by Steven Guptha
Posted on Tuesday 5th of July 2011
Benign prostatic hyperplasia (BPH) also known as benign prostatic hypertrophy ,benign enlargement of the prostate (BEP), and adeno fibromyomatous hyperplasia, refers to the increase in size of the prostate in middle-aged and elderly men
1. Testosterone reaches the prostate in extremely high concentrations, promoting the accelerated proliferation of prostate cells, leading to the gland's enlargement - BPH.
2. Androgens (testosterone and related hormones) are considered to play a permissive role in BPH by most experts.
3. Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2. This enzyme is localized principally in the stromal cells; hence, those cells are the main site for the synthesis of DHT.
4. There is growing evidence that estrogens play a role in the etiology of BPH. This is based on the fact that BPH occurs when men have, in general, elevated estrogen levels and relatively reduced free testosterone levels, and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT.
5. Adenomatous prostatic growth is believed to begin at approximately age 30 years. An estimated 50% of men have histologic evidence of BPH by age 50 years and 75% by age 80 years. In 40-50% of these patients, BPH becomes clinically significant.
It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections, BPH is not considered to be a premalignant lesion.
Signs and symptoms
1. Weak urinary stream
2. Prolonged emptying of the bladder
3. Abdominal straining
5. Irregular need to urinate
6. Incomplete bladder emptying
7. Post-urination dribble
8. Irritation during urination
9. Frequent urination
10. Nocturia (need to urinate during the night)
12. Incontinence (involuntary leakage of urine)
13. Bladder pain
15. Problems in ejaculation
1. Microscopic examination of different types of prostate
2. Transrectal ultrasound
3. Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe.
4. Blood tests are performed to rule out prostatic malignancy: Elevated prostate specific antigen (PSA)
1. Patients should decrease fluid intake before bedtime
2. Moderate the consumption of alcohol and caffeine-containing products
3. Follow timed voiding schedules.
Chronic hypertrophy of the prostate
Difficulty in voiding the urine
Straining of the urine
Urine flow stops and starts
General discomfort due to prostatic hypertrophy
Frequent pressing to urinate with small discharge
Straining to pass urine
Stiches from the rectum to the bladder
Discharge of the prostatic fluid in the morning on awaking
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