients often complain of lower urinary tract symptoms (LUTS) consisting of irritation symptoms (storage), obstruction symptoms (voiding), and post-micturition symptoms. Obstruction symptoms include labored voiding, weak and intermittent urinary output, and dissatisfaction after micturition. Irritation symptoms include increased urinary frequency, urgency (difficulty holding urine), and nocturia (more than one nighttime urination). Post-micturition symptoms include urine dribbling (terminal dribbling) and the most severe symptom of urine retention (inability to micturate).

The relationship between BPH and LUTS is complex. Not all BPH patients complain of micturition disorders or vice versa. Several retrospective studies in Indonesia showed that the frequency of complaints obtained in BPH patients included difficulty or inability to micturate (55.5%–59.6%), frequency symptoms (10.1%–48%), intermittent urine flow (7.9%–34%), voiding (7.9%–14%), feeling of inadequacy after micturition (5.6%–23%), and nocturia complaints (3.4%–44%).

To establish the diagnosis of BPH, a complete history and physical examination are necessary. There are also several questionnaires that can help direct and determine the presence of obstruction symptoms due to BPH. One questionnaire that has been widely used is the International Prostate Symptoms Score (IPSS). The use of a complaint score questionnaire in male patients with LUTS needs to be done routinely to assess complaints and the quality of life of patients with LUTS, as well as for re-evaluation during and/or after therapy. Supportive examinations such as laboratory tests, urinary tract ultrasound, uroflowmetry (urinary jet test), and Prostate Specific Antigen (PSA) examinations also need to be performed to establish the diagnosis and determine BPH management.

The management of BPH patients aims to improve the patient's quality of life. The therapy given to patients depends on the degree of complaints, the patient's condition, and the availability of hospital facilities. Treatment options for BPH are (1) conservative (watchful waiting), (2) medication, and (3) surgery.

Conservative therapy in BPH can be in the form of watchful waiting, where the patient does not receive any therapy but the development of the disease is still monitored by the doctor. This conservative therapy is usually done in patients with mild complaints that do not interfere with daily activities. In this conservative therapy, patients are given an explanation of everything that might improve or worsen their complaints, for example:

1. Avoid drinking a lot of water before going to bed.
2. Do not drink a lot and consume drinks that contain caffeine, alcohol, or chocolate because it will increase urine production.
3. Use the double voiding technique by emptying urine again with a 5-minute interval after the first micturition.
4. To stop pee from trickling after micturition, squeeze the base of the penis towards the urethra, or "milk the urethra."

If BPH patients have experienced complaints that interfere with their daily activities, it is necessary to provide medical therapy. Medicinal therapy that can be given includes giving alpha-1 blocker drugs (such as tamsulosin, silodosin, etc.), which can be combined with 5-alpha reductase inhibitor drugs (such as finasteride, dutasteride, etc.).

If BPH patients have experienced severe symptoms, it is strongly recommended to do surgery. The absolute indications for surgery in BPH patients include patients who cannot urinate, so they need to wear a catheter tube; recurrent urinary tract infections; recurrent bloody urine; bladder stones; and decreased kidney function due to prostate enlargement. While the relative indications for surgery include if the patient refuses medical therapy and patients who experience moderate to severe complaints but do not improve with medical therapy, surgical therapy in BPH patients is generally performed with the TURP (transurethral resection of prostate) method, which resects the transitional tissue of the prostate with a urological endoscopic process (surgery without incisions).

 

Download the Hermina Mobile Apps application to facilitate health access and registration at Hermina Soreang Hospital.

 

Bibliography

1. Tjahjodjati, et al. Panduan Penatalaksanaan Klinis Pembesaran Prostat Jinak (Benign Prostate Hyperplasia) 2021
2. Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: A systematic review and meta-analysis. Sci Rep. 2017; 11;7(1):7984
3. Azhar A., Eriawan Agung Nugroho, Ezra Endria Gunadi. Relationship between Prostate Volume and International Prostate Symptom Score (IPSS) Degree of Tamed Prostate Enlargement on Transabdominal Ultrasonography (TAUS) and Transrectal Ultrasonography (TRUS) Examination. BJI [Internet]. 2021 Jan.27 [cited 2021 Sep.27];7(1):112-7. accessed from: https://jurnalkedokteranunsri.id/index.php/BJI/article/view/259.
4. Adelia F., Monoarfa A., Wagiu A. Gambaran Benigna Prostat Hiperplasia di RSUP Prof. Dr. R. D. Kandou Manado Period January 2014–July 2017. e-Clinic. 2017
5. Prasetyo ZA, Budaya TN, Daryanto B. Characteristics of Benign Prostatic Hyperplasia (BPH) Patients Undergoing Transurethral Resection of Prostate (TURP). Jurnal Kedokteran Brawijaya; 31(4).