Benign Prostatic Hyperplasia
Although most men over age 50 have some prostatic enlargement, in benign prostatic hyperplasia (BPH) me prostate gland enlarges sufficiently to compress me urethra and cause some overt urinary obstruction, BPH begins with changes in periurethral glandular tissue. As the prostate enlarges, it may extend into the bladder and obstruct urine outflow by compressing or distorting the prostatic urethra. BPH may also cause a diverticulum musculature that retains urine when the rest of the bladder empties. Depending on the size of the enlarged prostate, the age and health of the patient, and the extent of the obstruction. BPH may be treated surgically or symptomatically.
Enlargement of the prostate gland can obstruct the normal flow of urine, which may cause:
Signs and Symptoms
One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.
The obstructive (problems with urethra and urination) symptoms of BPH are:
Several tests help to confirm this diagnosis: Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
Elevated blood urea nitrogen and serum creatinine levels suggest impaired renal function.
Urinalysis and urine culture show hematuria, pyuria, and, when the bacterial count exceeds 100,000/µl, UTI.
When symptoms are severe, cystourethroscopy is the definitive diagnostic measure and is used to help determine the best surgical procedure. It can show prostate enlargement, bladder wall changes, calculi, and a raised bladder.
A prostate-specific antigen test may be performed to rule out prostatic cancer.
Conservative therapy includes prostatic massages, sitz baths, short-term fluid restriction (to prevent bladder distention) and, if infection develops, antimicrobials. Regular sexual intercourse may help relieve prostatic congestion. Treatment with terazosin and finasteride has also proven effective. Terazosin (Hytrin), an alphaadrenergic blocker, releases the prostate arid bladder muscles, reducing straining with urination. Finasteride (proscar) inhibits the action of 5-alpha-reductase, thereby preventing conversion of testosterone to dihydrotestosterone. This may lead to reduced prostate size over time.
Surgery is the only effective therapy for relief of acute urine retention, hydronephrosis, severe hematuria, and recurrent UTI or for palliative relief of intolerable symptoms. A transurethral resection may be performed if the prostate weighs less than 2 oz (57 g).
In this procedure, a resectoscope removes tissue with a wire loop and an electric current. For high-risk patients, continuous drainage with an indwelling urinary catheter alleviates urine retention. Other transurethral procedures include vaporization of the prostate or a prostate incision with a scalpel or laser.
Other procedures involve open surgical removal of the prostate. One of the following operations may be appropriate:
Less frequently performed procedures include balloon dilatation, ultrasound needle ablation, and use of stents.
Ease symptoms by avoiding caffeine in drinks, not drinking late into the evening and cutting down on alcohol.
Medical treatments improve urine flow by reducing the size of the prostate or by relaxing the muscles at the neck of the bladder and in the prostate. Surgical treatment removes part of the prostate gland through the urethra or most of the prostate gland through the abdomen if the prostate is very large. Laser treatment is sometimes used to remove part of the prostate.
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