Benign prostatic hyperplasia(BPH) is non-malignant enlargement of the prostate. The prostate is a walnut-sized gland located at the neck of the bladder surrounding the urethra. It is part of the male reproductive system.
BPH is the most common benign neoplasm (non cancerous enlargement of the prostate gland) in men, and has a high prevalence that increases with age. The increase in size of the prostate inside its capsule exerts pressure on the urethra, which passes through the capsule, resulting in obstruction to urine flow.
Half of all men have BPH identifiable histologically at age 60 years, and by 85 years the prevalence is about 90%. In the USA about 25% of men will be treated for BPH by age 80, and over 300,000 surgical procedures are performed each year for BPH (mostly transurethral resection of the prostate, TURP). This makes TURP the second most common surgical procedure, second only to cataract surgery – at a cost estimated at $2 billion per year.
The exact cause of BPH is unknown. It may be related to changes in hormone levels as men age. These changes probably cause the prostate to grow. Eventually, the prostate becomes so enlarged that it puts pressure on the urethra. This causes the urethra to narrow or, in some cases, close completely.
There are several symptoms of BPH. Symptoms usually increase in severity over time.But most common symptoms are :-
Difficulty starting to urinate
Weak urination stream
Dribbling at end of urination
Sensation of incomplete bladder emptying
Urge to urinate frequently, especially at night
Deep discomfort in lower abdomen
Although there are a number of diagnostic test procedures which can be used for BPH, urine flow rate recording is the single best non invasive urodynamic test to detect lower urinary tract obstruction. There is insufficient evidence to recommend a cut-off value to document appropriateness of therapy.
The most common tests sre:
Urine flow study
Cystometrogram (a functional study of the way your bladder fills and empties)
X-ray of the urinary tract
Testing for prostate specific antigen (PSA) is often used to screen for prostate cancer, a malignant condition. However BPH, which is far more common, may cause a lesser elevation in PSA levels, which may raise false concerns about the presence of cancer.
There are a number of treatment options. These include watchful waiting, medical therapy, balloon dilatation and various surgical procedures. But In mild cases of BPH, no treatment is necessary. In many cases, men with BPH eventually request medical intervention.
Modern Medications include:
Finasteride (proscar) inhibits the production of the specific form of testosterone which is responsible for prostate glandular growth. (In some men, finasteride can shrink the prostate.)
Dutasteride (avodart) also inhibits the production of the specific form of testosterone which is responsible for prostate glandular growth. Like proscar, avodart can result in shrinking of the prostate
Alpha-blockers (flomax, uroxatral, cardura, terazosin) reduce bladder obstruction and improve urine flow by relaxing the muscles of the prostate and bladder neck.
Men with BPH should not take decongestant drugs containing alpha agonists such as pseudoephedrine. These drugs can worsen the symptoms of BPH.
Minimally Invasive Interventions
These are used when drugs are ineffective but the patient is not ready for surgery. Non-surgical treatments include:
Transurethral Microwave Thermotherapy (TUMT) uses microwaves to destroy excess prostate tissue
Transurethral Needle Ablation (TUNA) uses low levels of radio frequency energy to burn away portions of the enlarged prostate
Transurethral Laser Therapy uses highly focused laser energy to remove prostate tissue
Surgical procedures include:
Transurethral Surgical Resection of the Prostate (TURP) â€“ a scope is inserted through the penis to remove the enlarged portion of the prostate.
Transurethral Incision of the Prostate (TUIP) â€“ small cuts are made in the neck of the bladder to widen the urethra. The long-term effectiveness TUIP is not yet clearly established.
Open Surgery â€“ removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area. This is much more invasive then TURP or TUIP.
To these surgical options must be added a number of medical treatments currently under trial. The AHCPR report concluded that there was presently insufficient data on any of these to permit conclusions regarding their safety and efficacy. The new treatments should not form part of purchasing contracts until one year follow up data from properly conducted randomised controlled trials are available.
Preliminary clinical trials suggested positive results with saw palmetto, an herb native to the Southern United States. However recent studies, particularly a carefully conducted randomized double-blind study indicate that the use of saw palmetto is no different than placebo in reducing BPH symptoms, raising questions about the true clinical effectiveness of this product.
Because prostate enlargement occurs naturally with advancing age, there are no specific prevention guidelines.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.
Help taken from: http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=12003 and http://www.jr2.ox.ac.uk/bandolier/band11/b11-3.htm