Hello steemians !
Welcome to the New episode of Health & Medicine. Here 
Today I will be discussing about Benign prostatic hyperplasia (BPH)
- About 20% of male above 40 shows BPH . This figure rises to 70% by the age 60 and to 90% by the age 80
- Benign prostatic hyperplasia affects about 210 million males as of 2010 (6% of the population).
WHAT IS PROSTATE ?
Prostate is inverted cone shaped fibromuscular gland .It is only found in male.It is located below the neck of bladder . Normally it weighs about 7 to 16 gm.
Dimentions:-
- 4 cm transversly at base
- 3cm vertically
- 2 cm anteroposteriorly
Urethra from the bladder passes through prostate. Part of urethra inside prostate is called prostatic urethra.
Histologically prostate consists of Pseudostratified columnar epithelium and fibroelastic stroma containing smooth muscle bundle.At some part area of cuboidal or squamous epithelium is also found.
In 1968 John E. McNeal proposed the idea of "zones" in prostate.
They are :-
1.Peripheral zone :-70%
2.Central zone :-25%
3.Transitional zone:-5%
4.Anterior fibromuscular zone:- less than 5%
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BPH occur in Transistional zone
Function :- Prostate secrete milky white fluid that is alkaline in nature. This alkaline fluid helps to neutralize acidic media in female genital tract so that sperm can live longer.
WHAT IS BPH?
It is the nodular hyperplasia of prostatic stromal and epithelial cells. It commonly results into urinary obstructive symptoms.
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HOW DOES BPH OCCUR?
Basically, BPH occurs due to Androgen (testosterone).Dihydrotestosterone is a potent form of testosterone. With the help of enzyme 5α-reductase type 2 testosterone is reduced to Dihydrotestosterone in the stromal cell.It acts on the stromal cell in the autocrine fashion (i.e acts on the same cell where it was formed) and to the epithelial cell in a paracrine fashion (acts on near by cell).In both, the cells DHT acts on the nuclear receptor and signals the transcription of growth factor.These growth factor causes proliferation of cells . And also delay the death of cells leading to accumulation of more cells.
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Many theories suggest involuntary hyperplasia due to disturbances in the ratio of circulating androgen and estrogen.
With age, fall of estrogen level in not equel to fall of androgen. So, prostate enlarges through intermediate peptide growth factor.
SYMPTOMS
symptoms of voiding
- hesitancy
- poor flow not improving by straining
- dribbling even after micturation
- intermittent stream
- poor bladder emptying
symptoms of storage
- frequency increases
- urgency
- nocturia
- nocturnal incontinence
COMPLICATIONS
- Susceptibility of infection like pyelonephritis ( infection of kidney) and cystitis ( infection of bladder)
- Bladder hypertrophy, trabeculae formation along with sacculation and diverticulation.
- Hydronephrosis
- Acute Renal failure
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MANAGEMENT
1.Life style modification
- Decrease intake of fluid.
- Avoid use of alcohol and caffeine ( these works as diuretics)
2.Voiding positions
Voiding position may affect the urinary flow rate, voiding time and post voiding residual volume.
It is found that in males with BPH voiding in sitting position
- Decrease voiding time
- Increase flow rate
- Decrease post voiding residual volume
3.Medication
Two main drugs in the management of BPH are alpha blocker( alfuzosin, doxazosin, tamsulosin ,terazosin )and 5α-reductase inhibitors (finasteride and dutasteride )
4.Surgical
If medical treatment doesn't work one can go for surgery. There are varieties of surgical technique.
Most commonly done includes
- Transurethral resection of the prostate (TURP)
- Open prostatectomy
- Photoselective (laser) vaporization of the prostate (PVP)
References:-
1.cover photo
2.wikipedia
3.WebMD
4.SRB's Manual of surgery (5th edition)
Thanks for reading. Any feedback and comments are highly welcome.
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