Enlarged prostate gland
The prostate gland is located just below the bladder and surrounds the urethra, the tube that carries urine from the bladder to the outside. The main function of the prostate is to secrete fluids that nurture the sperm that come out with ejaculation. Prostatic disorders include:
prostate infection
prostate cancer
prostate enlargement
As a man ages, his prostate enlarges with benign, or non-cancerous, tissue. The medical term for this problem is benign prostatic hypertrophy.
Most doctors simply refer to enlarged prostate as BPH(Benign Prostatic Hyperplasia).
An enlarged prostate is the slow growth of the prostate gland, which is involved in the production of semen and reproductive function in men. The prostate wraps around the tube that transports urine out of the bladder. It is very common for the prostate gland to become enlarged as a man ages. BPH is generally not caused by infection or cancer.
Causes
Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a mans body, may cause the prostate to keep growing. Another theory is that changes in the ratio of testosterone and estrogen (female hormone)as men age cause the prostate to grow.
Enlarged prostate can happen due to a number of reasons:
1. Benign Prostate Hyperplasia
It is the most likely cause of enlarged prostate on men. As boys begin to enter puberty, the testosterone production starts and the prostate gland is activated. At the age of 20, the growth stops, however, at around 40, prostate experiences another growth spurt, which is indicated by an increase on the number of cells. Hyperplasia occurs in almost all men as they reach certain age. The cause of hyperplasia is still unknown, but it is suspected to be caused by hormonal changes.
2. Prostatitis
It is the prostate gland inflammation and the exact cause is also unknown. Prostatitis is suspected to be caused by bacterial infection on skin or the intestinal tract. Due to its close working relationship and proximity, prostate can be inflamed when an infection occurs in urethra. An inflamed and irritated prostate may swell, which leads to enlarged prostate.
3. Prostate Cancer
It is yet another cause of enlarged prostate. Cancer is essentially an uncontrollable growth of cells and can make the prostate to grow beyond its normal size. However, like many cancer types, its difficult to pinpoint the real cause of cancer. Risk factors for prostate cancer include poor diet and genetic reasons. Men above 55 years old are also more likely to have prostate cancer.
Spread out your fluid intake throughout the day -- avoid
drinking large amounts of fluid at one time.
Avoid cold and sinus medications. Decongestants and
antihistamines can worsen BPH symptoms. Exercise
regularly.
Reduce stress.
Signs and Symptoms:
The severity of the symptoms will vary from person to person and the symptoms may not be dependent on the size of the prostate. Some men with very enlarged prostates have few or no symptoms.
Symptoms of enlarged prostate can include:
A weak or slow urinary stream
A feeling of incomplete bladder emptying
Difficulty starting urination
Frequent urination
Urgency to urinate
Getting up frequently at night to urinate
A urinary stream that starts and stops
Straining to urinate
Continued dribbling of urine
Returning to urinate again minutes after finishing
When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately.
In rare cases, bladder or kidney damage can develop from BPH.
Diagnosis:
Physician may check the size of your prostate gland directly by putting a gloved finger in your rectum and feeling the back wall of the prostate. Physician will also order blood tests and possibly a urine sample. Other tests may include:
Urinary flow test Physician may ask you to urinate into a device that measures the flow of urine.
Intravenous pyelography Physician injects a dye into a vein to make the flow of urine visible on an x-ray.
Transrectal ultrasound Physician will insert an ultrasound probe in your rectum to get an image of your prostate gland.
In addition, you may be asked to complete a self screening form to evaluate the severity of your symptoms and the impact on your daily life. Physician can use this to monitor your condition over time.
Treatment:
For most patients suffering from an enlarged prostate who do not have kidney damage or serious infection, the ultimate decision must be left to the patient. While there are absolute indications of intervention, most situations depend on how bothersome the symptoms are to the individual. All options need to be discussed and considered along with their advantages and disadvantages.
Sometimes men may take antibiotics for a long period of time without any true benefit. In fact, many of these conditions are not infections but simply muscle spasms involving the prostate and surrounding tissue. This is a condition called prostatosis or prostadynia. Treatment for this includes muscle relaxants and warm baths. Hytrin or Cardura, typically used for high blood pressure are also muscle relaxants and have been shown to be successful.
A doctor may recommend treatment when:
the man is unable to urinate
there are recurrent urinary tract infections
there is recurrent blood in the urine
there are hemorrhoids and hernias
there may be damage done to the kidneys or bladder
there are bothersome symptoms like frequently interrupting sleep to go to the bathroom
there is an annoying sensation of always having to urinate
there is dripping of urine after stopping
Most experts agree that more serious symptoms such as the inability to urinate, kidney or bladder damage may require surgical treatment.
However, for other less serious symptoms, patients may need to consider whether the symptoms are bad enough to warrant some type of treatment. There is no one absolute treatment for bothersome symptoms. Each of the treatment alternatives listed below has its advantages and disadvantages.
Surgery
Removal of part of the prostate is an option if symptoms are very bothersome, or if medicines do not help. Around one in four men with an enlarged prostate will have an operation at some stage. In these operations, only the central part of the prostate is removed (creating a wide channel for urine to flow through), leaving the outer part behind.
There are many different types of operation now available that can remove prostate tissue. Your surgeon will discuss the most suitable operation for you in more detail.
Some of the more commonly done operations are listed below:
Transurethral resection of the prostate (TURP)
This is the most common operation carried out for an enlarged prostate.
Under anaesthetic, either spinal or general, a rigid cystoscope is inserted through the urethra into the bladder. A cystoscope is a narrow tube-like telescope through which small instruments pass to allow the operation to be carried out.
A semicircular loop of wire has an electrical current passed through it. It is this loop that sticks out from the end of the cystoscope and cuts out small chips of prostate that are then washed out at the end of the operation. This operation nearly always gives good relief of symptoms. 80-90% of men after this operation will have retrograde ejaculation, which is when semen goes backwards into the bladder
Transurethral incision of the prostate (TUIP)
This may be offered if you only have a slightly enlarged prostate. For this operation the surgeon makes small cuts in the prostate where the prostate meets the bladder. This then relaxes the opening to the bladder resulting in there being an improved flow of urine out of the bladder. There is less risk of retrograde ejaculation with this operation.
Open prostatectomy
This is a more traditional operation which involves cutting the skin to get to the prostate. It is now rarely done. It is only performed when the prostate is very large.
Laser prostatectomy
This is simply the application of newer technologies to achieve the same goal as either TURP or open prostatectomy. It has the advantage of fewer side-effects, a shorter period of having a catheter in, and a shorter stay in hospital (often just one night).
Lifestyle
Many men with BPH have only minor symptoms. Some simple lifestyle changes may be all you need to feel better:
Urinate when you first get the urge.
Go to the bathroom when you have the chance, even if you dont feel a need to urinate.
Avoid alcohol and caffeine, especially after dinner. Try not to drink within 2 hours before going to bed.
Spread out your fluid intake throughout the day -- avoid drinking large amounts of fluid at one time.
Avoid cold and sinus medications. Decongestants and antihistamines can worsen BPH symptoms.
Exercise regularly.
Reduce stress. n(Reprint)
Dr. A. Faizul Huq Chowdhury
e-mail: [email protected]
