🩺 Men's Health

Benign Prostatic Hyperplasia (BPH) — Nigeria

Prostate enlargement causing urinary symptoms in men over 50 — medical and surgical options

Benign prostatic hyperplasia (BPH) is non-cancerous enlargement of the prostate gland that obstructs urinary flow. It affects over 50% of Nigerian men over 50 and over 80% of men over 70. Urinary symptoms significantly impact quality of life — frequent nighttime waking (nocturia), weak stream, and difficulty starting urination are common. BPH is not prostate cancer, but both can coexist. Effective medical treatment reduces the need for surgery in most men.

Signs and Symptoms

✓ Weak or hesitant urinary stream — difficulty initiating urination

✓ Nocturia — waking 2 or more times per night to urinate

✓ Urinary frequency — needing to urinate more than 8 times per day

✓ Urgency — sudden strong urge with difficulty reaching the toilet in time

✓ Incomplete emptying — feeling that the bladder has not fully emptied

✓ Urinary retention — complete inability to pass urine (medical emergency)

✓ Recurrent UTIs — urine stasis predisposes to infection

✓ Haematuria — blood in urine (always needs investigation — may indicate other pathology)

Risk Factors

Age — incidence rises sharply after 50
Family history of BPH
Obesity and metabolic syndrome — associated with higher BPH risk
Sedentary lifestyle
Diabetes mellitus — autonomic neuropathy worsens bladder dysfunction
Medications — decongestants, antihistamines, antidepressants can precipitate urinary retention

When to Seek Help

EmergencyComplete inability to pass urine (acute urinary retention) — requires emergency catheterisation

EmergencyUrinary retention with fever — infected obstructed urinary tract

Same dayBlood in urine in a man with BPH — also investigate for bladder or prostate cancer

RoutineLower urinary tract symptoms affecting quality of life — assessment and treatment options

RoutineProstate cancer screening discussion — PSA test with informed consent, especially if family history or African ancestry (higher risk)

Tests & Diagnosis

🧪 International Prostate Symptom Score (IPSS)

Validated 7-question questionnaire scoring symptom severity (0–35). Guides treatment decisions and monitors response

🧪 Urine dipstick and MSU

Detects haematuria, infection, or glucose (diabetes)

🧪 PSA (Prostate Specific Antigen)

Cannot distinguish BPH from prostate cancer alone, but very elevated PSA or rapid rise suggests cancer. Discuss with patient before ordering — requires counselling about implications

🧪 Post-void residual urine (ultrasound)

Measures incomplete bladder emptying. >150 ml suggests significant obstruction

🧪 Transrectal ultrasound (TRUS)

Measures prostate volume — important for selecting medical treatment. Large prostate (>40 ml) responds better to 5-alpha reductase inhibitors

🧪 Renal function (creatinine, eGFR)

Bilateral obstruction can cause hydronephrosis and renal impairment

Treatment Options

Watchful waiting (mild symptoms, IPSS <7)

Lifestyle advice: reduce fluid before bed, avoid caffeine and alcohol, void when urge first felt. Annual monitoring. No medication needed for mild symptoms

Alpha-blockers (moderate to severe symptoms)

Tamsulosin 0.4 mg once daily (first choice), or alfuzosin 10 mg once daily. Relax smooth muscle in the prostate and bladder neck — improve urine flow within days. Side effects: postural hypotension (especially in elderly — first dose at bedtime), retrograde ejaculation

5-alpha reductase inhibitors (large prostate >40 ml)

Finasteride 5 mg or dutasteride 0.5 mg daily. Shrink the prostate over 3–6 months. Prevent progression and reduce need for surgery. Combined with alpha-blocker in moderate-severe symptoms (combination therapy). Side effects: reduced libido, ejaculatory dysfunction, gynaecomastia

Combination therapy (alpha-blocker + 5-ARI)

Most effective for large prostates — greater symptom relief and reduces risk of acute retention and surgery progression. CombAT trial evidence supports this approach

Phosphodiesterase-5 inhibitors (tadalafil 5 mg daily)

Approved for BPH — also treats erectile dysfunction (often coexistent). An option for men with both conditions

Surgical treatment — TURP

Transurethral resection of the prostate — the gold standard surgical treatment. Performed under spinal/general anaesthesia. Significant symptom improvement in >90%. Available at LUTH, UCH, ABUTH, and major teaching hospitals. Post-TURP physiotherapy important for continence recovery

Laser prostatectomy (HoLEP, GreenLight)

Minimally invasive laser procedures — fewer complications than TURP. Less bleeding, shorter hospital stay. Available at limited centres in Nigeria. Particularly suited to patients on anticoagulants

Urethral catheterisation for acute retention

Urethral or suprapubic catheter for emergency relief. Trial without catheter (TWOC) after 2–3 days on alpha-blocker — 50–70% void successfully. If retention recurs, proceed to surgery

Frequently Asked Questions

Is BPH the same as prostate cancer?

No. BPH is benign (non-cancerous) prostate enlargement. Prostate cancer is a malignant tumour. They can coexist. A raised PSA does not mean cancer — it can be elevated in BPH, prostatitis, or after vigorous exercise. An elevated PSA or hard, irregular prostate on examination warrants biopsy to exclude cancer.

Will I need surgery for BPH?

Most men with BPH can be managed long-term with medication. Surgery is reserved for those with severe symptoms not responding to medication, repeated urinary retention, recurrent infections, bladder stones, or kidney damage from obstruction. Medication is highly effective for most.

Can BPH be prevented?

There is no proven prevention, but maintaining a healthy weight, regular exercise, and limiting alcohol and caffeine reduce symptom burden. Finasteride or dutasteride prevent BPH progression in men with large prostates.

Is the weak stream in old men just normal ageing?

No — it is a symptom of BPH (or occasionally prostate or urethral cancer) and should be investigated. Urinary symptoms significantly impair quality of life and are now highly treatable. Many Nigerian men accept these symptoms as 'old age' when effective treatment would transform their lives.