Definition
It is a common disease in aging men. Is a non-cancerous enlargement or hypertrophy of the prostate gland. When the prostate enlarges, then it can squeeze down on the urethra and impede (slow) the flow of urine. It is also known as benign prostatic hyperplasia and abbreviated as BPH.
Causes:
- Unknown (idiopathic)
Risk Factors
- Aging-: >40 years Only Men
- Family history. Having a blood relative, such as a father or brother, with a prostate means a person is more likely to have a chance to get BPH.
- Ethnic background. Prostate enlargement is less common in Asian men than in white and black men.
- Diabetes and heart disease. Studies show that diabetes, as well as heart disease and the use of beta blockers, might increase the risk of BPH.
- Lifestyle. Obesity increases the risk of BPH, while exercise can lower the risk
Sing and Symptoms
common signs and symptoms of BPH include:
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Straining while urinating
- Inability to completely empty the bladder
Less common signs and symptoms include:
- Urinary tract infection
- Inability to urinate
- Blood in the urine
- Fatigue
- Anorexia
- Nausea and vomiting
- Pelvic discomfort
Diagnosis evaluation
• History collection
Present health history
Past health history
• Physical examination
• A digital rectal exam (DRE): during the examination, the doctor/ Nurse gently puts a lubricated, gloved finger of one hand into the rectum and use the other hand to press on the lower belly or pelvic area.
• Urinary blood test to screen for bladder cancer
• Ultrasound of the Prostate
• Prostate-specific antigen (PSA) test: PSA is a protein made only by the prostate gland. PSA level above 4.0 ng/ml. In BPH it is found High
• Urodynamic assessment: a special test called to see how well the bladder and urethra can hold and release urine.
Transrectal ultrasound-guided biopsy): biopsy of the prostate done through the rectum using an ultrasound to guide
Medical Management
| Lifestyle
Decreasing fluid intake before bedtime, Avoid alcohol, smoking, consumption. voiding position Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume) • A meta-analysis found no differences between the standing and sitting positions for healthy males, but that, for elderly males with lower urinary tract symptoms, voiding in the sitting position: • The post void residual volume was decreased • The maximum urinary flow was increased, comparable with pharmacological intervention • The voiding time was decreased
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| • This urodynamic profile is associated with a lower risk of urologic complications, such as cystitis and bladder stones
Medications • The two main medication classes for bph management are alpha adrenergic blockers and 5α-reductase inhibitors. • Alpha adrenergic blockers: these are the most common choice for initial therapy like Alfuzosin, Doxazosin. • alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow. • 5α-reductase inhibitors: the 5α-reductase inhibitors finasteride and dutasteride may also be used in men bph. These medications inhibit the 5α-reductase enzyme, which, in turn, inhibits production of dht {dihydrotestosterone or androstanol one}, a hormone responsible for enlarging the prostate.
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| Surgical management
If medical treatment is not effective: TURP – transurethral resection of the prostate: Transurethral resection of the prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from benign prostatic hyperplasia (bph). Transurethral incision of the prostate (TUIP} A combined visual and surgical instrument (resectoscope) is inserted through the tip of penis into the tube that carries urine from bladder (urethra). The prostate surrounds the urethra. The surgeon cuts one or two small grooves in the area where the prostate and the bladder are connected (bladder neck) to open the urinary channel and allow urine to pass through more easily.
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| • Laser PVP (photo selective vaporization of the prostate)
During laser PVP surgery, a tube with an imaging system (cystoscope) is inserted into the penis. A surgeon places a laser through the cystoscope to burn away (vaporize) excess tissue that is blocking urine flow through the prostate. Transurethral microwave therapy (TUMT) Transurethral microwave therapy (TUMT) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate. It’s generally used for men with small- to moderate-sized prostates.
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| Transurethral needle ablation (tuna)–radiofrequency ablation
• A combined visual and surgical instrument (cystoscope) is inserted through the tip of penis into the tube that carries urine from bladder (urethra). The prostate surrounds the urethra. Using the cystoscope, your doctor guides a pair of tiny needles into the prostate tissue that is pressing on the urethra. • Radio waves are then passed through the needles, generating heat that creates scar tissue. Special shields protect the urethra from the heat. The scarring shrinks prostate tissue, allowing urine to flow more easily. |