What is Benign Prostatic Hyperplasia (BPH)? Symptoms, Diagnosis and the Latest Treatment Methods

Benign Prostatic Hyperplasia (BPH), commonly known as benign prostate enlargement, is one of the most common health problems men face as they age and can significantly affect quality of life. This condition, which affects approximately half of men over the age of 50 and 90% of men over the age of 80, is not cancerous but can lead to serious kidney and bladder problems if left untreated.

In this comprehensive guide, we will examine everything in detail, from the causes and symptoms of BPH to modern diagnostic methods and current treatment options such as HoLEP, TURP and Rezum.

What is Benign Prostatic Hyperplasia (BPH)?

The prostate is a walnut-sized gland that forms part of the male reproductive system. It is located just below the bladder (urinary bladder) and surrounds the urethra (urinary tract). Its primary function is to produce the fluid that preserves the viability of sperm.

Benign Prostatic Hyperplasia (BPH) is an enlargement of the prostate gland due to an increase in the number of cells within it. The term ‘benign’ indicates that this enlargement is non-cancerous and does not spread to other parts of the body.

As the prostate enlarges, it begins to press on the urethra, which runs through its centre. This pressure makes urination difficult, prevents the bladder from emptying completely, and eventually leads to weakening of the bladder muscles.

What Causes Benign Prostatic Hyperplasia (BPH)? Risk Factors

Although the exact cause of BPH is not fully understood, it is thought that changing hormone balances (testosterone and oestrogen) associated with ageing play a key role in this process.

Key Risk Factors:

  • Ageing: BPH is rare in men under the age of 40. The risk increases exponentially with age.
  • Family History (Genetic): If there is a history of prostate enlargement in the father or brothers, the risk is higher.
  • Diabetes and Heart Disease: Studies indicate a link between type 2 diabetes and heart disease and BPH.
  • Lifestyle: Obesity and a sedentary lifestyle increase the risk, while exercise can reduce it.

What are the symptoms of BPH?

The symptoms of prostate enlargement can vary from person to person. The severity of symptoms is not always proportional to the size; a small enlargement can severely constrict the urinary tract, while a very large prostate may cause fewer symptoms.

Symptoms are generally examined in two main groups:

1. Obstructive Symptoms

It occurs as a result of physical obstruction of urine flow:

  • Difficulty initiating urination (prolonged waiting time).
  • Intermittent urination.
  • Decreased urine flow rate and weak stream.
  • Dribbling at the end of urination.
  • Feeling that the bladder is not completely empty.

2. Irritative Symptoms

It occurs as a result of impaired bladder storage function:

  • Frequent urination (pollakiuria): The need to go to the toilet more often than normal during the day.
  • Night-time urination (nocturia): Sleep being interrupted at least 2-3 times.
  • Sudden urge to urinate (Urgency): Fear of not reaching the toilet in time.
  • Burning or pain during urination.

Important Note: Blood in the urine (haematuria) may be a symptom of BPH, but it may also be a sign of bladder cancer or stones, and therefore requires urgent medical attention.

How is BPH Diagnosed?

Urology specialists perform various tests to diagnose BPH and rule out other diseases such as prostate cancer.

  1. Physical Examination (Digital Rectal Examination): This is the most basic examination, in which the doctor checks the size, shape and firmness of the prostate.
  2. PSA Test (Prostate-Specific Antigen): The PSA level in the blood is measured. PSA may increase when the prostate enlarges, but it is also critical for differential diagnosis as it rises in prostate cancer.
  3. Urine Analysis: This is performed to check for infection or bleeding.
  4. Uroflowmetry (Urinary Flow Test): The patient is asked to urinate into a special container. The speed and flow rate of the urine are measured.
  5. Ultrasound: Used to measure the volume of the prostate and to check the kidneys.
  6. Cystoscopy: In necessary cases, a thin instrument with a camera is inserted through the urinary tract to observe the prostate and inside the bladder.

Treatment Methods for Benign Prostatic Hyperplasia

BPH treatment is determined based on the patient’s age, prostate size, severity of symptoms, and overall health.

1. Watchful Waiting

If the symptoms are mild and do not impair the patient’s quality of life, the doctor may recommend monitoring the condition with regular check-ups instead of medication or surgery. Lifestyle changes (reducing caffeine intake, limiting fluid intake in the evening) are recommended during this process.

