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Benign Prostate Hyperplasia

 

 

 

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Καλοήθη υπερπλασία προστάτη
Rik factors
Overview
 

Benign Prostatic Hyperplasia (BPH), also known as benign prostatic hypertrophy or enlarged prostate, is a noncancerous increase in the size of the prostate gland. This enlargement of the prostate can lead to urinary symptoms, as the enlarged gland may squeeze the urethra, which passes through the center of the prostate, leading to difficulties with urination.

Causes

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Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, commonly seen in older men. The exact cause of BPH is not completely understood, but several factors are believed to contribute to its development:
 

  1. Aging: The risk of BPH increases with age. It's believed that factors associated with aging and the testicles may promote the growth of the prostate gland. Men who have their testicles removed at a young age (for example, due to testicular cancer) do not develop BPH.

  2. Hormones: Changes in levels of hormones (like testosterone and its byproducts) could be involved in the prostate gland's growth. Dihydrotestosterone (DHT), a male hormone produced in the prostate, is believed to be responsible for its growth.

  3. Cell Growth Factors: There's evidence suggesting that some cell growth factors are more active in prostates of men with BPH. These factors may promote cell growth, leading to the enlargement of the prostate.

  4. Genetic Factors: If other men in your family have had BPH, you might be at increased risk, suggesting a possible genetic component.

  5. Ethnic Background: BPH is more common among some ethnic groups. For instance, it's more frequent in men of African or European descent compared to men of Asian descent.

  6. Associated Conditions: Some conditions, such as obesity, type 2 diabetes, and heart disease, might increase the risk of BPH, though the exact relationship is not clear.

  7. Lifestyle and Dietary Factors: Some studies suggest that exercise and diet might influence the risk of developing BPH, though the evidence isn't strong.

  8. Medications: Some medications, like beta-blockers, have been associated with increased risk of BPH.
     

Despite these potential causes and risk factors, the exact mechanisms underlying BPH remain a subject of research. If someone is experiencing symptoms suggestive of BPH (like frequent urination, difficulty starting or stopping urination, or weak urine flow), they should consult a healthcare professional for evaluation and potential treatment.

Symptoms

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Benign Prostatic Hyperplasia (BPH), also known as prostate gland enlargement, is a common condition as men get older. It 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. The symptoms of BPH vary, but the most common ones include:

  1. Frequent or urgent need to urinate: This includes a frequent need to urinate during the night (nocturia).

  2. Increased frequency of urination at night (Nocturia): Needing to get up several times during the night to urinate.

  3. Difficulty starting urination: Experiencing hesitancy or straining to begin the urine stream.

  4. Weak urine stream or a stream that stops and starts: The flow of urine may be weaker than usual or may stop and start.

  5. Dribbling at the end of urination: Involuntary leakage of urine immediately after urination.

  6. Inability to completely empty the bladder: A feeling of partial bladder emptying after urination.

  7. Urinary retention: The inability to urinate despite an urge to go.

  8. Urinary tract infections (UTIs): Recurrent UTIs may occur due to incomplete emptying of the bladder.

  9. Blood in the urine (hematuria): This can be a sign of BPH or other more serious conditions like cancer.

  10. Bladder stones: These are small stones that form in the bladder from the urine that's not completely emptied from the bladder.

It's important to note that the size of the prostate does not always determine the severity of the symptoms. Some men with slightly enlarged prostates can have significant symptoms, while others with very enlarged prostates can have only minor urinary symptoms.

If you're experiencing any of these symptoms, it's important to see a healthcare provider. They can provide a diagnosis and help manage symptoms through medication, lifestyle changes, or surgery if necessary.

Complications

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Benign Prostatic Hyperplasia (BPH) can lead to several complications if not managed appropriately. Some of these complications include:

  1. Acute Urinary Retention (AUR): This is a sudden inability to urinate, which can be triggered by medications, alcohol, cold temperatures, or a prolonged period of immobility.

  2. Chronic Urinary Retention: This refers to the incomplete emptying of the bladder after urination, which can lead to urinary frequency, urgency, or the sensation of incomplete emptying.

  3. Urinary Tract Infections (UTIs): Stagnation of urine due to incomplete bladder emptying can become a breeding ground for bacteria, leading to infections.

  4. Bladder Stones: These are hard masses of minerals in the bladder that can form when urine is retained. They can cause pain, blood in the urine, and can further obstruct urine flow.

  5. Bladder Damage: Chronic retention can weaken the bladder muscles over time, affecting its ability to contract and fully expel urine.

  6. Kidney Damage: Prolonged bladder obstruction due to BPH can cause back-pressure on the kidneys, leading to kidney infections, kidney stones, or even kidney failure in severe cases.

  7. Hematuria: Presence of blood in the urine, which can result from the increased vascularization of the enlarged prostate or from bladder stones.

  8. Recurrent Urinary Retention: Even after treatment for an episode of urinary retention, some men may experience repeated episodes.

  9. Bladder Diversions: In extreme cases, when other treatments aren't effective, it might be necessary to surgically create an alternate way for urine to exit the body.
     

