وصف
Prostate enlargement, or benign prostatic hyperplasia (BPH), often manifests with urinary symptoms such as increased frequency, urgency, and difficulty in initiating or maintaining a steady stream. Patients may experience a sensation of incomplete bladder emptying, leading to the need for frequent trips to the bathroom. Nocturia, or waking up at night to urinate, is a common symptom associated with prostate enlargement, impacting the quality of sleep. A weakened urinary stream and straining during urination are indicative of the obstructive effects of an enlarged prostate on the urethra. Diagnosis often involves a digital rectal examination, where a healthcare provider assesses the size and consistency of the prostate gland through the rectum. Blood tests, such as the PSA test, help measure levels of a protein produced by the prostate, aiding in the diagnosis and monitoring of prostate conditions. Transrectal ultrasound may be used to visualize the prostate, providing detailed images that aid in assessing the size and structure of the gland. In some cases, a cystoscopy may be recommended to directly visualize the interior of the urethra and bladder, providing additional information for diagnosis and treatment planning. Early detection and proper management can help alleviate symptoms and improve the quality of life for individuals with prostate enlargement.
ملخص
- The prostate is a walnut-sized gland at the base of the bladder in males, surrounding the urethra and contributing fluids to semen. Common problems include prostate enlargement (BPH), prostatitis, and prostate cancer. BPH, or benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate, pressing the urethra and causing bladder outlet obstruction. It is an age-related problem, with incidence increasing with age, affecting up to 80% of men over 80.
- BPH and prostate cancer are separate diseases arising in different zones of the prostate, with BPH never a precursor to cancer. Blood tests, including PSA, cannot differentiate between the two. BPH growth is influenced by androgens, with increased epithelial and stromal cell numbers in the perurethral area. Testosterone converts to dihydrotestosterone (DHT) via five alpha reductase, contributing to prostate enlargement.
- Bladder outflow obstruction due to BPH has dynamic (smooth muscle tone) and static (prostate volume) components. Obstruction leads to bladder wall thickening, trabeculation, diverticula, and potentially poor contractility. Long-term, the bladder may become less compliant, leading to high volume bladders and increased intrarenal pressure, potentially causing hydronephrosis and renal dysfunction.
- Lower urinary tract symptoms (LUTS) encompass irritative and obstructive symptoms, applicable to both sexes and various ages. Initial evaluation involves proper history, physical examination, and urinary symptom grading via IPSS scoring. Examination includes general health assessment, bladder palpation, inguinal region examination, genital examination, and digital rectal examination (DRE) to assess prostate size and texture.
- Treatment goals include alleviating bothersome symptoms, preventing symptom deterioration, and reducing long-term complications. Options range from watchful waiting and lifestyle modifications to medications and surgical interventions. The treatment decision should be patient-centered and based on the impact on quality of life, rather than solely on test results.
- Drug treatments include alpha blockers, which relax prostate smooth muscles; five alpha reductase inhibitors, which decrease prostate size; and PDE5 inhibitors. Alpha blockers provide rapid relief, while five alpha reductase inhibitors alter the disease's natural history. Combination therapies, such as alpha blockers and five alpha reductase inhibitors, are often used for moderate to severe LUTS.
- Surgical options for BPH include TURP (transurethral resection of the prostate), laser surgeries, and minimally invasive surgeries (MIS). TURP remains the gold standard, while laser surgeries offer reduced bleeding and shorter hospital stays. MIS options like prostate urethral lift (Urolift) and water vapor therapy (Rezūm) provide less invasive alternatives with varying contraindications and outcomes.
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