Benign Prostatic Hyperplasia: What It Is, Causes, Symptoms, Treatment, & Types

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia is the enlargement of the prostate that puts pressure on the urethra and makes normal urine flow difficult. The prostate is a small gland, roughly the size of a walnut, located directly below the bladder. It surrounds the urethra, which carries the urine from the bladder. As men get older, it is natural for the prostate to enlarge gradually.

But when it puts pressure on the urethra, it may lead to symptoms such as difficulty starting urination, frequent urination, a weak urine stream, and a feeling that the bladder has not emptied.

Types of Benign Prostatic Hyperplasia

Below are the types of benign prostatic hyperplasia (BPH):

How Common is Benign Prostatic Hyperplasia in India?

BPH is one of the most common urological conditions in men in India, which is increasing parallelly with the growing elderly population in the country.

According to clinical studies, the total number of BPH cases has increased from around 95.5 lakh in 2000 to nearly 1.82 crore in 2019, an increase of almost 90.9%. This shows BPH is a growing and common health concern among adults. Individuals who have diabetes, heart diseases, or a family history of BPH are susceptible to BPH. Sedentary lifestyle (lack of physical activity) and obesity are other risk factors of BPH.

What are the Symptoms of Benign Prostatic Hyperplasia?

As the prostate enlarges, it increases pressure on the urethra, causing a slow deterioration of urine symptoms. Initial symptoms are mostly associated with urine flow, but if left untreated, the condition can progress to bladder dysfunction, recurrent infections or renal-related problems.

Some of the early and advanced symptoms of benign prostatic hyperplasia are:

What Causes Benign Prostatic Hyperplasia?

Direct causes and risk factors involved with benign prostatic hyperplasia are:

What are the Stages of Benign Prostatic Hyperplasia?

BPH does not have measurable stages like cancer. Rather, clinicians identify it based on symptom severity using the IPSS (International Prostate Symptom Score) and the presence of complications. This classification allows doctors to choose the most effective treatment method.

Take a look at this classification of benign prostatic hyperplasia in the table below:

Disease Similar to Benign Prostatic Hyperplasia

Many prostate problems have similar symptoms affecting urination, so it is important to get the right diagnosis. These illnesses can overlap in their symptoms but are very different in their cause, course and treatment.

Benign Prostatic Hypertension (BPH) vs Prostate Cancer vs Prostatitis

What are the Complications of Benign Prostatic Hyperplasia?

Complications associated with benign prostatic hyperplasia include:

• Acute Urinary Retention: An abrupt and complete inability to urinate. It is the most critical complication of BPH and should be treated with emergency catheterisation to relieve the pressure.

• Chronic Urinary Retention: Insidious accumulation of a large volume of urine in the bladder, causing it to become permanently weak through stretching and distention.

• Bladder Stones: When minerals crystallise in stagnant retained urine, it causes pain, infections, and additional blockage.

• Recurrent UTIs: If urine does not drain properly, bacteria will grow, and infections may recur frequently.

• Bladder Diverticula: With prolonged straining, pockets (diverticula) can develop in the bladder wall, trapping urine and putting the bladder at risk for infection.

• Hydronephrosis: If the blockage is present for a long time, the urine accumulates in the kidneys, causing them to swell. This is known as hydronephrosis.

• Chronic Kidney Disease: Old back-pressure (backed up urine) can lead to permanent kidney damage and, in cases of extreme back-pressure, kidney failure.

When Should I See a Healthcare Provider?

Contact your healthcare provider when:

• You are unable to pass urine at all, not even for a short time.

• You wake up three or more times each night to urinate, interfering with sleep regularly.

• You see blood in your urine more than once.

• You feel a burning sensation or pain when urinating, along with your other symptoms of urination.

• You get 2 or more urinary tract infections in six months.

• You have a feeling of persistent pressure or discomfort in your lower abdomen or pelvic region.

• Your urinary symptoms have been getting worse over a number of weeks.

• You experience fever along with difficulty urinating, which can indicate a serious infection.

How is Benign Prostatic Hyperplasia Diagnosed?

The doctor may conduct the following evaluations, tests, and medical examinations to diagnose BPH:

How is Benign Prostatic Hyperplasia Treated or Managed?

