Benign prostatic hyperplasia

Benign prostatic hyperplasia is an abnormal development of the prostate gland. Symptoms include obstruction of bladder evacuation (weak urine stream). The symptoms then gradually progress to incontinence. We will explain the principle of hypertrophy before looking at the symptoms and possible complications.

What is benign prostatic hyperplasia?

In some men, as they get older, the prostate gland becomes too large and interferes with urination. This excessive growth is known as benign prostatic hypertrophy (BPH), or prostatic adenoma. Two out of three men over the age of 50 may have no symptoms of urination problems linked to the condition of their prostate. However, the likelihood of symptomatic BPH increases with age. After the age of 60, 60% of men experience prostate problems, rising to 90% after the age of 85.

The prostate explained

The prostate, an exocrine gland of the male genital tract, is the size of a walnut and is located under the bladder. It plays an essential role in secreting around 20% of seminal fluid, a crucial constituent of sperm. Its structure, similar to a chestnut or cone, surrounds the upper urethra where it joins the bladder. This gland increases in volume after the age of forty and then continues to grow with age.

Anatomically, the prostate is located in the pelvic cavity, between the bladder, the rectum and the pubic symphysis. It is surrounded by the muscles that elevate the anus. It weighs around 20g in young adults.

Functionally, the prostate produces an alkaline liquid, which is essential for neutralising vaginal acidity and preventing sperm coagulation. It also plays a role in urination and ejaculation, thanks to the striated sphincter beneath it.

With age, the prostate tends to hypertrophy, a common phenomenon after the age of 50. The prostate is dependent on androgens, male hormones, for optimal function. In women, the paraurethral glands are sometimes considered to be the equivalent of the prostate.

What is benign prostatic hyperplasia?

In some men, as they get older, the prostate increases excessively in size, making it difficult for them to pass urine. This disproportionate growth is known as benign prostatic hyperplasia or prostatic adenoma. The risk of developing this condition increases with age: after the age of 60, 60% of men suffer from it, and this figure rises to 90% after the age of 85. The incidence of BPH therefore increases with age, with a higher prevalence among men aged 79 and over. Studies show that almost 70,000 men in France undergo BPH-related surgery every year. Obesity can also increase the risk of this condition.

Benign prostatic hyperplasia never develops into prostate cancer and does not increase the risk of developing prostate cancer. It is a non-cancerous increase in the size of the prostate due to cell proliferation. Unlike cancer, BPH does not spread to other parts of the body and is generally not fatal.

BPH is usually diagnosed by digital rectal examination, which may be accompanied by blood tests to rule out prostate cancer. In terms of treatment, drugs such as terazosin or finasteride are used to relax the prostate muscles or reduce the size of the prostate. In some cases, surgery may be necessary.

What causes prostate cancer?

Benign prostatic hyperplasia (BPH) has no single established cause. It is therefore considered to be a natural development linked to the ageing of the transitional zone of the prostate. Although BPH is not a risk factor for prostate cancer, it does lead to hyperplasia of the prostatic constituents.

This increase is often linked to dystrophy or atrophy. Smooth muscle cells and interstitial fibroblasts also proliferate. Hyperplasia varies according to the different zones of the prostate. The prostate is made up of five distinct anatomical zones:

• the peripheral zone
• the central zone
• the transitional zone
• the anterior fibromuscular stroma zone
• the periprostatic gland zone.

BPH mainly affects the transitional zone, causing urethral obstruction and impeding urine drainage. Symptoms result from contraction of the smooth muscle (a dynamic mechanism) and an increase in glandular volume (a static mechanism), stimulated in particular by androgens such as dihydrotestosterone.

Risk factors associated with BPH include ageing, abdominal obesity and lack of physical activity. Age-related hormonal changes may influence BPH. These include variations in testosterone and dihydrotestosterone. However, this hypothesis remains to be confirmed.

Certain drugs exacerbate the symptoms of BPH. These include antihistamines and nasal decongestants. These products can also cause urinary retention. It is important to report any urinary problems to a doctor or pharmacist.

Identifying the symptoms of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH ) makes urination difficult: urine is slow to start, the flow is weak and discontinuous, and drops persist after urination. Men with BPH are more likely to develop bladder stones and recurrent urinary tract infections .

Symptoms, known as dysuric urination disorders, include :

• Pollakiuria: increased frequency of urination.
• Small-volume urination.
• Difficulty initiating and completing micturition.
• Weak or intermittent stream of urine.
• Delayed post-micturition drops.
• Nocturia: frequent need to urinate at night.
• Incontinence, leading to urine leakage.
• Presence of blood in the urine.

BPH may manifest as a feeling of incomplete emptying, prompting frequent urination. The symptoms of BPH are often so characteristic that patients themselves may suspect the condition before consulting a doctor.

Rarely, BPH may be revealed by acute urinary retention, triggered by various factors such as new medication, anaesthesia, urinary infection or constipation. Some men may have no symptoms at all, with symptoms becoming more common after the age of 50.

When the enlarged prostate puts pressure on the urethra and bladder, it can reduce or block the diameter of the urethra, causing changes in urinary habits and difficulty in passing urine.

BPH can also be confused with other disorders, such as infection, prostate cancer or overactive bladder. Symptoms fall into two categories:

• Irritative: Frequent and sudden need to urinate, particularly at night.
• Obstructive: Difficulty urinating due to narrowing of the urethra, including a weak micturition stream and a feeling of incomplete emptying.

Complications associated with benign prostatic hyperplasia

A bladder that does not empty completely increases the risk of urinary infections and kidney problems. In some men, benign prostatic hyperplasia (BPH) can lead to the formation of bladder stones or repeated urinary tract infections. Cases of urinary retention are also observed, and in rare situations, total obstruction of the urethra may occur, constituting a medical emergency known as acute urinary retention. BPH can also have a negative impact on patients’ sex lives due to its psychological impact.

Although BPH never turns into prostate cancer, the two conditions can present similar symptoms. It is possible to have prostate adenoma and prostate cancer at the same time.

Complications associated with BPH include:

• Acute urinary retention: manifested by an inability to urinate and intense suprapubic pain. It requires an emergency urinary catheter.
• Chronic urinary retention: characterised by persistent urinary residue in the bladder, leading to overflow incontinence. This can lead to renal failure.
• Urinary tract infection and bladder stones: caused by urine stagnating in the bladder, which can lead to haematuria.
• Bladder hyperactivity: observed in some patients with BPH. It increases the risk of urinary infections and kidney problems.

It is important to note that the symptoms and complications of BPH vary. Urinary problems associated with BPH require appropriate management to avoid complications of varying severity.

Sources:

• https://www.chu-lyon.fr/hypertrophie-benigne-de-prostate-adenome-de-prostate#:~:text=Elle results in a,is not cancer.
• https://www.vidal.fr/maladies/reins-voies-urinaires/hypertrophie-benigne-prostate-hbp.html