BPH (Benign Prostate hyperplasia)

Benign Prostate Hyperplasia(BPH)

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Q. What is Prostate?

The prostate is a gland present in the pelvic region of our body.
Its main function is producing semianl fluid for the sperm to swim in.

Anatomy of Prostate

the prostate is a small muscular gland of the male reproductive system , it surrounds the urethra and it helps propel the fluid forward during ejaculation

BPH is a fairly common problem in men of age above 60 , sometimes even younger , this is enlargement of prostate. (enlarged prostate)

if your doctor told you that you might be suffering from BPH or benign prostate hyperplasia, don't worry you do not have Prostate Cancer it is just an enlarged prostate which is not cancerous . this does sometimes share prostate cancer symptoms and signs of prostate cancer. but there are some very easy ways to differentiate between the two by doctors .by the help of DRE (digital rectal exam) or the infamous prostate exam.

BPH occurs when the cells of the Prostate gland begin to multiply. this leads to an enlarged prostate and this enlarged prostate starts to swell and it squeezes the urethra and can lead to urine flow problems.

Causes

1. the main cause of the BPH is unknown
2. but it is seen in Aging men
3. DHT (Dihydrotestosterone ) is a problem of testosterone as it stimulates the prostate and it becomes dihydrogen testosterone leads to stimulation and enlargement of prostate
4. genetic causes
5. abnormality with your testes
6. if a man was castrated prepubescent he wont develop BPH

Symptoms

symptoms are normally mild but if the problem is not treated in time it can lead to death even

1. incontinence
2. reduced stream
3. hesitancy
4. stopping and starting
5. frequent urination during night time
6. dribbling
7. inconvininece
8. acute urinary retention
9. pain and distention of the bladder
10. blood in urine
11. sometimes the backflow of urine can take place
    • hydroureter
    • hydronephrosis

How is BPH diagnosed?

BPH diagnosis is fairly simple

1. physical exam
2. medical exam
3. DRE ( digital rectal exam)
4. prostate exam
5. Urinalysis
6. urodynamic test
7. prostate specific antigen (PSA) - prostate antigen is raised by a lot in people suffering from prostate cancer
8. Post Void residual urine test
9. the endoscopy of urinary bladder
10. some Drugs can lead to BPH
    • antidepressants
    • diuretics
    • antihistamines
    • sedatives

Treatment of BPH

there are mainly two option

1. Medication
2. surgery

you will have to discuss with a health care professional before you start any kind of treatment

the Doctor will look at the symptoms like

1. are the symptoms interfearing with your life
2. how much larger is your prostate than normal
3. what is your age
4. your overall health
5. other medical condition
6. some drugs which you are taking

now after all this if the Doctor goes for the Drug option then there are 2 types

1. Alpha blockers
2. 5-alpha reductase inhibitors
3. sometime combined medicine

alfa blockers

these drugs are muscle relaxants also known as myorelaxants. these relax the smooth muscles of the prostate gland and leads to easier passage of the urine from the bladder

alfa blockers start to show there effects fairly early like 2 to 3 days

examples are

1. alfuzosin
2. doxazosin
3. silodosin
4. tamsulosin
5. terazosin

5-Alpha reductase inhibitors

the 5 alpha reductase is an enzyme which helps the Testosterone to be converted into the dihydrotestosterone and is inhibited by 5 alpha reductase inhibitor

1. Dutasteride
2. finasteride

these Drugs take some time to act, it can be upto 6 months before the symptoms start to recede

Minimally invasive choices

1. transurethral microwave therapy (TUMT)
2. Transurethral needle ablation (TUNA)

surgery

1. transurethral surgery (first choice)
2. transurethral incision of the prostate(TUIP)
3. Laser Surgery
4. open simple prostatectomy

Outpatient procedures

Outpatient procedures involve inserting an instrument into your urethra and into the prostate gland. They include:

• Transurethral needle ablation (TUNA). Radio waves are used to scar and shrink prostate tissue.
• Transurethral microwave therapy (TUMT). Microwave energy is used to eliminate prostate tissue.
• Transurethral water vapor therapy (Rezūm). Water vapor is used to destroy excess prostate tissue.
• Water-induced thermotherapy (WIT). Heated water is used to destroy excess prostate tissue.
• High-intensity focused ultrasonography (HIFU). Sonic energy is used to eliminate excess prostate tissue.
• Urolift. The enlarged prostate is surgically lifted with the help of implants so that it doesn’t block the urethra.

Urolift and Rezūm have both been shownTrusted Source to be nearly as effective as inpatient surgical treatments like TURP, with the added benefits of being less invasive, less costly, and more likely to preserve sexual functionality.

Inpatient procedures

Inpatient procedures might be recommended if you have any of the following symptoms:

• kidney failure
• bladder stones
• recurrent urinary tract infections
• incontinence
• a complete inability to empty the bladder
• recurrent episodes of blood in the urine

Inpatient procedures include:

• Transurethral resection of the prostate (TURP). This is the most commonly used surgical treatment for BPH and remains the gold standard surgical treatment. Your doctor inserts a small instrument through your urethra into the prostate. The prostate is then removed piece by piece.
• Simple prostatectomy. Your doctor makes an incision in your abdomen or perineum, which is the area behind your scrotum. The inner part of your prostate is removed, leaving the outer part. After this procedure, you may have to stay in the hospital for up to 10 days.
• Transurethral incision of the prostate (TUIP). This is similar to TURP, but your prostate isn’t removed. Instead, a small incision is made in your prostate that will enlarge your bladder outlet and urethra. The incision allows urine to flow more freely. You aren’t always required to stay in a hospital with this procedure.

self care

1. pelvic strength exersise
2. decrease alcohol and smoking

what are the complication which may arise due to BPH

1. UTI
2. Urolithiasis
3. damage to the kidneys
4. hematouria
5. acute urinary retention
6. hydronephrosis
7. hydroureter
8. chronic pyelonephrites
9. muscular hypertrophy of bladder wall
10. trabeculation
11. compressed and lengthened prostatic urethra
12. enlarged prostate gland

Q. should you be worried about malignancy or prostate cancer

1. Prostate cancer is most common cancer in men
2. Prostate cancer can cause identical UTI symptom to benign prostatic hyperplasia
3. Prostate specific antigen - in all men PSA increses with age but in malignancy it will increase by a lot
4. If PSA was raised with low UTI symptoms then we need to palpate the  prostate with DRE
5.  in BPH we do DRE the prostae is anterior to the rectum and in BPH it can be felt through the wall it is enlarged and the  key think is that the surface of the gland feels sort of soft and more rubberish but it is smooth not lumpy
6. Whereas in malignancy we can get bits of tumor which are sticking out  which give a lumpy feeling to the gland and it feels hard in malignancy (  because tumors are hard if they are malignant)