A comprehensive list of today's common ailments and health conditions.
By Niki Hampton
Benign prostatic hyperplasia (BPH) is a benign increased size of the prostate. Hyperplasia of the prostatic stromal and epithelial cells results in large discrete nodules in the periurethral region. If this formation becomes excessively large, the nodules can push on or block the urethra. This causes difficulty in urination. Because of this obstruction, the bladder is required to work harder to push the urine out.
This can lead to progressive hypertrophy, instability or weakness of the bladder muscle. Though prostate antigen levels can be elevated due to increased organ volume and inflammation, BPH does not cause cancer or increase the risk of cancer.
The symptoms of benign prostatic hyperplasia are classified as either voiding or storage.
Voiding symptoms include incomplete bladder emptying, weak or intermittent stream, straining to urinate, and difficulty initiating the stream. Pain and dysuria are not usually present.
Storage symptoms include urinary urgency, urgency incontinence, and voiding at night (nocturia). Nocturia can contribute to insomnia, and urinary incontinence may occur.
BPH can be a progressive disease, and if left untreated, can cause urinary tract infections. Urinary bladder stones can also form from the crystallization of salts in the residual urine. Urinary is classified as acute or chronic depending on the level of progression. Acute urinary retention is the inability to void (urinate). Chronic urinary retention is when the residual urinary volume increases and the bladder distends. This can result in bladder hypotonia, and, may eventually, progress to renal failure.
Most experts believe the androgens play a major role. This indicates that androgens must be present for BPH to occur, but they do not have to be the direct cause of the condition. The fact that castrated boys do not develop BPH when they age supports it. However, administering high amounts of testosterone is not associated with an increased risk of BPH.
Dihydrotestosterone (DHT), a metabolite of testosterone, is critical in prostatic growth. DHT is synthesized and acts like a super hormone in that it is 10 times more potent than testosterone.
Diagnosis is done through a rectal examination of the prostate. With the enlargement of the middle lobe, an urologist can feel the immediate concern. Blood tests are also done to rule out prostatic malignancy. An ultrasound examination of the testicles, prostate, and kidneys can also be done. This is another method of ruling out malignancy and hydronephrosis.
To deal with the symptoms of BPH, lifestyle changes like fewer fluids before bed and moderate amounts of caffeine can help with urgency. Also, it’s important to avoid medications that can make the symptoms worse. These can include opiates, decongestants, antihistamines, diuretics, and tricyclic antidepressants.
There are two main medications used to treat BPH: alpha blockers and 5g-reductase. Alpha blockers are the most common used. Some of the names of alpha blockers used are alfuzosin, tamsulosin, doxazosin, terazosin, and silodsin. These are equally effective in treating the disease, but offer different side effects.
There is also the option of a minimally invasive therapy called super-selective intra-prostatic androgen deprivation (SPAD) therapy. Other minimally invasive options include transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA).
Surgery is an option that most doctors reserve for extreme cases where other treatment methods are not helping the patient.
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