Benign Prostate Hyperplasia

What is a prostate ?

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.
The vasa deferentia (singular: vas deferens) bring sperm from the testes to the seminal vesicles. The seminal vesicles contribute fluid to semen during ejaculation.

What is benign prostat hyperplasia(BPH)

BPH is a non-cancerous increase in the size and number of cells that make up the prostate.BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH.

Why BPH occurs

BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH.

Sign and symtoms

When the prostate gland enlarges, it may begin to obstruct the flow of urine through the urethra. It may also push up against the bladder causing some irritation. The most typical symptoms of BPH include:

• A slow urinary stream
• An interrupted stream—one that starts and stops
• Having to strain to urinate
• Hesitancy-having to wait before the stream will start
• Feeling that the bladder doesn’t empty all the way
• Urgency—having to urinate more often then when you were younger
• Having to get up at night to urinate

These symptoms will almost always be worse at night time. In the early stages for instance, men will have hesitancy and a slow, interrupted stream at night, but after being up for a few minutes in the morning, they will urinate perfectly fine the rest of the day.

As symptoms progress, you may develop:

• Bladder stones
• Bladder infection
• Blood in your urine
• Damage to your kidneys from back pressure caused by retaining large amounts of extra urine in the bladder
• Sudden blockage of the urinary tube, making urination impossible

How to diagnose BPH

The doctor will do digital rectal examination.Because the prostate gland is in front of the rectum, the doctor can feel if the back of the gland has any abnormalities during this examination.

Several studies may be done to help diagnose your condition:

• A urine test called a urinalysis.
• A seven-question BPH Symptom Score Index survey to evaluate the severity of your symptoms.
• A flow study to measure how slow the urinary stream is compared with normal flow(uroflometry)
• A study to detect how much urine is left in the bladder after urination is done.
• Ultrasound abdomen pelvis

Treatment for BPH

Medication. Proscar was one of the first drugs used to treat BPH. Avodart is another similar drug that can be used. They both work by inhibiting the conversion of testosterone to the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland.

Surgery. A number of surgery types can remove the prostate tissue blocking the flow of urine. The most common is called transurethral resection of the prostate, or TURP. It involves removing the tissue blocking the urethra (urine tube) with a special instrument.

Minimally Invasive Treatments. Newer treatments can effectively reduce the size of the prostate and relieve urinary obstruction, but are less invasive and damaging to healthy tissue than surgery.

Minimally invasive treatments include:

• ·         Transurethral Microwave Thermotherapy (TUMT).
• ·         Interstitial Laser Coagulation.
• ·         Transurethral Needle Ablation (TUNA).
• ·         Transurethral Electrovaporization
• ·         Intraurethral Stents. Stents (wire devices shaped like springs or coils) are placed within the prostate channel (where the urethra runs through the gland) to help keep the channel from tightening around the urethra.