2. Drug Therapy

It is the first-line treatment for moderate symptoms.

  • Alpha Blockers: They relax the muscles in the prostate and bladder neck, facilitating urine flow (e.g., Tamsulosin, Alfuzosin). Their effect begins quickly.
  • 5-Alpha Reductase Inhibitors: Aim to shrink the prostate by blocking the hormones that cause its enlargement (e.g., Finasteride, Dutasteride). The effect may take months to become apparent.
  • Combination Therapy: The use of both drug groups together.

3. Surgical and Interventional Treatments

Surgical methods are employed when drug treatment proves inadequate, causes side effects, or the prostate is excessively enlarged.

A. TURP (Transurethral Resection of the Prostate)

It is a closed surgical method that has been considered the ‘gold standard’ for years.

  • How is it performed? The prostate tissue is cut into small pieces using electrical energy and removed through an incision at the tip of the penis.
  • Advantage: Long-term results are very good.
  • Disadvantage: There is a risk of bleeding and a possibility of ‘retrograde ejaculation’ (semen entering the bladder/dry ejaculation).

B. HoLEP (Holmium Laser Enucleation of the Prostate)

Today, it is one of the most popular and effective methods, especially for large prostates.

  • How is it done? Using laser energy, the prostate tissue is separated from its capsule, like removing an orange from its peel, and pushed into the bladder. There, it is broken down and removed.
  • Advantages: The risk of bleeding is very low (it is safe even for patients using blood thinners), the catheterisation period is short (usually 1-2 days), and the risk of recurrence is negligible.

C. Summary (Steam Treatment)

It is a newer and minimally invasive method.

  • How is it done? Sterile water vapour is injected into the prostate tissue. The vapour causes cell death and the prostate shrinks over time.
  • Advantage: The procedure is very short (10-15 minutes) and has a high rate of preserving sexual function.
  • Disadvantage: Its effect may be limited in very large prostates.

D. Open Prostatectomy

It is preferred in cases of very large prostates (generally over 100-120 grams) and when accompanied by large bladder stones. However, with the increasing prevalence of HoLEP, the need for open surgery is gradually decreasing.

What Happens if BPH is Left Untreated? (Complications)

Many men delay seeing a doctor, believing the symptoms to be a natural part of ageing. However, untreated BPH can lead to serious problems:

  • Sudden Urinary Obstruction (Glob Vezikale): This is a condition where it is impossible to urinate. An emergency catheter must be inserted.
  • Urinary Tract Infections: Urine remaining in the bladder creates a suitable environment for bacteria.
  • Bladder Stones: These form when accumulated urine crystallises.
  • Bladder Damage: The bladder muscle loses its elasticity.
  • Kidney Failure: High pressure in the bladder can affect the kidneys (hydronephrosis), permanently impairing kidney function.

Frequently Asked Questions (FAQ)

1. Does prostate enlargement turn into cancer? No. BPH (benign enlargement) and prostate cancer are different diseases. However, both conditions can occur in the same patient at the same time. Therefore, regular check-ups are essential.

2. Does prostate surgery end sexuality? With modern methods (especially HoLEP and Rezum), the risk of erectile dysfunction is very low. The most common side effect is dry ejaculation, where semen flows into the bladder instead of outwards; this does not prevent orgasm or erection.

3. What is the best diet for BPH? Foods rich in zinc, vitamin C and lycopene (tomatoes, broccoli, pumpkin seeds) support prostate health. Avoiding alcohol, caffeine and excessively spicy foods may alleviate symptoms.

4. How long does recovery take after surgery? It varies depending on the method. Patients are usually discharged within 1-2 days after TURP and HoLEP and return to their normal lives within 1-2 weeks. It is generally recommended to wait 4 weeks before heavy lifting and sexual activity.

Result

Benign Prostatic Hyperplasia may seem like an inevitable part of a man’s fate, but it is not without solutions. With advances in technology, there are now more comfortable treatment options available that reduce hospital stay duration and preserve sexual function (HoLEP, Rezum, etc.).

If you frequently get up at night to use the toilet, cannot fully empty your bladder, or feel a weakening of the flow, do not put it off by saying ‘it’s just old age’. Early diagnosis protects your kidneys and your quality of life.