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BENIGN PROSTATIC HYPERPLASIA

Introduction

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also abbreviated as BPH.Cause
Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Another theory is that changes in the ratio of testosterone and estrogen (female hormone) as men age cause the prostate to grow.Signs and Symptoms
These may include:Needing to urinate frequently

  • Difficulty starting urination
  • Stopping and starting while urinating
  • Urinating frequently at night (nocturia)
  • Dribbling after urination ends
  • Being unable to empty your bladder
  • Blood in the urine (BPH can cause small blood vessels to burst)
  • Recurrent urinary tract infections (UTIs)

 BPH can be a progressive disease, especially if left untreated. Some patients that suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.DiagnosisYou may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide the best way to manage it and they include:a) Digital Rectal Examination (DRE)
This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.b) Prostate-Specific Antigen (PSA) Blood Test
To rule out cancer as a cause of urinary symptoms, a PSA blood test is done. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer but it does not confirm the presence of cancer.c) Rectal Ultrasound and Prostate Biopsy
In this procedure, a probe inserted in the rectum directs sound waves at the prostate. To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.d) Urine Flow Study
This uses a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.e) Cystoscopy
In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.Treatment
Men who have BPH with symptoms usually need some kind of treatment at some time. Since BPH can cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk. Common treatments include:a) Lifestyle management
Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules. Medications that worsen symptoms like decongestants and antihistamines may have to be switched and Kegel exercises may be also useful.b) Drug Treatment
The two main medications for management of BPH are alpha blockers and 5α-reductase inhibitors.Medication is often prescribed as the first treatment option. This is discarded if patients don’t achieve sustained improvement in symptoms or they may stop taking the medication because of side-effects.c) Minimally Invasive Therapy
Because drug treatment is not effective in all cases, there are a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery. They include:• Transurethral microwave procedures
• Transurethral needle ablation
• Water-induced thermotherapy
• High-intensity focused ultrasound
d) Surgery
Removal of the enlarged part of the prostate is the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The types of surgery are:i. Transurethral surgery. In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra. Most doctors suggest using TURP whenever possible. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. One possible side effect of TURP is retrograde, or backward, ejaculation. In this condition, semen flows backward into the bladder during climax instead of out the urethra.
ii. Transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
iii. Open surgery. In the few cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. After Surgery
It will probably take a couple of months for you to heal completely. During the recovery period, the following are some common problems that can occur.1. Problems Urinating: You may notice that your urinary stream is stronger right after surgery, but it may take a while before you can urinate completely normally again. This problem will gradually lessen, and after a couple of months you should be able to urinate less frequently and more easily.2. Incontinence: As the bladder returns to normal, you may have some temporary problems controlling urination, but long-term incontinence rarely occurs.3. Bleeding

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