Prostate median lobe hyperplasia is a non-cancerous condition in which the central part of the prostate gland enlarges, potentially leading to urinary symptoms, primarily affecting older men. In this article, I will talk about the causes, diagnosis and treatment of median lobe hyperplasia, which is a condition in which benign prostatic hyperplasia grows into the bladder.

What is the prostate median lobe hyperplasia?

Prostate median lobe hyperplasia, also known as median lobe hypertrophy, is a benign condition that occurs in the prostate gland of some men, especially as they age. In this condition, the central or median part of the prostate gland enlarges or grows larger than usual. The prostate gland is a small, walnut-sized organ located beneath the bladder, and it surrounds the urethra, the tube that carries urine and semen out of the body.

When the median lobe of the prostate hyperplasia occurs, it can exert pressure on the urethra, causing various urinary symptoms. Common symptoms associated with this condition include increased frequency of urination, difficulty starting or stopping urination, weak urine flow, a feeling of incomplete bladder emptying, and sometimes, the need to urinate during the night. These symptoms can impact a man’s quality of life and may require medical evaluation and management.

It’s important to note that prostate median lobe hyperplasia is different from prostate cancer. It is a non-cancerous condition characterized by the enlargement of prostate tissue, whereas prostate cancer involves the abnormal growth of cancerous cells within the prostate gland. Treatment for prostate median lobe hyperplasia may include lifestyle changes, medications, or, in some cases, surgical procedures to alleviate urinary obstruction and improve the patient’s quality of life.

What are the causes of prostate median lobe hyperplasia?

The exact causes of prostate median lobe hyperplasia are not fully understood, but several factors have been associated with its development. This condition primarily affects older men, and age-related changes in hormone levels and the prostate gland itself are believed to contribute to its occurrence. Here are some of the factors and potential causes associated with prostate median lobe hyperplasia:

• Aging: Prostate median lobe hyperplasia is more commonly seen in older men. As men age, changes in hormone levels, particularly an increase in dihydrotestosterone (DHT), can lead to the growth of prostate tissue, including the median lobe.
• Hormonal changes: Hormonal imbalances, particularly changes in testosterone and DHT levels, may play a role in the development of prostate median lobe hyperplasia. DHT, in particular, is known to stimulate the growth of prostate cells.
• Genetic factors: There is evidence to suggest that genetics may contribute to an individual’s susceptibility to prostate median lobe hyperplasia. A family history of the condition can increase the risk.
• Hormone-related medications: Certain medications or treatments that affect hormone levels, such as testosterone replacement therapy, may potentially contribute to the development or progression of prostate median lobe hyperplasia.
• Lifestyle factors: While not direct causes, some lifestyle factors like diet and obesity have been associated with an increased risk of prostate gland enlargement. A diet high in saturated fats and obesity may influence hormonal changes that affect the prostate.

It’s essential to note that while these factors may increase the risk of prostate median lobe hyperplasia, the exact cause can vary from person to person. Additionally, this condition is considered benign and non-cancerous, in contrast to prostate cancer, which has different risk factors and causes. If you have concerns about prostate health or are experiencing urinary symptoms, it’s important to consult with a healthcare professional for a proper diagnosis and appropriate management.

Symptoms of prostate median lobe hyperplasia

Prostate median lobe hyperplasia can cause various urinary symptoms due to the enlargement of the central part of the prostate gland, which can put pressure on the urethra. These symptoms can vary in severity and may include:

• Increased frequency of urination: Men with this condition often feel the need to urinate more frequently, including during the night (nocturia). This can disrupt sleep patterns.
• Weak urine flow: The enlarged prostate can obstruct the urethra, leading to a weaker and slower urine stream. Men may notice that it takes longer to empty their bladder.
• Difficulty starting and stopping urination: Some individuals may find it challenging to initiate urination or may have trouble stopping the flow once it begins.
• Urgency and hesitancy: There can be a sense of urgency to urinate, where the need to urinate comes on suddenly and strongly. However, when attempting to start urination, there may be a delay or hesitancy.
• Incomplete bladder emptying: After urination, some men may feel as though their bladder has not completely emptied, leading to a sensation of residual urine.
• Straining during urination: To overcome the obstruction caused by the enlarged prostate, men may need to strain or push to fully empty their bladder.
• Urinary tract infections (UTIs): In some cases, urinary retention or incomplete emptying of the bladder can increase the risk of UTIs.

