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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.

PSA blood test

The Prostate Specific Antigen (PSA) test enables the medical practitioner to detect prostate cancer at an early stage. prostate Specific Antigen (PSA) is a protein produced in small amounts in the cells of the prostate gland. A PSA blood test helps to determine whether stage of prostate cancer is advanced enough to perform a biopsy of the prostate gland or not. When the prostate gland enlarges, PSA level in the blood tends to rise. This is indicative of cancer or benign non-cancerous conditions. PSA is called biological marker or tumor. As men age, both benign prostate conditions and prostate cancer become more frequent. The most common benign prostate conditions are prostatitis which is inflammation of the prostate, and benign prostatic hyperplasia - BPH which refers to the enlargement of the prostate.


BPH - Benign Prostatic Hyperplasia is not usually dangerous by itself. Any strain on the bladder owing to urine retention can lead to complications like bladder/kidney damage, kidney stones, Urinary tract infection (UTI) or incontinence. The etiology of BPH is still not clear while most agree that the metabolism of testosterone can partially exacerbate BPH. A part of the secreted testosterone ends up as DHT - Dihydrotestosterone which may accentuate other conditions other than BPH - like male pattern baldness.

When the PSA test is combined with rectal examination, 90% of prostate cancers can be detected. In the U.S., the American Cancer Society recommends PSA blood test at least once a year to avoid the risk of prostate cancer.

The PSA test has been called the 'male PAP test'. The normal range for a PSA blood test is between 0 - 4 ng/ml (nanograms per milliliter). A PSA level of 4 - 10 ng/ml is considered slightly elevated. Levels between 10 -20 ng/ml are considered moderately elevated. Anything about 20 ng/ml is considered highly elevated. Although the higher the PSA level, the higher the risk of cancer, one abnormal PSA test result does not necessarily mean it is cancer that is present, as various other factors may cause PSA levels to fluctuate.


The PSA test is a radioimmunoassay. In a diagnostic laboratory, the patient's blood sample is exposed to the antibody against PSA. That moment the amount of antigen (PSA) can be measured. It should be borne in mind that a man who is undergoing hormone therapy for prostate cancer may have a low PSA test reading during or immediately after the treatment. The low level may not be a true measurement of PSA in the patient's body. It is essential that such patients brief the doctor who may probably advise him to wait a few months after hormone treatment before having a PSA test done.

PSA test does not help a man with fast-growing tumors or aggressive cancer. It helps only in detection of small tumor and slow growing tumors which are unlikely to threaten a man's life. PSA test also cannot detect cancers spreading to the other parts of the body beforehand. There is a fear of false positives test results in PSA testing. Sometimes PSA level could be elevated but that does not necessarily mean cancer is present. A fear of false negative test result can also occur in PSA testing. That is the PSA test result will show negative even if prostate cancer is actually present in the patient. PSA blood test is often followed by other diagnostic tests such as ultrasound, x rays and cystoscopy to determine the presence of cancer or any other problem in the prostate.


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.


Urination can be affected for various reasons such as weather, emotions, and hormonal imbalance, incontinence due to anatomical disorders and also underlying inflammations or infections. The regulation of blood pressure and adrenal surge is also involved in proper generation of urine. Physicians analyze the uroflowmetry parameters in order to diagnose urinary tract infections and also to evaluate the normal flow rate of urine to determine the normal function of the urinary tract and associated muscles.


Uroflowmetry is widely recommended in many countries, as it has become the foundation for diagnosing prostrate enlargement, urethritis and obstruction. Males over 30 years are advised to undergo this test as it is necessary to detect the early signs of an underlying condition such as prostate cancer, bladder tumor or neurogenic bladder dysfunction where the cause is spinal cord injury or lesion. Typical conditions where uroflowmetry might be advised are difficulty in urinating, frequency of urination, nocturia, enuresis, Benign Prostatic Hyperplasia, urethral stenosis or incomplete bladder emptying.


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.


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Collection of Pages - Last revised Date: September 15, 2019