It's essential for men with symptoms suggestive of BPH to seek medical evaluation and treatment to avoid these potential complications. Effective treatments, ranging from medications to minimally invasive procedures and surgeries, are available to manage BPH and reduce the risk of complications.

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Diagnosis

 

Benign Prostatic Hyperplasia (BPH), commonly referred to as an enlarged prostate, is diagnosed through a combination of clinical evaluation, symptom assessment, and specific diagnostic tests. Here are the steps typically involved in diagnosing BPH:

  1. Medical History: The doctor will start by asking the patient about their medical history, especially about urinary symptoms, any medications they are on, and any previous surgeries.

  2. Symptom Assessment: A commonly used tool is the International Prostate Symptom Score (IPSS) questionnaire. It asks about the frequency and severity of common BPH symptoms.

  3. Digital Rectal Examination (DRE): The doctor will insert a gloved, lubricated finger into the rectum to feel the size, shape, and consistency of the prostate.

  4. Urine Tests: A sample of urine can be analyzed (urinalysis) to rule out infections or other conditions that could be causing the symptoms.

  5. Prostate-Specific Antigen (PSA) Test: This blood test measures the level of PSA, a protein produced by the prostate. Elevated levels may suggest BPH, prostate inflammation, or prostate cancer.

  6. Uroflowmetry: Measures the strength and amount of urine flow.

  7. Postvoid Residual Volume Test: Measures the amount of urine left in the bladder after urinating.

  8. Imaging Tests: These might include ultrasound, especially transrectal ultrasound, to visualize the prostate and measure its size.

  9. Cystoscopy: A procedure where a thin tube with a camera (cystoscope) is inserted into the urethra to examine the bladder and prostate.

  10. Pressure Flow Study: Evaluates the pressure in the bladder during urination.
     

It's important to note that BPH is a benign condition and is not prostate cancer. However, the symptoms of BPH can be similar to those of prostate cancer, so it's crucial to get an accurate diagnosis. Always consult with a urologist or medical professional to get a proper diagnosis and treatment recommendations.

 

Treatment

 

The treatment of Benign Prostatic Hyperplasia (BPH), which is the enlargement of the prostate gland, can vary depending on the severity of symptoms and the patient's overall health. Here are common treatment strategies:

  1. Watchful Waiting or Active Surveillance:

    • For men with minimal symptoms, doctors may recommend regular monitoring without immediate treatment.

  2. Medications:

    • Alpha-blockers: Relax the muscles of the bladder and prostate to relieve symptoms

    • 5-Alpha Reductase Inhibitors: Shrink the prostate by blocking hormonal changes that cause growth.

    • Phosphodiesterase-5 Inhibitors: Originally used for erectile dysfunction, can also help with BPH symptoms.

    • Combination therapy: For some men, combining medications can be more effective than taking one drug alone.

  3. Minimally Invasive Therapies:

    • Transurethral Microwave Thermotherapy (TUMT): Microwaves are used to destroy excess prostate tissue.

    • Transurethral Needle Ablation (TUNA): Radio waves are used to create scar tissue that reduces prostate size.

    • Laser therapy: High-energy lasers are used to remove or shrink overgrown tissue.

    • Urolift: A mechanical method to hold the enlarged prostate tissue out of the way of the urethra.

  4. Surgical Options:

  5. Lifestyle Changes:

    • Dietary adjustments: Reducing caffeine and alcohol intake, focusing on a diet rich in vegetables and fibers.

    • Bladder training: Learning to delay urination.

    • Exercise: Regular physical activity and pelvic floor exercises can help reduce symptoms.
       

The choice of treatment depends on various factors, including the size of the prostate, age, health conditions, the severity of symptoms, and the presence of other medical conditions. It's essential for patients to have a thorough discussion with their healthcare provider about the risks and benefits of each treatment option.

Risk factors

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Benign Prostatic Hyperplasia (BPH) is a common condition in older men where the prostate gland enlarges. Several risk factors are associated with the development and progression of BPH:

  1. Age: BPH is more common in older men, with the risk increasing as a man ages. The majority of men over the age of 60 have some degree of BPH.

  2. Family History: Men with a family history of BPH (e.g., father or brother with the condition) are at a higher risk of developing it themselves.

  3. Ethnicity: BPH tends to be more common in men of African or European descent compared to men of Asian descent.

  4. Hormonal Levels: Changes in hormone levels, especially testosterone and its byproduct dihydrotestosterone (DHT), are believed to play a role in the development of BPH.

  5. Medical Conditions: Conditions such as diabetes, heart disease, and obesity may increase the risk of BPH. The exact mechanisms connecting these conditions to BPH aren't fully understood.

  6. Lifestyle Factors: Sedentary lifestyles and obesity might be associated with a higher risk of BPH.

  7. Diet: Some studies suggest a diet high in red meat or fat might increase the risk of BPH, while diets rich in fruits and vegetables might decrease the risk. However, more research is needed in this area.

  8. Medications: Some medications, particularly those that affect hormones like testosterone, might increase the risk of BPH.
     

It's important to note that having one or more of these risk factors does not mean a man will definitely develop BPH, but rather that his risk might be higher compared to someone without these factors. Regular check-ups with a healthcare provider can help monitor prostate health, especially in individuals with multiple risk factors.

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