The disease where the prostrate gland is enlarged is termed as Benign prostatic hyperplasia (BPH). Though the cause still remains unknown, the experts confirm that it is not cancerous in nature, and in no way associated with prostrate cancer. Benign prostatic hyperplasia is caused by the hyperplasia of prostatic stromal and epithelial cells that results in the formation of large, detectable nodules in the periurethral region of the prostate that tends to compress the urethral canal, causing either partial or complete obstruction of the urethra, which obstructs the normal flow of urine.
Cause Of Benign Prostatic Hyperplasia
Most medical experts opine that the androgens like testosterone and related hormones are play an important role in Benign prostatic hyperplasia, though they are not solely responsible for this ailment. A metabolite of testosterone dihydrotestosterone (DHT) plays a critical role in the growth of prostrate glands. Estrogens also play a role in causing BPH.
This happens when prostrate tissues become more sensitive to estrogens and less to DHT. Men above the age of 40 years are mostly affected by benign prostatic hyperplasia, and this disease can run in the families too. Since the enlargement of prostrate gland in men cannot be prevented with increasing age, about 45% of men after 46 years of age are seen to suffer from the symptoms of Benign prostatic hyperplasia .
Symptoms of Benign Prostatic Hyperplasia
Benign prostatic hyperplasia causes obstruction in the normal flow of urine because of the enlarged prostrate gland and irritation while passing urine. The International Prostate Symptom Score (IPSS) questionnaire, which has been specially designed to access the severity of benign prostatic hyperplasia, evaluates all these irritative and obstructive symptoms as follows:
Increase in the urgency to pass urine more frequently
Disturbance of sleep at night because of frequent needs to go to the toilet
Problem in passing urine at first each time
A narrow stream of urine
Sudden discontinuations in the flow while passing urine
The problem of dribbling persisting even minutes after the completion of passing urine
A sensation of retention of urine in the bladder even after passing urine
Immediate need to pass urine
Involuntary leakage of the urine, generally termed as incontinence of urine
Irritation while passing urine, etc.
Consequences of Benign Prostatic Hyperplasia
Retention of urine in the bladder results in bacteria formation in the bladder that may further result in urinary tract infection.
Crystallisation of salts from the residual urine leads to the formation of stones in the bladder.
Continuous retention of residual urine in the bladder might even affect the kidney and eventually lead to renal failure in the patient.
Benign Prostatic Hyperplasia Diagnosed
Rectal examination, to measure the increase in the size of the prostrate gland Transrectal ultrasonography, to detect symptoms of cancer, if any, at the early stage .
Ultrasound examination of the testicles, prostate, and kidneys to ensure that there is no sign of malignancy and hydronephrosis.
Blood tests, to rule out the possibility of prostatic malignancy.
Prostate specific antigen (PSA) investigations to measure and reinterprete PSA density and PSA free percentage
What is the treatment of Benign prostatic hyperplasia?
Benign prostatic hyperplasia can be somewhat avoided if treated in the initial stage by a change in lifestyle after a person attains 45 yrs of age; or they can be treated with medication if detected early. Surgery is rendered to treat BHP at an acute stage.
Change in Lifestyle
Researches in China have proved that men leading a westernized life have more chances of Benign prostatic hyperplasia than their rural counterparts. This can be avoided by:
Avoiding too much caffeine in drinks
Less intake of alcohol
No late night drinking
Decrease in fluid intake before bedtime
Medication
Medical treatments can reduce the size of the prostrate or relax and smooth the muscles around the neck of the bladder and the prostrate gland to ensure improved urine flow. The former is known as 5α-reductase inhibitors, whereas the latter is termed as alpha-blockers.
Doxazosin, terazosin, alfuzosin and tamsulosin are some of the modern available drugs.
Surgery
When medical treatment fails, surgical treatment is rendered to give relief to the patients. Surgery includes TURP or removal of part of the prostate gland through the urethra or through the abdomen if the prostrate is too large.
Other surgical processes include visual laser ablation (VLAP), laser TURP, Transurethral electrovaporization of the prostate (TVP), TransUrethral Microwave ThermoTherapy (TUMT), TransUrethral Needle Ablation (TUNA), ethanol injection, etc.
Nowadays, different methods of laser treatments are also being experimented with.
