The prostate is a glandular organ which surrounds the neck of the urinary bladder at the junction connecting the urethra, which is known as the chute pipe, to the bladder. It is a small, muscular gland in the male reproductive system. It plays an important role during the passage of urine and sexual intercourse as it produces much of the fluid in semen and contracts to propel urine through the urethra and the semen during ejaculation.

In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra: the “chute” through which urine and semen exit the body.

As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

 

Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

SYMPTOMS

Symptoms of enlarged prostate can include:

  • A weak or slow urinary stream
  • A feeling of incomplete bladder emptying
  • Difficulty starting urination
  • Frequent urination
  • Urgency to urinate
  • Getting up frequently at night to urinate
  • A urinary stream that starts and stops
  • Straining to urinate
  • Continued dribbling of urine
  • Returning to urinate again minutes after finishing

 

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency. In rare cases, bladder and/or kidney damage can develop from BPH.

Most men put up with an enlarged prostate for months, even years, before seeing a doctor.

DIAGNOSIS

BPH can be diagnosed by either of the following:

  • Urinalysis (urine test)
  • PSA blood test to screen for prostate cancer
  • Urinary blood test to screen for bladder cancer
  • Post-void residual volume (PVR) to measure urine left in the bladder after urinating
  • Uroflowmetry to measure how fast urine flows
  • Cystoscopy to look at the urethra or bladder with a scope
  • Urodynamic pressure to test pressure in the bladder during urinating
  • Ultrasound of the prostate.
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TREATMENT

The choice of treatment is dependent on the size of the prostate, age of the client and overall health. What is suitable for a man of 50 years might not be ideal for a man above 60 years or below 50. This is why it is important to consult with the doctor once the symptoms of difficulty in passing urine present.

Doctors use the BPH Index to gauge how the patient responds to medication.  BPH index is a symptom measuring tool that helps to keep check the whether the condition is improving or otherwise. Some ways in which the condition can be managed may include:

Treatment involves the use of medications such as Alpha blockers, Alpha Reductase Inhibitors, Invasive and Non-invasive procedures.

Alpha blockers: These groups of drugs are very effective at relieving symptoms but do not shrink the enlarged prostate. They work by relaxing the prostate muscle around the neck of the bladder and the urethra to allow the easy flow of urine. They can improve the symptoms within 24 to 48 hours and are mostly effective in men with mild to moderate prostate enlargement.  Examples of the drugs include Flomax (tamsulosin), Cardura (doxazosin) and Rapaflo (silodosin)

Originally these groups of drugs were created to manage created to high blood pressure. The commonest side effect may include dizziness, headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.

 

5-Alpha reductase inhibitors: These groups of drugs can partially shrink the prostate by reducing levels of a male hormone — dihydrotestosterone (DHT) — which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months. These drugs can reduce risk of acute retention (inability to urinate) — and also reduce the need for prostate surgery. Treatment duration may last 6 to 12 month before the effect can be noticed. The drugs may include Proscar (finasteride) and Avodart (dutasteride).

Possible side effects include erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs: or after the first year of taking the drugs.

There is also drug combination therapy, which may be effective against symptoms associated with BPH. Some examples of combined drugs include an alpha-blocker and a 5-alpha-reductase inhibitor; or an alpha-blocker and an anticholinergic.

Management

In this case, two stages are involved:

  • Non-surgical management for an Enlarged Prostate.
  • Surgical Management for an Enlarged Prostate.

Non-surgical (non-invasive) management for an enlarged prostate may include:

Minimally Invasive Treatments for an Enlarged Prostate: When medications don’t help your enlarged prostate, several procedures can relieve symptoms: without surgery.

TUMT (transurethral microwave thermotherapy): This therapy is for mild to moderate blockage of the urethra. It helps to reduce urinary frequency, urgency, straining, and intermittent flow: but does not correct any bladder-emptying problems. In this procedure, computer-regulated microwaves are used to heat portions within the prostate to destroy select tissue. A cooling system protects the wall of the urethra during the procedure. TUMT is performed in a doctor’s office and requires only topical anesthesia and pain medications.

