BPH (Benign Prostatic Hyperplasia)

Benign prostatic hyperplasia is the age-related proliferation of stromal and epithelial cells in the transition zone of the prostate, the part that surrounds the urethra. Growth there compresses the urethra mechanically and increases smooth muscle tone dynamically, producing the storage and voiding symptoms collectively called lower urinary tract symptoms. Histological BPH is present in about half of men in their fifties and 80-90% of men over eighty, though only a subset develop bothersome symptoms. The driver is dihydrotestosterone rather than testosterone itself. Type 2 5-alpha-reductase converts testosterone to DHT within the prostate, where it accumulates and drives glandular proliferation; the shifting testosterone-to-oestrogen ratio with age appears to amplify this. Metabolic syndrome, obesity, insulin resistance and inflammation are all independently associated with faster prostate growth and worse symptoms, which is why the condition responds partly to metabolic improvement. Symptoms fall into two groups. Voiding symptoms — hesitancy, weak stream, straining, incomplete emptying, dribbling — reflect obstruction. Storage symptoms — frequency, urgency, nocturia — reflect the detrusor changes that follow. Nocturia is usually what drives men to seek help, since it fragments sleep. Standard care starts with alpha-1 blockers such as tamsulosin, which relieve symptoms within days, and adds a 5-alpha-reductase inhibitor such as finasteride or dutasteride for larger glands, shrinking prostate volume by 20-25% over six to twelve months. Daily tadalafil helps both urinary and erectile symptoms. Minimally invasive procedures including UroLift and Rezum, and ultimately transurethral resection, are options when medication fails. Crucially, BPH and prostate cancer produce overlapping symptoms, and BPH does not cause cancer. Any man with new urinary symptoms needs a proper assessment: symptom scoring, digital rectal examination, urinalysis and PSA in appropriate cases. Untreated obstruction can progress to urinary retention, recurrent infection, bladder stones and, rarely, renal impairment.

• •Weak or intermittent urinary stream
• •Hesitancy in starting urination
• •Straining to void
• •Sensation of incomplete emptying
• •Urinary frequency during the day
• •Urgency
• •Nocturia, waking two or more times to urinate
• •Post-void dribbling
• •Acute urinary retention in advanced cases

• •Age-related accumulation of dihydrotestosterone in prostate tissue
• •Shifting testosterone to oestrogen ratio with ageing
• •Type 2 5-alpha-reductase activity in the transition zone
• •Chronic prostatic inflammation
• •Metabolic syndrome and insulin resistance
• •Obesity, particularly central adiposity
• •Physical inactivity
• •Family history of BPH

{"Intraprostatic DHT accumulation driving stromal and epithelial proliferation","Age-related hormonal shift toward relative oestrogen excess","Chronic low-grade prostatic inflammation","Insulin resistance and metabolic syndrome","Increased alpha-1 adrenergic smooth muscle tone at the bladder neck"}