Benign Prostate Hyperplasia
The prostate gland is an exocrine gland found only in the male. Exocrine glands secrete chemicals to the outside of the body. It is a glandular organ and is found just below the bladder and at the top of the penis. It is normally about the size of a walnut and it surrounds the urethra which is the tube that brings urine from the bladder to the outside of the body. It is made of fibrous tissue and some muscle tissue. Anatomy The gland is divided into zones or lobes. The peripheral zone is the outside part of the prostate and this is where most prostate cancers are found.
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The central zone makes up about 25% of the gland and the transition zone makes up about 5% of the gland. The transition zone, however, is where are the hypertrophy happens. This part of the prostate is closest to the urethra so as it grows it puts pressure on and squeezes the urethra causing problems with urination. However, in benign prostate hyperplasia, the prostate grows and begins to cause the person problems. It is usually an age related disease which is nonmalignant. Large lesions grow on that central section of the prostate.
It is believed that 60% of men over the age of 60 have BPH (Porth & Matfin, 2007). The exact cause is unknown but there are some risk factors which include age, history, race, dietary fat, and hormonal factors. The older one gets, the more likely to have it and African American men get it most often. When young the gland grows with the hormones testosterone and dihydrotestosterone and it is believed that in some men the hormones do not slow down and stop when they should so the gland continues to grow past what would be normal. Signs and Symptoms
BPH causes compression on the urethra so it causes partial or complete obstruction of urine flow. As the obstruction increases (prostate gets larger), acute or emergent retention of the urine may occur with distention of the bladder. The urine that is left in the bladder when a man tries to urinate and is not able to empty his bladder causes a frequency to occur, consistently trying to empty the bladder. This usually becomes worse at night. When there is a lot of bladder distention accidents may happen every time pressure is put on the abdomen or when coughing causing pressure inside the abdomen.
When urine is not completely emptied from the bladder the chances of a urinary infection occurs and this sometimes happens frequently. All of this develops in stages over time so there is often changes in the kidney and ureters because of the long time back up of urine causing hydronephosis which eventually begins to kill kidney gomeruli. If not treated early this can lead to renal failure. Diagnosis When making a diagnosis of BPH seven questions are at first ask. These questions are regarding incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia.
A final question relates to the quality of life the patient is having related to this problem. A history, physical exam and rectal exam is done. Also to be done are urinalysis, PSA, and serum creatinine as well as other blood tests. The urinalysis is done to detect bacteria or infection, the serum creatinine is used to estimate whether there is renal function problems and the PSA is used to screen for cancer. Our Patient JJ has BPH and he has symptoms of frequent or urgent need to urinate, he also has developed cysts in his urine and a urinary tract infection.
All of these symptoms make sense because they are symptoms of the enlarged prostate putting pressure on the urethra. The urinary tract infection has occurred because of the retention of urine in the bladder. His treatment plan is medications and TURP or TIP. Treatment Treatment in the early stages is aimed at symptom relief, then there is a time of watchful waiting which is suggested by most physicians. There are presently medications that work pretty well for some time. These are Finasteride which reduces prostate size by blocking the effect of androgens on the prostate.
This drug also cause atrophy of the prostate cells which can cause a 20% reduction in volume. The onset of the drug takes some time, sometimes 3-6 months but it usually works for some time. The side effects may be erectile dysfunction and decreased libido. There can also be the surgical removal of the enlarged prostate gland. This surgery can be done through the urethra, through a suprapubic incision, or through an incision in the peritoneum. The most commonly used way is called a TURP which is transurethral prostatectomy or through the urethra.
The prostate is a very vascular organ and though this procedure is fairly simple to do, there is a great deal of bleeding on average and irrigations are often necessary post-operatively. There are presently many experimental treatments that it is hoped will provide less side effects. These include laser surgery, transurethral vaporization, transurethral microwave therapy, and transurethral needle ablation. There is also a new technique using balloon dilation but these effects at this time seem to be transitory. Stents can also be placed in those men that have major heart of lung issues and cannot tolerate surgical procedures.
Treatment Plan So, JJ had symptoms of BPH which was treated by medication but his symptoms persisted and he had a TURP. This procedure after recovery relieved his symptoms and he is progressing quite well with most of his symptomology gone at this time. Conclusion BPH which is thought of as a cancerous condition of the prostate is a benign condition of the prostate. The symptoms which it causes are usually the method of treatment in the beginning and this may last for some time, but there may be a later need for a more aggressive method of treatment which at this time is the TURP.
There are side effects of this surgery, some of them immediate because of the vascular condition of the prostate. This surgery, at this time usually solves the problem long term. There are many more less invasive procedures being studied at this time. Our patient JJ is doing quite well after a TURP and will most likely not need a further procedure. It does not relieve him however, of the possibility of prostate cancer because that part of the prostate is still there so he will need to continue to have checkups. References Porth,C and Matfin, G. (2007). Pathophysiology. 8th ed. Lippincott: Boston Add textbook