The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.
You will be surprised to know that Urinary obstruction from prostatic hypertrophy has been described for many centuries, starting with the ancient Egyptians in the 15th century BC. The word "prostate" comes from the Greek prostat, which means "one who stands before or in front of", which, in this case, means in front of the bladder.
Benign prostate hyperplasia (BPH) is a condition that affects the prostate gland of the male reproductive system. The prostate gland enlarges in size though this may not cause problems until late in life. It is estimated that about 90% of men in the age group of 70-85 years have BPH. It is one of the most common problems experienced by men during the old age.
As the name suggests, there is hyperplasia or overgrowth of the prostatic tissue. This leads to enlargement of the prostate gland. Now since prostate surrounds the urethra. So any enlargement will definitely cause constriction of the urethra. So in BPH, the flow of urine is also reduced, making it increasingly difficult to empty the bladder. Similar symptoms may also be present when a person has prostate cancer. So it is very important for the physician to carefully rule out the possibility of the latter. To know more about prostate cancer,Click Here
For centuries, BPH has been associated with older men. The cause of BPH is not well understood. There have been various theories which have been put forward for the same. One suggests that men produce two hormones through out their life- oestrogen (small quantity) and testosterone (high proportion). As aging occurs, the amount of testosterone decreases, leaving a higher proportion of oestrogen. Studies done on animals have suggested that BPH may occur because the higher amount of oestrogen increases the activity of substances that promote cell growth. One more theory says that BPH is a result of lack of DHT, a substance which is derived from testosterone. DHT helps in controlling the growth of prostate gland. But due to aging, most animals lose their ability to produce DHT and this may cause BPH.
A person having BPH may remain asymptomatic for quite some time. Infact he may just come to know about it during a clinical examination. Sometimes a person may suddenly start experiencing urination problems. So it is always advised to go for a routine health check up. AASTHA offers various Health Packages for different age groups to ensure proper assessment of health.
problems related with urination, like:
In case the prostate is much enlarged, then there may be severe urine blockage problems. In urinary retention, the urine does not flow out of the bladder leading to accumulation of bacteria and distension of bladder. Untreated, this leads to a decrease in renal function and hydronephrosis (obstructive uropathy). Besides this, due to accumulation of urine in bladder, it can lead to formation of stones. So bladder stones, and incontinence-the inability to control urination may be present. This in the long run may lead to bladder or kidney damage, So it is very important to diagnose BPH at early stage to ensure that it does not lead to complications.
The patient may either report with some problem or the doctor may diagnose during a routine checkup. If BPH is suspected, you will be attended by a urologist. An urologist may do any or all of the following test to determine the level of enlargement:
Prostate-Specific Antigen (PSA) Blood Test
One very interesting fact is that the earliest useful therapy for urinary obstruction from prostatic enlargement was a catheter, which was first used by the Romans Celsus and Galen in the first century AD! They made catheter out of wood, leaves, rubber etc
Today, advancement in medical science has provided many new ways to treat the cases of BPH. Men who have this problem usually need some kind of treatment at some time. In case the person presents with a mild and asymptomatic case of BPH, the physician may closely monitor the patient and give the treatment only if the symptoms deteriorate. But if a person comes with symptomatic picture of BPH, there are two ways to treat it. They are:
It is a major operation and carried out under a general anesthesia. An incision is made in the lower abdomen between the umbilicus (belly-button) and the penis through which the prostate gland is removed. Usually Foley catheter is used but occasionally, a suprapubic catheter may also be inserted in the abdominal wall to help drain the bladder. Foley catheter is an artificial tube to remove urine from the body. This is a much more involved procedure and usually requires a longer hospitalization and recovery period. It may take a couple of weeks to several months to recover from surgery, depending on the exact surgical approach. Most men can return to sedentary work in two or three weeks and vigorous physical labor and sexual activity in about six weeks
The procedure always begins with a careful cystoscopic inspection of the anterior urethra, external urinary sphincter, prostatic urethra, and bladder. This inspection is important not only to verify the absence of associated pathologies but also to give the surgeon an idea of the anatomical relations inside.
The procedure is usually done under a general anesthesia. There is a long thin instrument called resectoscope, which is passed into the urethra. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. It has a lens so it allows the surgeon to view the prostate either directly or on a video screen. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate. The surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. This creates a sort of cavity inside the gland. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation. Foley catheter is an artificial tube to remove urine from the body. This is placed to help drain the bladder after surgery.
The patient is supposed to stay in the hospital for 1-2 days. One can expect some blood or small blood clots in the urine afterward for sometimes.one may experience some pain while micturition for first few days after the surgery.
Laser surgery uses a high-energy laser to destroy overgrown prostate tissue. In March 1996, the FDA approved a surgical procedure that employs side-firing laser fibers and Nd: YAG lasers o vaporize obstructing prostate tissue.