Description
Benign prostatic hyperplasia (BPH) also called prostate gland enlargement is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems. As the gland enlarges, it can squeeze the urethra. The bladder wall becomes thicker. Over time the bladder may weaken and lose the ability to empty fully. Urine then remains in the bladder. These problems cause many of the lower urinary tract symptoms (LUTS) of BPH. If you are not able to pass urine at all (called retention) or if you have renal failure, immediate attention is required. But, other symptoms like weak urine stream or the need to push or strain can many times be monitored.
Résumé
- The prostate gland, a walnut-sized organ in the male reproductive system, sits anterior to the rectum and contributes about 70% of seminal fluid. Its anatomy includes anterior, posterior, median, and lateral lobes, as well as periurethral, peripheral, and transition zones, crucial for understanding BPH and malignancies.
- Benign prostatic hypertrophy (BPH) involves enlargement of the inner transitional zone, compressing the urethra. While the prostate develops early in fetal life, BPH typically manifests later, with the outer peripheral zone being more prone to malignancies. This expansion doesn't occur naturally outwards due to the capsule, rather medially impacting the urethra.
- Epidemiology reveals that about 50% of men over 60 and 90% of men over 85 experience BPH. Dihydrotestosterone (DHT), a byproduct of testosterone via 5-alpha reductase, is implicated in prostatic enlargement. Other factors include hyperinsulinemia, metabolic syndrome, insulin-like growth factors, norepinephrine, and angiotensin II.
- The pathogenesis of BPH involves gland enlargement and urethra compression, leading to bladder wall thickening, trabeculation, and potential diverticula formation. Urinary stasis, due to poor bladder emptying, increases susceptibility to urinary tract infections and calculi formation. Backflow can cause ureteral dilation (hydroureter) and kidney damage (hydronephrosis).
- Key symptoms of BPH involve a triad of frequency, urgency, and hesitancy. Obstructive symptoms include poor flow, straining, and incomplete evacuation, while irritative symptoms, like frequency and urgency, arise from bladder wall stretching. The International Prostate Symptom Score (IPSS) helps grade symptom severity for treatment planning.
- Diagnosis involves clinical examination, rectal examination, and assessing prostate size and nodularity. Investigations include blood urea and creatinine levels, uroflowmetry, and ultrasound. Elevated PSA is also a marker of malignancy.
- Treatment ranges from lifestyle modifications, like controlled fluid intake and avoidance of irritants, to medical management with alpha-blockers (like terazosin, doxazosin, tamsulosin, silodosin) and 5-alpha reductase inhibitors. Medical management aims to relax the smooth muscle surrounding the bladder neck and decrease DHT production.
- Surgical options, primarily transurethral resection of the prostate (TURP), are considered when medical management fails or complications arise. During TURP, prostatic tissue is shaved away via electrical current. Complications can include incontinence, retrograde ejaculation, impotence, strictures, and TURP syndrome (hyponatremia). Minimal invasive procedures, like transurethral incision of the prostate, are occasionally used.
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