BPH: Benign prostatic hyperplasia -
Clinical features: Male over the age of 40, The hallmark of this problem is frequency of urination. Nocturia, narrowed stream, hesitancy, urgency and increased frequency of UTIs.
The prostate has three lobes. 2 posterior lobes on the left and the right. 1 anterior lobe in the center. The commonest location of BPH is the anterior lobe. There is a groove in the prostate as one feels it from the back. This groove gets less prominent as the anterior central lobe grows into it.
Treatment is symptomatic. Medical and surgical options exist.
Medical management includes 2 effective options.
1. Alpha blockers: Use of Terazosin (Hytrin) or Prazosin (Cardura) and now Tamsulosin and Alfuzosin. No significant difference between these. Terazosin and Prazosin are now generic and thus less expensive.
2. 5 alpha reductase inhibitors: Known to reduce the influence of testosterone on the prostate gland. These reduce the size of the prostate.
Alpha blockers are superior. 4 groups were studied. 1. Alpha blocker alone, 2. Alpha blocker + 5 Alpha reductase inhibitors, 3. group with 5 Alpha reductase inhibitors alone and 4. placebo. 3 was better than 4. 2 was better than 3 but was no better than 1. Therefore addition of 5 alpha reductase added no additional benefit compared to alpha blocker alone.
Surgical options are TURP and TUNA.
TURP is Trans-urethral resection of Prostate.
TUNA is Trans-urethral needle ablation.
TURP is more effective. Side effects are similar. Recovery is quicker with TUNA. TURP may not be associated with increased incidence of ED