Treatment usually involves lifestyle changes for mild symptoms and surgery for advanced symptoms. These include:

Medicines Used to Treat Benign Prostatic Hyperplasia

For most patients with mild to severe symptoms, doctors advise taking medicines. The medicine prescription depends on the size of the prostate, the intensity of symptoms, age and other connected health issues. Some of the medicines used for treating benign prostatic hyperplasia are:

• Alpha-blockers (Tamsulosin, Alfuzosin, Silodosin): These medicines allow urine to flow more easily by relaxing the muscles around the prostate and bladder neck.

• 5-alpha reductase inhibitors (Finasteride, Dutasteride): These medicines gradually shrink the prostate by reducing dihydrotestosterone (DHT) production. They are generally prescribed for men with larger prostate glands and may take several months to achieve maximum benefit.

• Combination Therapy: Doctors may prescribe an alpha-blocker together with a 5-alpha reductase inhibitor for men with moderate to severe symptoms or significantly enlarged prostates.

• Phosphodiesterase-5 inhibitors (Tadalafil): Daily low-dose tadalafil may improve urinary symptoms, particularly in men who also have erectile dysfunction.

• Antimuscarinic Agents (Solifenacin, Tolterodine): These medicines help control urinary urgency and frequency when bladder overactivity accompanies BPH.

• Beta-3 Adrenergic Agonists (Mirabegron): Mirabegron relaxes the bladder muscle and reduces urgency and frequent urination without significantly affecting urine flow.

Disclaimer: Any medications should be taken only under the direction of a competent healthcare provider. Self-medicating or stopping prescribed medications without medical supervision might worsen symptoms or cause consequences.

Living with Benign Prostatic Hyperplasia in India: Challenges and Medical Care

Here is how living with benign prostatic hyperplasia can affect your daily life:

What is the Prognosis of Prostatic Hyperplasia?

There is no cure for BPH. However, it is extremely manageable with the correct treatment method. Many men can have a good response to both lifestyle changes and medication, which can provide a long period of relief from symptoms and stabilise prostate size. Surgical treatment (TURP) provides long-term relief and is effective in most patients with urinary obstruction.

BPH does not affect life span. However, uncontrolled complications can have an impact on overall health, including kidney damage and recurrent infection. The long-term prognosis is better if treatment is initiated as early as possible.

Benign Prostatic Hyperplasia Treatment Cost in India

The cost of benign prostatic hyperplasia treatment in India varies depending on symptom severity, hospital facilities, city, and the treatment. Many patients can get relief from drugs, but in later stages, they may need a minimally invasive procedure or surgery.

The approximate prices of treatment routinely seen across the Indian hospitals are given in the table below:

Disclaimer: These costs are estimates and may vary depending on the hospital, city, surgeon's expertise, room category, investigations, and individual medical requirements. The final treatment cost should always be confirmed with the treating hospital before planning care.

Does Health Insurance Cover Benign Prostatic Hyperplasia?

Yes. health insurance plans in India usually cover the cost of hospitalisation for BPH. The coverage includes room rent, nursing fees, in-patient diagnostic tests, TURP and HoLEP surgery, and surgeon fees, amongst others. They also pay for pre and post-hospitalisation costs and OPD expenses, depending on the policy terms and conditions.

If BPH is diagnosed before policy purchase, it will be treated as a pre-existing disease (PED). In this case, a maximum waiting period of 36 months will have to be served.

For seniors who have other health issues and are taking care of BPH, critical illness insurance can be a good option in case of a complication such as kidney failure. Such plans provide a lump sum benefit on the diagnosis of the condition and come with a waiting period of up to 90 days.

How Much Health Insurance Coverage is Needed for Benign Prostatic Hyperplasia Treatment?

The cost of benign prostatic hyperplasia treatment in India depends on the severity of the condition and the type of procedure required. The cost of TURP surgery can go up to ₹6 lakh in India. However, the cost of HoLEP surgery is higher, as it is a more advanced procedure.

A medical coverage of at least ₹10 lakh is usually considered adequate for BPH treatment, including hospitalisation costs, surgery expenses, and medications.