What is refractory benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is a common condition that occurs when the prostate gland enlarges in men. It is non-cancerous and does not increase the risk of developing prostate cancer. This gland typically begins to grow after the age of 40 and continues to enlarge with age. This enlargement can compress the bladder and urethra, obstructing urine flow and causing a range of bothersome urinary symptoms.

When BPH is referred to as "refractory," it means that the associated urinary symptoms have not responded sufficiently to initial treatments, such as lifestyle modifications or medications. These symptoms may include a frequent or urgent need to urinate, waking up multiple times at night to urinate, difficulty starting urination, a weak or interrupted urine stream, the feeling of incomplete bladder emptying, or post-void dribbling. In these cases, a physician may recommend considering more interventional treatment options, including surgical procedures.

When should surgical options be considered?

Surgical options for BPH are pursued when medications or lifestyle changes are not sufficiently effective in relieving symptoms, or when symptoms are severe and significantly impact the patient's quality of life. Surgery may also be necessary if serious complications arise due to BPH, such as acute urinary retention (the sudden inability to urinate), recurrent urinary tract infections, bladder damage, bladder stones, or kidney damage [1].

It is important to consult a physician to evaluate your symptoms and determine if surgery is the most appropriate option. The doctor can explain the potential benefits and risks of each treatment option to help you make an informed decision.

Signs indicating a potential need for surgery

Several signs may suggest that you might need surgery for BPH:

• Lack of response to medication: If you have been taking prescribed medications for BPH regularly and have not felt a noticeable improvement in symptoms after a sufficient duration of treatment [2].
• Worsening symptoms: If urinary symptoms become worse, such as an increased urgent need to urinate or greater difficulty emptying the bladder.
• Acute urinary retention: A medical emergency in which you cannot urinate at all. This condition requires immediate medical attention [1].
• Recurrent urinary tract infections: If you suffer from frequent urinary tract infections due to incomplete bladder emptying.
• Blood in the urine: Although blood in the urine (hematuria) can have multiple causes, it may be linked to BPH in some cases [3]. Any appearance of blood in the urine must be evaluated by a physician.
• Bladder or kidney damage: If tests show damage to the bladder or kidneys resulting from the constant pressure caused by prostate enlargement.

Available types of surgery

Several types of surgeries are available for treating BPH, and these procedures vary in how they remove or reduce the volume of the enlarged prostate tissue. Common options include [2]:

• Transurethral Resection of the Prostate (TURP): A procedure where an instrument is inserted through the urethra to remove parts of the enlarged prostate tissue.
• Laser surgery: Uses different types of lasers to vaporize or excise enlarged prostate tissue.
• Transurethral electrovaporization: This procedure uses heat to destroy a portion of the prostate.

There are also other minimally invasive procedures that may be suitable for certain cases. A specialist, typically a urologist, can discuss the most appropriate options for your health condition [2]. For more information on these options, you can visit Refractory Benign Prostatic Hyperplasia: When to Consider Surgical Options? (Arabic).

Your next steps

If you are experiencing BPH symptoms that have not improved with treatment, or if you have developed any of the warning signs mentioned above, it is essential to see your doctor. The physician will perform the necessary examinations, such as a clinical exam, urine tests, prostate-specific antigen (PSA) test, and may order additional tests such as urodynamic tests or cystoscopy to accurately evaluate your condition [1]. Based on these results, they will be able to provide the best treatment recommendation for you.

Medical references

• Enlarged Prostate (BPH)
• Enlarged Prostate (Benign Prostatic Hyperplasia)
• Blood in Urine