 Prostate Gland: Benign Prostatic Hyperplasia(BPH)
Benign Prostatic Hyperplasia(BPH)
BPH(Benign prostatic hyperplasia) is enlargement of prostate gland mainly due to increase in number of its cells and a bit due to to increase in size. It is one of the common problems of prostate gland middle age and old age men
Prostate Gland:
Prostate gland is like breast , a gland that produces and flows fluid. Prostate is one of the vitals structure of male reproductive system it is almost size of a plum but shaped like a walnut with two side lobes(parts) and one in center. Its covered by almost 2 layers of fibrous tissue or capsule .
Prostate gland is above the root of penis and covers the base(lowermost) part of the urinary bladder(urine store house) and lies in front of rectum(that continues as anal canal and anus). prostate gland also covers or encircle part of urethra(urine passing tube/ejaculatory fluid passing tube)
Role Of Prostate In Male Sexual Health:
Prostate gland produce fluid and this fluid forms almost one-third of the ejaculatory fluid(semen). Prostate fluid has many substances that give nourishment to the sperms also help in sperm motility(movement).
Prostate gland secretions/fluid is rich in zinc, citric acid, acid phosphatase and prostate specific antigen(PSA)
Zinc gives protection against bacterial infection to sperms. Prostate specific antigen has a role to keep semen after discharge in vagina in liquid form so that sperms may move forward.
Position of prostate gland as well as its wrapping makes it a millstone when its swelling(or enlargement) occurs due to infection or any other growth or growth of the gland itself and produce pressure over urinary bladder and urethra and causes symptoms and discomfort.
BPH(Benign Prostatic hyperplasia):
It is enlargement of prostate gland that is non-cancerous and is not a risk factor for cancer and may start in late 30's however mostly does not produce symptoms until 50's.Mostly symptoms are either related to pressure over bladder and tightening around urethra(urine tube) or else due to irritation of bladder. So, mainly symptoms are urinary.
Risk Factor For Gland Enlargement And Symptoms:
Why prostate gland enlarges with age is not known . However there is both enlargement of muscular and glandular part and the cause is hormonal. Male type hormone(testosterone) produced from testes is converted into another hormone (DHT) and this causes prostate enlargement.
As the gland will enlarge, if the part that is on sides and covers the urinary tube(urethra) will enlarge it will more lead to urinary obstruction(or failure to pass urine comfortably) symptoms. However if center part (center of walnut) enlarges it will start to irritate the urinary bladder and will cause irritative or urgent desire to urinate symptoms.
Main Symptoms can be:
1) increased Frequency of Urination and especially at night
2) Urgency to pass urine and inability to hold
3) Difficulty in starting urine stream, poor flow of urine
4) Straining is required for proper flow
5) Continuous leaking or dribbling of urine after end of stream
6) Feeling of incomplete urinary bladder emptying
7) Residual urine issue(or retention/storing)
If any one above symptoms or problem are faced then physician or urologist consultation be done as soon as possible.
Problem with urine retention is that it can cause urinary infection and blood in urine and also prolonged retentions(storing) may lead to kidney damage.
Diagnosis Of BPH:
Adequate history of patient symptoms combined with noting the size of gland via rectum with digital(gloved finger) examination or if required with ultrasound of pelvis is mostly enough to diagnose if patient is not old aged. However blood test for PSA level may be done as when prostate gland enlarges it is produced more .Also Urine Test For Pus cells To rule out Infection with it may be done.
If patient is old aged with associated diabetes or other nerve related issues need more elaborated tests to rule out any other urinary tract issues.
These include volume and pressure of urine in bladder(urodynamic study) also flow of urine (uroflowmetry).Also the amount of urine that is left in bladder after urination.
Treatment:
Which treatment is to be undertaken depends solely on patients severity of symptoms, discomfort or unease or inability to cope with daily life.
1) if symptoms are not severe patient may just be observed and some times gland do shrink/regress in size with time
2) Other option is medicine, to treat symptoms. The two most commonly used groups are:
A) Block Hormone Production: these prevent the conversion of male hormone(testosterone from testes) to be converted to another hormone(DHT) that causes gland enlargement
B) Relax Smooth Muscles: The muscle on urinary bladder.urethra and prostate gland are relaxed so that problem with urine flow is delt.
3) Surgery: Its mostly opted when kidney damage or urinary stones or total inability to urinate requiring catheterization(tube placement for urine ) .In all When Symptoms are severe.
There are many surgical techniques and options for BPH and they range from simple procedures to long and complexed. Even only shrinkage of some cells be done or a tiny part of gland may be removed or a lobe or even full gland removal(rare) as per requirement. Lasers can also be used to shave off part of gland.Mostly the part that is putting pressure is removed and rest saved.
Besides the routine problem associated with any surgery no major issue arises if only a part of gland is removed.
4) Prostatic Stents: patients who cannot undergo surgery may get temporary relief by putting a device in urethra to aid urine flow.
next:
other issues of prostate gland and after gland removal
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