Possible side effects include painful urination for several weeks. Temporary urgency and frequency of urination is also possible. There may be less semen ejaculated. Many men must have this procedure repeated, either because symptoms return or do not improve.

 

TUNA (transurethral radio frequency needle ablation): This procedure also destroys prostate tissue to improve urine flow and relieve symptoms. It involves heating the tissue with high-frequency radiowaves transmitted by needles inserted directly into the prostate with the help of anaesthesia. The procedure does not require a hospital stay. Possible side effects include painful, urgent, or frequent urination for a few weeks.

 

Prostatic stents: In some cases, a tiny metal coil called a stent can be inserted in the urethra to widen it and keep it open. Stenting is done on an outpatient basis under local or spinal anesthesia. Usually, stents are only for men who are unwilling or unable to take medications: or who are reluctant or unable to have surgery. The majority of doctors don’t consider stents a good option for most men.

 

Side effects may be serious and may cause some discomforts for some men. Some don’t see any improvement in symptoms while others may complain of a shift in the stent. In some cases, men experience painful urination or have frequent urinary tract infections. Stents are expensive, and are quite difficult to remove.

TURP (transurethral resection of the prostate): This is the most common surgery for an enlarged prostate, and considered to bring the greatest reduction in symptoms. Only the tissue growth that is pressing against the urethra is removed to allow urine to flow easily. This procedure involves an electrical loop that cuts tissue and seals blood vessels. It is the most preferred treatment for BPH as it is less traumatic and fast recovering. It does not affect penile erection and only the tissue pressing on the urethra that is cut and removed.

 

Laser Surgery: This procedure uses a high energy vaporizing laser to destroy prostate tissue. It is done under general anesthesia and may require an overnight stay at the hospital. It provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks. In general this procedure causes less blood loss, and side effects can include retrograde ejaculation. These procedures include:

 

  • Transurethral holmium laser ablation of the prostate (HoLAP)
  • Transurethral holmium laser enucleation of the prostate (HoLEP)
  • Holmium laser resection of the prostate (HoLRP)
  • Photoselective vaporization of the prostate (PVP)

 

Open Prostate Surgery (Prostatectomy): When a transurethral procedure cannot be used, open surgery may be used. This allows the surgeon to remove tissue in the prostate. Open prostatectomy is typically done when the prostate gland is greatly enlarged, when there is bladder damage, if there are bladder stones, or if the urethra is narrowed. The inner part of the prostate is removed. This surgery is done under general or spinal anesthesia, and recovery can take a few weeks to several months.

Side effects are similar to TURP, including blood loss requiring a transfusion, urinary incontinence and retrograde ejaculation.

 

SOURCES:

  • Kevin Slawin, MD, professor of urology, Baylor School of Medicine, Houston.
  • Lenaine Westney, MD, division director of urology, The University of Texas Medical School, Houston.
  • American Urological Association Foundation: “Benign Prostate Hyperplasia.”
  • Mayo Clinic.com: “Enlarged Prostate (BPH).”
  • National Kidney and Urologic Diseases Information Clearinghouse: “Prostate Enlargement: Benign Prostatic Hyperplasia.”
  • Bent, S. New England Journal of Medicine; Feb. 9, 2006.
  • DiPaola, R. New England Journal of Medicine; Feb. 9, 2006.
  • eMedicine: “Benign Prostate Hyperplasia.”
  • Drug Digest: “Pygeum.”
  • NIH Office of Dietary Supplements.
  • American Urological Association Education and Research. Guideline on the management of benign prostatic hyperplasia (BPH). American Urological Association Education and Research, Inc.; 2010.
  • Benign Prostate Hypertrophy. WebMD, 2008.

 

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