BENIGN PROSTATIC HYPERPLASIA (BPH)


It can be described as a disease of old age as it is almost never seen below fifty years of age. Hyperplasia of the prostate occurs, affecting the inner glandular and fibrous tissue thus compressing the outer portion of the male urethra. It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate.

CAUSES OF BPH
The causey is not exactly known, but the popular theory is that it is an involutional hypertrophy in response to a changing in the hormonal environment. Though prostate starts enlarging at the age of 40yrs, but patients usually present with symptoms between the ages of 50 to 70 years. Increasing age is a potential risk for suffering from prostatic hyperplasia or any possible malignancy.

ANATOMY & PHYSIOLOGY
The prostate is a gland located in the male pelvis and is surrounded by the rectum and the bladder. The male urethra passes through the prostate. TESTOSTERONE the major circulating androgen is converted by the enzyme 5-alpha reductase to di-hydroxytestosterone in the gland. Changes in prostate size occur during puberty and after the age of 55 in the periurethral portion of the gland.

The prostate gland may be referred to as being divided into 3 lobes
1 median lobe & 2 lateral lobes.
Histological process of benign prostatic hyperplasia usually affects all the lobes equally. Enlargement of the median lobe gives rise to mainly irritative symptoms e.g. nocturia, frequency and urgency. Enlargement of the lateral lobes mainly give rise to obstructive symptoms e.g. slow stream, terminal dribbling and hesitancy

SIGNS & SYMPTOMS
Increased frequency of micturition particularly at night is the earliest symptom.
Frequency gradually progresses and then may presents both by day and night.
Another symptom is urgency i.e. intense desire to void.
Gradually residual urine increases and frequency becomes more and more evident with advent of cystitis (inflammation of the
urinary bladder) and polyuria due to renal insufficiency
Difficulty in micturition is quite common. The patient has to wait before the stream starts. The stream is weak and dribbles down instead of being projected. Straining hinders the flow instead of increasing the flow.

Haematuria. Some patients present with retention of urine either acute or chronic.
Others may present with overflow incontinence.
It may so happen that patient may present with symptoms of uraemia – headache, drowsiness, vomiting and even haematemesis.

INVESTIGATIONS
Blood is routinely examined for Hb%, Total blood cell count, E.S.R., urea and sugar.
Urine needs to be examined for routine examination, culture and sensitivity.
Ultrasound scanning of the abdomen-pelvis is done to confirm the diagnosis. It gives all the details including residual urine after voiding, size of the prostate etc

Estimation of prostate specific antigen (PSA) has been reported of some benefit in diagnosis but it is not elevated in all the cases and thus some patients may be left undiagnosed

Urography to evaluate the functional status of the kidneys and presence or absence of hydronephrosis.
Cystography to demonstrate filling defect due to projection of median lobe inside the bladder.
Cystoscopy to exclude presence of diverticulum, stone and growth.
Transrectal ultrasound scanning and transrectal biopsy with ultrasound control.

QUESTIONS YOU NEED TO ANSWER TO CHECK IF YOU SUFFER FROM BPH.
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?

Over the past month, how often you have had to urinate again less than 2 hours after you finished urinating?

Over the past month, how often you have you found that you stopped and started again when you were urinating?
How often have you found it difficult to postpone urination?
How often have you had a weak urinary stream?
Over the past month how often have you had to push or strain to begin urination?
If you are around 50 years of age & getting positive answers to the above questions we would advise you to consult a physician as you might be suffering from BPH

TREATMENT
Asymptomatic patients do not require treatment regardless of the size of the gland.
Allopathic treatment involves use of substances such as finasteride which blocks the conversion of testosterone to di-hydroxytestosterone (they have shown to decrease prostate size & increase urine flow rate)

Alpha adrenergic blockers such as terazosine act by relaxing the smooth muscles of the bladder neck and increasing peak urinary flow rate.

Those with an inability to urinate, gross haematuria, recurrent infection or bladder stones may require surgery.

Surgical approaches include a transurethral resection of the prostate (TURP) (The prostatic tissue which is involved in BPH is different from the one which may lead to carcinoma. Hence it does not provide any prevention from carcinoma.
Transurethral ultrasound guided laser induced prostatectomy (TULIP)
Our treatments are homoeopathic and individualized as per individual case. We make sure that there are absolutely no side effects and are committed to deliver results.

COMPLICATIONS OF BPH
Retention of urine
Gross Haematuria
Recurrent infection
Bladder stones