Begin Prostatic Hyperplasia
Although most men over age 50 have some prostatic enlargement, in benign prostatic hyperplasia or hypertrophy (BPH), the prostate gland enlarges sufficiently to compress the urethra and cause some overt urinary obstruction. Depending on the size of the enlarged prostate, the age and health of the patient, and the extent of obstruction, BPH is treated symptomatically or surgically.
Recent evidence suggests a link between BPH and hormonal activity. As men age, production of androgenic hormones decreases, causing an imbalance in androgen and estrogen levels and high levels of dihydrotestosterone, the main prostatic intracellular androgen. Other theoretical causes include neoplasm, arteriosclerosis, inflammation, and metabolic or nutritional disturbances.
Whatever the cause, BPH begins with changes in periurethral glandular tissue. As the prostate enlarges, it may extend into the bladder and obstruct urinary outflow by compressing or distorting the prostatic urethra. BPH may also cause a pouch to form in the bladder that retains urine when the rest of the bladder empties. This retained urine may lead to calculus formation or cystitis.
Signs and symptoms
Clinical features of BPH depend on the extent of prostatic enlargement and the lobes affected.
Urinary symptoms :- Characteristically, the condition starts with a group of symptoms known as prostatism: reduced urinary stream caliber and force, difficulty starting micturition (straining), feeling of incomplete voiding and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, incontinence and, possibly, hematuria.
Physical examination reveals a visible midline mass (distended bladder) that represents an incompletely emptied bladder; rectal palpation discloses an enlarged prostate. The examination may also detect secondary anemia and, possibly, renal insufficiency secondary 10 obstruction.
Later effects :- As BPH worsens, complete urinary obstruction may follow infection or ingestion of decongestants, tranquilizers, alcohol, antidepressants, or anticholinergics. Possible complications include infection, renal insufficiency, hemorrhage, and shock.
Clinical features and a rectal examination are usually sufficient for a diagnosis. Other test findings help to confirm it.
In severe symptoms, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
Conservative therapy includes prostate massages, sitz baths, fluid restriction for bladder distention, and antimicrobials for infection. Regular ejaculation may help relieve prostatic congestion.
Urine flow rates can be improved with alpha,-adrenergic blockers, such as terazosin and prazosin. These drugs relieve bladder outlet obstruction by preventing contractions of the prostatic capsule and bladder neck. Finasteride may also reduce the size of the prostate in some patients.
Surgery is the only effective therapy to relieve acute urine retention, hydronephrosis, severe hematuria, recurrent urinary tract infections, and other intolerable symptoms.
A transurethral resection may be performed if the prostate weighs less than 2 oz (56.7 g). In this procedure, a resectoscope removes tissue with a wire loop and electric current. In high-risk patients, continuous drainage with an indwelling urinary catheter alleviates urine retention.
Alternatively, very large prostates can be removed by one of two surgical approaches:
Balloon dilatation of the prostate isn't effective. Transurethral microwaves (heat therapy) are now being used in some patients. Their efficacy lies between that of the use of alpha-adrenergic blockers and surgery.
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