Rigi10™ Malleable Penile Prosthesis
Also Known As
Enlarged prostate, Benign Prostatic Hypertrophy, BPE (Benign Prostatic Enlargement), Prostate Gland Enlargement.
Definition
Benign Prostatic Hyperplasia (BPH) is a noncancerous enlargement of the prostate gland, a common condition in aging men.¹ It is characterized by the proliferation of stromal and epithelial cells within the transition zone of the prostate, which surrounds the urethra.³ This growth can compress the urethra, leading to obstruction of urine flow and a variety of lower urinary tract symptoms (LUTS).² BPH is not prostate cancer, nor does it increase the risk of developing prostate cancer, though both conditions can coexist. The primary purpose of understanding BPH is to effectively diagnose and manage its symptoms, improving the quality of life for affected individuals.
Clinical Context
Benign Prostatic Hyperplasia is clinically relevant when it causes bothersome lower urinary tract symptoms (LUTS) that affect a patient’s quality of life.4 These symptoms can be categorized as storage symptoms (e.g., urinary frequency, urgency, nocturia) or voiding symptoms (e.g., weak stream, hesitancy, straining, incomplete emptying).1
Patient Selection Criteria:
Men presenting with LUTS are typically evaluated for BPH. Evaluation includes a medical history, physical examination (including a digital rectal exam – DRE), urinalysis, and often a symptom score questionnaire (like the AUA Symptom Index).4 Prostate-Specific Antigen (PSA) levels may be checked to assess prostate volume and to screen for prostate cancer, especially before initiating certain treatments or surgery. Further investigations like uroflowmetry, post-void residual (PVR) volume measurement, and imaging (e.g., transrectal ultrasound) may be used to confirm the diagnosis, assess severity, and rule out other conditions 4
Surgical Procedures/Treatments:
Treatment options for BPH range from watchful waiting for mild symptoms to medical therapies and surgical interventions for moderate to severe symptoms.4
Medical Therapies:
Commonly include alpha-blockers (to relax prostate and bladder neck muscles), 5-alpha-reductase inhibitors (to shrink the prostate), and sometimes combination therapy. Tadalafil (a PDE5 inhibitor) is also approved for LUTS due to BPH.
Minimally Invasive Surgical Therapies (MISTs):
Options like Prostatic Urethral Lift (PUL), Water Vapor Thermal Therapy (Rezum), and Temporary Implanted Nitinol Device (TIND) are available for certain patients.
Surgical Therapy:
Transurethral Resection of the Prostate (TURP) has long been the gold standard. Other surgical options include Transurethral Incision of the Prostate (TUIP), laser therapies (e.g., HoLEP, PVP), and simple prostatectomy (open, laparoscopic, or robotic) for very large prostates.4
Expected Outcomes:
The goal of treatment is to alleviate LUTS, improve quality of life, and prevent complications such as acute urinary retention, recurrent UTIs, bladder stones, and renal impairment.4 Medical therapies can provide significant symptom relief for many men. Surgical interventions generally offer the most substantial and durable improvement in symptoms and flow rates but carry a higher risk of side effects, including sexual dysfunction (e.g., retrograde ejaculation, erectile dysfunction) and incontinence.4 The choice of treatment depends on symptom severity, prostate size, patient comorbidities, and patient preference after a thorough discussion of risks and benefits.