It’s important to note that not everyone with prostate median lobe hyperplasia will experience all of these symptoms, and the severity can vary from person to person. These urinary symptoms can significantly impact a man’s quality of life, and if left untreated, they may lead to complications such as acute urinary retention, bladder stones, or UTIs.

If you or someone you know is experiencing urinary symptoms, especially if they are persistent or bothersome, it is advisable to seek medical evaluation and consultation with a healthcare professional. Accurate diagnosis and appropriate management can help alleviate these symptoms and improve overall well-being.

Diagnosis of prostatic median lobe hyperplasia?

The diagnosis of prostate median lobe hyperplasia typically involves a combination of medical history assessment, physical examination, and various diagnostic tests. Here’s an overview of the diagnostic process:

• Medical History: The healthcare provider will begin by taking a detailed medical history. They will ask about your urinary symptoms, their duration, and any other relevant medical conditions or medications you may be taking. It’s essential to provide accurate information about your symptoms and any changes in urinary habits.
• Physical Examination: A physical examination, including a digital rectal examination (DRE), may be performed. During a DRE, the doctor inserts a gloved, lubricated finger into the rectum to assess the size, shape, and consistency of the prostate gland. This can help determine if the prostate is enlarged and if the median lobe is involved.
• Uroflowmetry: Uroflowmetry is a test that measures the rate and force of urine flow during urination. It can help assess the strength of the urinary stream, which may be compromised in cases of prostate median lobe hyperplasia.
• Post-Void Residual (PVR) Measurement: After you urinate, a PVR measurement can determine if there is any residual urine left in the bladder. An ultrasound or catheter may be used to measure this volume. An elevated PVR may suggest incomplete bladder emptying, which can be associated with prostate median lobe hyperplasia.
• Prostate-Specific Antigen (PSA) Test: A PSA blood test may be conducted to measure levels of PSA in the bloodstream. While a high PSA level can be indicative of various prostate conditions, including prostate cancer, it can also be elevated in cases of prostate median lobe hyperplasia.
• Imaging Studies: In some cases, imaging studies like transrectal ultrasound (TRUS) or cystoscopy may be performed to visualize the prostate gland and assess the size and configuration of the median lobe.
• Biopsy (Rarely): In some instances, a prostate biopsy may be recommended, especially if there is concern about prostate cancer or if other diagnostic tests do not provide a definitive diagnosis.

It’s important to note that the diagnosis of prostate median lobe hyperplasia is primarily based on clinical evaluation, medical history, and the presence of urinary symptoms. Imaging and other tests help confirm the diagnosis and rule out other potential causes of urinary symptoms, such as prostate cancer.

If you are experiencing urinary symptoms or have concerns about your prostate health, it is crucial to seek evaluation and guidance from a healthcare professional, such as a urologist, who can accurately diagnose your condition and recommend appropriate management and treatment options.

Indications of treatment of prostatic median lobe

The treatment of prostate median lobe hyperplasia, like benign prostatic hyperplasia (BPH), is typically indicated when the condition causes bothersome symptoms that significantly affect a patient’s quality of life or when complications arise. Indications for treatment may include:

• Moderate to Severe Symptoms: Treatment is often recommended when urinary symptoms associated with prostate median lobe hyperplasia become moderate to severe. These symptoms may include frequent urination, weak urine flow, difficulty starting or stopping urination, urgency, nocturia (nighttime urination), and a feeling of incomplete bladder emptying.
• Acute Urinary Retention: If you experience acute urinary retention, which is the sudden inability to urinate, it is considered a medical emergency. It requires immediate intervention, such as catheterization, and is a clear indication for treatment of the underlying prostate median lobe hyperplasia.
• Recurrent Urinary Tract Infections (UTIs): If you have recurring UTIs due to urinary retention or incomplete bladder emptying caused by prostate median lobe hyperplasia, treatment may be recommended to prevent further infections.
• Bladder Stones: The presence of bladder stones resulting from urinary retention or incomplete emptying of the bladder is an indication for treatment. Treatment may involve addressing the underlying prostate enlargement and removing the stones.
• Hematuria: If you experience blood in the urine (hematuria) as a result of prostate median lobe hyperplasia, further evaluation and treatment may be necessary.
• Significant Quality of Life Impairment: Even if symptoms are not severe, if prostate median lobe hyperplasia significantly impairs your quality of life, interferes with daily activities, or causes emotional distress, you and your healthcare provider may discuss treatment options.
• Medication Failure: If medications prescribed for prostate median lobe hyperplasia fail to provide adequate symptom relief or if you experience bothersome side effects from the medication, alternative treatment options may be considered.

