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Introduction
Benign Enlargement of Prostate is the commonest cause of urinary symptoms, also known as LUTS (Lower Urinary Tract Symptoms) that occur after the age of 50. In such a case, the prostate gland enlarges and encircles the bladder neck. Since it involves the urethra, the increase in size can directly block urine passage.
Epidemiology:
Microsopic BPH is present in 10% of all men at age of 40, rising to 90% at age of 80 years. It is not true that BPH equals LUTS. Bladder problems contribute mainly to LUTS in old men. Moderate to severe LUTS with accompanying impairment of quality of life is significant problem in around 50% of men. Most men with BPH and mild LUTS do not suffer any complication related to their condition.
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Causes & Risk factors
Causes :
The exact cause of BEP still eludes the scientific community working on it. Many consider that Testosterone (an important male hormone) is responsible. Throughout lifetime male produce Testosterone (male hormone) and small amount of Estrogen (a female hormone). As the age increase, the amount of Testosterone decreases and hence the proportion of Estrogen becomes more in the blood. Many of the studies have pointed that increased proportion of this Estrogen can inspires call growth within the prostate which can translate into BEP. It is important to note here that BEP is common in older population and BEP does not occur in men whose testes are removed.
Another theory is that accumulation of a substance called as DHT (dihydrotestosterone) which is actually a product derived from Testosterone in the prostate can cause BEP. Some prominent scientists also report that men who do not produce DHT do not develop BEP.
BEP may also be a result of “instructions” given to the cells in the early life. The theory says that one section of the gland may “reawaken” later in life to follow these “instructions” to growth or to be more sensitive to the hormones that influences growth.
Risk Factors :
Age (more in older age) and heredity (more in individuals with family history of BEP) are important risk factors. | |
 | | Anatomical Position Of The Prostate Gland In The Body And Normal Stream Of Urine | | |
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 | | Enlarged Prostate Gland And Weak Urine Flow | | |
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Symptoms and signs
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A weak urinary stream
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Need to pass urine more often, especially by night
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The feeling that the bladder does not empty well
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Difficulty in starting urination
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Urine Dribbling
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The requirement to run for the bathroom, and leaks urine sometimes before reaching there.
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Investigations
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Urine test (urinalysis)
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Prostate-specific antigen (PSA) blood test
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Urinary flow test
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Postvoid residual volume test by doing USG or using Catheter
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Transrectal ultrasound
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Urodynamic studies and pressure flow studies
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Serum Creatnine, Blood Urea Nitrogen, Serum Electrolytes
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Prostate Biopsy
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Intravenous Pyelogram or CT Urogram
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Digital Rectal Examination (DRE)
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Cystoscopy
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Treatment
The choice of therapy is based on:
• The patient’s perception of symptom severity
• The degree to which it interferes with quality of life
• The quality of life of the partner
Frequent urination at night results in sleep deprivation and significantly impacts quality of life. The urologists, thus, prescribe medications called alpha-blockers, for patients with bothersome symptoms. Around 70 % respond favorably to these medicines. Addition of certain other group of medicines like alpha-reductase inhibitors and anti-cholinergics may be beneficial in some patients.
Complications of Medical Treatment:
In spite of medications, 30% of all l treated patients report back to the doctor with complications of prostate enlargement. Most of them report non-responsiveness to the therapy.
Surgical Treatment:
The surgical treatment is effective in patients with any of the complications, arising out of enlargement of prostate or due to non-responsiveness to therapy
• TURP- transurethral resection of prostate
• Open prostatectomy – still a valid option for small number of patients with very large prostates.
• Laser enucleation of prostate
• Laser vaporization of prostate
Complications of Surgery:
• Bleeding
• Infection
• Strictures
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Case Study
Case 1 - A 75-year-old married man leading a sedentary lifestyle developed bothersome LUTS, which coincided with starting medication for some breathing trouble diagnosed as COPD. On examination, DRE showed prostate of more than 40 grams. His kidney functions were normal. An ultrasound revealed a well-defined mass arising from the prostate and extending into the bladder (also called median lobe enlargement). He had high residual urine - 600 ml. He was catheterized and put on alpha blockers. After three weeks, it was found that trial without catheter was successful and he was advised regular follow up with local urologist.
Case 2 - A 65 year old widower noticed over a period of 2 years that his urine has become more frequent and he has to pass urine urgently. Occasionally he had bed wetting especially during cold season. On examination he had a palpable bladder and enlarged prostate. Investigations done revealed benign enlargement of prostate and chronic retention of urine with kidney insufficiency. He was catheterized for a period of 6 weeks when his kidney function became normal. He underwent TURP successfully with complete recovery of kidney functions.
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References
http://www.eu-acme.org/europeanurology/upload_articles/Novara2.pdf
http://www.auanet.org/resources.cfm?ID=452
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