The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.
You will be surprised to know that Urinary obstruction from prostatic hypertrophy has been described for many centuries, starting with the ancient Egyptians in the 15th century BC. The word "prostate" comes from the Greek prostat, which means "one who stands before or in front of", which, in this case, means in front of the bladder.
What is Benign prostatic hyperplasia or BPH?
Benign prostate hyperplasia (BPH) is a condition that affects the prostate gland of the male reproductive system. The prostate gland enlarges in size though this may not cause problems until late in life. It is estimated that about 90% of men in the age group of 70-85 years have BPH. It is one of the most common problems experienced by men during the old age.
As the name suggests, there is hyperplasia or overgrowth of the prostatic tissue. This leads to enlargement of the prostate gland. Now since prostate surrounds the urethra. So any enlargement will definitely cause constriction of the urethra. So in BPH, the flow of urine is also reduced, making it increasingly difficult to empty the bladder. Similar symptoms may also be present when a person has prostate cancer. So it is very important for the physician to carefully rule out the possibility of the latter. To know more about prostate cancer, click here.
What are the causes?
For centuries, BPH has been associated with older men. The cause of BPH is not well understood. There have been various theories which have been put forward for the same. One suggests that men produce two hormones through out their life- oestrogen (small quantity) and testosterone (high proportion). As aging occurs, the amount of testosterone decreases, leaving a higher proportion of oestrogen. Studies done on animals have suggested that BPH may occur because the higher amount of oestrogen increases the activity of substances that promote cell growth. One more theory says that BPH is a result of lack of DHT, a substance which is derived from testosterone. DHT helps in controlling the growth of prostate gland. But due to aging, most animals lose their ability to produce DHT and this may cause BPH.
What are the symptoms?
A person having BPH may remain asymptomatic for quite some time. Infact he may just come to know about it during a clinical examination. Sometimes a person may suddenly start experiencing urination problems. So it is always advised to go for a routine health check up. AASTHA offers various Health Packages for different age groups to ensure proper assessment of health.
problems related with urination, like:
* incomplete emptying of the bladder
* difficulty in starting to pass urine,
* weak stream,
* need to strain to pass urine,
* need to pass urine urgently,
* urgency and leaking or dribbling
* Feeling a burning sensation or pain when passing urine.
* Frequent urinary tract infection as incomplete voiding leads to stasis of bacteria in the bladder
In case the prostate is much enlarged, then there may be severe urine blockage problems. In urinary retention, the urine does not flow out of the bladder leading to accumulation of bacteria and distension of bladder. Untreated, this leads to a decrease in renal function and hydronephrosis (obstructive uropathy). Besides this, due to accumulation of urine in bladder, it can lead to formation of stones. So bladder stones, and incontinence-
the inability to control urination may be present. This in the long run may lead to bladder or kidney damage, So it is very important to diagnose BPH at early stage to ensure that it does not lead to complications.
How is it diagnosed?
The patient may either report with some problem or the doctor may diagnose during a routine checkup. If BPH is suspected, you will be attended by a urologist. An urologist may do any or all of the following test to determine the level of enlargement:
Digital Rectal Examination (DRE)
This examination is usually the first test done. In this, the doctor inserts the finger in the rectum and tries to palpate the prostate gland. He gets a general idea about the size and density of the gland.
Prostate-Specific Antigen (PSA) Blood Test
This test measures the level of PSA in the blood. PSA, a protein produced by prostate cells. PSA levels are very high in men who have prostate cancer. So this test is conjugated along with other test to rule out prostate cancer.
If the urologist suspects prostate cancer, he may advice for a biopsy. This involves removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will examine the biopsy sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumour will spread. The lower the number, the less likely the tumour is to spread. There are 2 types of biopsy procedures used to diagnose prostate cancer:
* Transrectal biopsy: The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle. A pathologist views the tissue under a microscope to look for cancer cells.
* Transperineal biopsy: The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate. A pathologist views the tissue under a microscope to look for cancer cells.
If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe is inserted in the rectum. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor.
Urine Flow Study
Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.
In cystoscopy, a small tube (called cystoscope) is inserted through the opening of the urethra in the penis. The cystocope contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.
Some other blood tests may be recommended (include kidney function tests and test for diabetes). Both of these problems can also cause urinary symptoms. Abdominal ultrasound may be necessary to check for bladder stones.
What are the treatment options?
One very interesting fact is that the earliest useful therapy for urinary obstruction from prostatic enlargement was a catheter, which was first used by the Romans Celsus and Galen in the first century AD! They made catheter out of wood, leaves, rubber etc.
Today, advancement in medical science has provided many new ways to treat the cases of BPH. Men who have this problem usually need some kind of treatment at some time. In case the person presents with a mild and asymptomatic case of BPH, the physician may closely monitor the patient and give the treatment only if the symptoms deteriorate. But if a person comes with symptomatic picture of BPH, there are two ways to treat it.