The choice of treatment will depend on the specific circumstances and the patient’s preferences. Conservative management, such as lifestyle modifications and watchful waiting, may be suitable for mild cases with minimal impact on daily life. For more severe cases or when complications occur, medical or surgical interventions are often recommended to alleviate symptoms and improve overall well-being.

It is crucial to have open and thorough discussions with a healthcare provider to determine the most appropriate treatment plan based on individual needs and the specific indications for treatment. Regular follow-up appointments are essential to monitor progress and adjust treatment as needed.

Treatment of prostate median lobe hyperplasia

The treatment of prostate median lobe hyperplasia, also known as benign prostatic hyperplasia (BPH) with a prominent median lobe, depends on the severity of symptoms and the impact on a patient’s quality of life. Treatment options can range from conservative approaches to more invasive procedures, and the choice of treatment should be made in consultation with a urologist or healthcare provider. Here are some common treatment options for prostate median lobe hyperplasia:

• Watchful Waiting: If the symptoms of prostate median lobe hyperplasia are mild and not significantly affecting your daily life, your healthcare provider may recommend a “watchful waiting” approach. This involves regular monitoring of your condition without immediate intervention. Lifestyle modifications, such as dietary changes and fluid management, may be suggested to help manage symptoms.
• Medications: Various medications can help alleviate the symptoms of BPH with a prominent median lobe. These medications include:

Alpha-Blockers: Drugs like tamsulosin (Flomax), alfuzosin (Uroxatral), and terazosin (Hytrin) relax the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms.

5-Alpha Reductase Inhibitors: Medications like finasteride (Proscar) and dutasteride (Avodart) can shrink the prostate over time by reducing the production of dihydrotestosterone (DHT).

Combination Therapy: In some cases, a combination of an alpha-blocker and a 5-alpha reductase inhibitor may be prescribed for more significant symptom relief.

• Minimally Invasive Procedures: If medication is not effective or symptoms are moderate to severe, minimally invasive procedures may be considered. These include:

Transurethral Microwave Therapy (TUMT): This procedure uses microwave energy to heat and shrink prostate tissue, improving urinary flow.

Transurethral Needle Ablation (TUNA): TUNA uses radiofrequency energy to reduce excess prostate tissue.

Prostatic Urethral Lift (UroLift): This procedure involves the insertion of small implants to hold the prostate lobes apart, relieving urethral obstruction.

• Transurethral Resection of the Prostate (TURP): TURP is a surgical procedure in which the surgeon removes excess prostate tissue using a thin, electrified wire. It is effective in relieving symptoms but involves more significant recovery time than minimally invasive procedures.
• Laser Therapy: Various laser-based treatments, such as GreenLight laser therapy or Holmium laser enucleation of the prostate (HoLEP), can remove or vaporize prostate tissue to alleviate symptoms.
• Open Surgery: In rare cases when other treatments are not effective or appropriate, open surgery (prostatectomy) may be recommended to remove the enlarged prostate tissue.

• The choice of treatment depends on factors such as the severity of symptoms, the size of the prostate, the patient’s overall health, and individual preferences. It’s essential to have a thorough discussion with your healthcare provider to determine the most suitable treatment option for your specific case. Regular follow-up appointments are crucial to monitor the effectiveness of treatment and make adjustments as needed.

Is medical treatment effective for median lobe hyperplasia?

Drug treatments used for BPH can be used in the treatment of prostate median lobe hyperplasia. But these drug treatments are often not effective and these patients require surgery. As surgery, we generally prefer HOLEP surgery.

Summary

Prostate median lobe hyperplasia, a condition related to benign prostatic hyperplasia (BPH), involves the abnormal enlargement of the central part of the prostate gland in men, known as the median lobe. This non-cancerous condition primarily affects older men and can lead to urinary symptoms, including increased frequency, weak urine flow, difficulty starting and stopping urination, urgency, and a feeling of incomplete bladder emptying. The exact cause of prostate median lobe hyperplasia is not fully understood but is related to age-related hormonal changes. Treatment options vary based on the severity of symptoms and may include medications, minimally invasive procedures, or surgical interventions. The choice of treatment depends on individual factors and is aimed at improving urinary function and quality of life. Regular medical evaluation and discussion with a Urologist are crucial for proper diagnosis and treatment planning.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY