Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia or BPH, also referred to as prostate gland enlargement is one of the most significant medical conditions among elderly men. It is a serious condition which proactively leads to other complications such as urinary tract infections and prostate gland functional abnormalities. The prostate gland is a two-lobed walnut shaped gland often associated with sperm mobilization. The growth of the prostate gland is directly related to age. The exact mechanism or the cause of this condition is not well determined. However, many studies indicate that the hormonal imbalance as the age increases in a man is responsible for the enlargement of the prostate gland. This refers to the excessive production of estrogen and decrease in the male sex hormone testosterone.
Clinical manifestations of BPH
The symptoms of Benign Prostatic Hyperplasia (BPH) worsen with age. The most common clinical symptom is repeated urination episodes. Often patients either complain of frequent urination, urinary urge or even difficulty in passing urine if there is an associated infection. These symptoms occur because of the inability of the tissues to make space for the enlarged or hypertrophic prostate gland. This lays pressure on the urethra to stimulate the process of urination frequently. Many patients complain of Nocturia. In addition to these symptoms, patients also suffer renal stones and reduced kidney function.
Diagnosis and Management of Benign Prostatic Hyperplasia
BPH is diagnosed based on various urological criteria. The American Urological Association recommends a score system. In most cases patients are examined to identify the presence of malignancy in the prostate region and hence test such as prostate specific antigen (PSA) is recommended along with cytological study of the prostate gland. Important parameters such as post-void residual volume, uroflowmetry, urinary pressure studies are conducted. Along with these diagnostic parameters, kidney function test is done to rule out other associated complications.
BPH can also transmit as a genetic disorder in some cases. The high risk groups are generally obese or suffer diabetes and hypertension. Along with these, other factors such as alcoholism, drug abuse and erectile dysfunction can lead to BPH.
Treatment of Benign Prostatic Hyperplasia
BPH patients are often kept under surveillance to avoid medical emergencies. The drugs administered for this condition reduce blood pressure and facilitate smooth muscle relaxation of the prostate gland thereby regulating urine flow. The drugs used are predominantly alpha blockers such as alfuzosin, terazosin and anticholinergics.
Uroflowmetry
Urinary disorders can often indicate a lot of underlying complications. Urination and the excreted product is very significant in evaluating a person's health in associated with kidney function and prostrate health in case of men. Urination is a complex procedure, which involves the contraction of the muscles associated with the detrusor and the external bladder tissues. The cerebral cortex facilitates the initiation and emptying of the bladder during the urination process.
Preparation and procedure
Patients undergoing uroflowmetry procedure are advised to drink plenty of water in order to fill up the bladder as it provides a comprehensive analysis of the bladder functionality. They are also asked to hold the urine for a few hours before the test. Unlike other urinary examinations, here the specimen is not collected in a cup but the patient is asked to urinate into a funnel that connects to a container underneath. Special toilets are provided in some diagnostic centers for this procedure. The funnel shaped device measures the urine flow rate and quantity and the results obtained are recorded.
The normal flow rate of the urine varies from 10 ml to 20 ml per second. The results associated may vary both in males and females. The flow rate in women is often less as it may take 15 ml to 18 ml per second. In men, urine flow declines with age. Women have lesser change with age.
14 - 45 years
The average flow rate for males is 21 ml/sec.
The average flow rate for females is 18 ml/sec.
46 - 65 years
The average flow rate for males is 12 ml/sec.
The average flow rate for females is 18 ml/sec.
66 - 80 years
The average flow rate for males is 9 ml/sec.
The average flow rate for females is 18 ml/sec.
The diagnostic evaluations based on this can indicate the strength of the bladder muscles and also other disorders. Delayed urine flow indicates obstruction and also infections that are causing tissue inflammation. Increased flow of urine also indicates weak bladder muscles and also lack of cerebral cortex control. Incontinence is widely reported in elderly groups. Neurological conditions and trauma can also affect urine flow rate.
Enlarged Prostate
Prostate gland enlargement is common in men as they grow older. For men above 50, the most common prostate problem is prostate enlargement. 50% of men by age 60 suffer from this problem and over 90% of men suffer from this problem when they are 80 plus. Enlarged prostate is also known as prostatic hypertrophy, benign prostatic Hyperplasia or prostate gland enlargement.
Enlarged prostate is a benign enlargement and is non- cancerous. This condition often induces urinary problems. If left untreated, the problem can block the flow of urine out of the bladder and cause urinary infection, kidney and bladder problems. The prostate gland is located beneath the bladder; this tube passes through the center of the prostate and transports urine from and out of the penis. Therefore when the prostate is enlarged, it obstructs the flow of urine. With time, the bladder muscles thicken severely and become over sensitive thus forcing the person to urinate frequently as the bladder can't hold even small amount of urine.
Symptoms of prostate gland enlargement
Diagnosis includes:
Physical examination and understanding the patient's medical history.
Rectal examination to identify if the prostate is enlarged.
Urine tests.
Urine flow test.
PSA (Prostate Specific Antigen) test in blood.
Trans rectal ultrasound to measure prostate.
Neurological examination to identify reasons other than prostate enlargement for urinary incontinence etc.
Post void residual volume test, to identify if the patient can empty the bladder completely.
Prostate biopsy.
CT urogram to identify blocks in urinary bladder.
Cystoscopy to check bladder and urethra.
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Bibliography / Reference
Collection of Pages - Last revised Date: October 9, 2024