I am Dr Shawn, a urological surgeon from the 2nd China Medical Team in the Solomon Islands. Today, I will share my experience in the diagnosis and treatment of Benign prostatic hyperplasia that every man should know.
What is BPH？
Benign prostatic hyperplasia (BPH) is a health issue with age suffering the problems of passing urine. It means every man may not escape from this issue. BPH troubles men almost after the age of 40 years old, and about 50% of males 60 years old will have the disease and 80% in their 80 years old. As they aged, the problem of frequent urine or trouble of passing urine will be got worse. It isn’t clear what causes the prostate to get bigger. But it might be due to changes in the balance of sex hormones as grow older.
At the early stage of BPH, the main symptom is the frequent or urgent need to pee or peeing more often at night. As it develops, problems are followed as a weak urine stream, or a stream that stops and starts dribbling at the end of urination, even urge incontinence or urine retention. What’s worse, a series of urinary diseases may arise from BPH like severe blood urine, urinary tract infections, bladder stone, double hydronephrosis, inguinal hernia etc.
Ways to diagnose BPH
There are several methods to diagnose BPH. We can choose one of the tests according to the doctors’ advice.
1. Digital rectal exam（DRE）is one of the most important, convenient, and economical methods to diagnose BPH. By inserting a finger into the rectum, it can check if the prostate is enlarged or not, and it also can know whether the tissue of the prostate is with the nodules.
2. Urinary tract ultrasound can detect the size, shape, and structure of the prostate, as well as the kidneys, ureters, bladder, and residual urine volume. Ultrasound is non-invasive and has no radiation hazard to the human body, so we recommend it as a normal way to check it.
3. Though cystoscopy can reveal the condition of the urethra and the extent of prostatic hyperplasia, it is an invasive test and is not routinely used.
4. Urodynamic testing provides a more complete objective assessment of the voiding function. When measuring urine flow rate, bladder manometry can determine detrusor function and the degree of impairment simultaneously. This is a crucial test to make sure of the appropriate timing for surgery.
5. Prostate-specific antigen (PSA is a protein made in the prostate) blood test is one of the important measures to screen for prostate cancer, and most prostate cancer patients will have elevated serum PSA levels. The higher the PSA levels, the greater the likelihood of prostate cancer. Especially for patients with a PSA level above the normal range of 10, the possibility of prostate cancer is very high. Of course, not all people with abnormal PSA results are prostate cancer, and a small number of patients with prostatic hyperplasia will have mildly elevated PSA levels. Urologists recommend that men aged 50 years of age visit the hospital regularly to have blood drawn for a PSA test, usually 1 time per year.
6. Magnetic resonance imaging (MRI)can help doctors distinguish between benign prostatic hyperplasia and prostate cancer.
7. The most accurate way to distinguish is a pathological biopsy of the prostate, but it is an invasive test and does not recommend a needle biopsy for every patient with BPH.
Treatments of BPH
BPH is very common in middle-aged and elderly people. However, urologists emphasize that not every BPH patient needs surgery. Treatments of BPH include watchful waiting, medication, and surgery.
In the early stages of BPH, if the patient does not have the problem of urinating and quality of life is not affected, watchful waiting is an option. However, watching and waiting does not mean doing nothing on it, patients should have health education, lifestyle adjustments, and regular follow-up.
Drug therapy for patients with BPH can relieve the patient’s urination symptoms, delay the clinical progression of the disease, and prevent complications of BPH. The overall goal of pharmacotherapy is to maintain a high quality of life while reducing the side effects of drug therapy.
Doctors will depend on your urination symptoms, test results, and physical condition to determine whether to recommend surgery. There are many types of surgery for BPH, but minimally invasive surgery is the mainstream treatment. Transurethral resection of the prostate (TURP) is the most routine surgical procedure.
Urologists from China have rich experience in minimally invasive prostate surgeries including TURP and plasma resection of the prostate (PKRP).
If you are unfortunately suffering from BPH, you can visit the NRH to see Dr Melly and me in urological specialist clinics every Monday morning.
（Translated by HUANG BAILIN, International Office, Guizhou Medical University）
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