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| Diagram illustrating normal prostate (left) and benign prostatic hyperplasia (right). source: wikipedia |
Introduction to Benign Prostatic Hyperplasia
Benign Prostate Enlargement (BPH) is a benign growth on the prostate gland, which causes enlarged prostate. Enlarged prostate common in men over 50 years. Adenomatous prostatic growth is believed to begin at approximately age 30 years. An estimated 50% of men have histologic evidence of BPH by age 50 years and 75% by age 80 years. In 40-50% of these patients, BPH becomes clinically significant.
Cause
The cause is unknown, but may be due to changes in hormone levels that occur because of the aging process. Prostate gland surrounding the urethra (the tube that carries urine out of the body), so the growth in the glands will gradually narrow the urethral tract. In the end the flow of urine becomes blocked. As a result, the muscles of the bladder grow into bigger and more powerful to push urine out.
Symptom
Initial symptoms occur if an enlarged prostate starts clogging the flow of urine. At first, patients have difficulty to start urinating. Patients also felt that their urination is not complete yet. Patients become more frequent urination at night (nocturia) and when urinate they have to "squeeze" stronger. Micturition volume and fluid emission power is minimal. As the result, the bladder fill up quickly and the desire to urinate arises again. When the patient is bearing to urinate, small veins on the urethra and bladder can break so that the urine containe blood. Total blockage causes the sufferer unable to urinate, so patients feel full bladder and severe pain arising in the lower abdomen. If, somehow, there is a bladder infection, there will be a burning sensation during urination, fever as well. Urine retained in the bladder also cause increased pressure on the kidneys, but rarely causes permanent kidney damage.
Diagnosis
Diagnosis is based on symptoms and physical examination. The technique is to do manual rectal examination to feel / touch the prostate gland.With this examination, we can know of an enlarged prostate, hard lumps (indicating cancer) and tenderness (indicating infection). Also usually performed blood tests to determine kidney function and for prostate cancer screening (to measure levels of prostate specific antigen or PSA).
In patients with BPH, PSA levels increased by approximately 30-50%. If an increase in PSA levels, it is necessary to do further tests to determine whether the patient also suffered from prostate cancer.
To measure the amount of urine remaining in the bladder after the patient urinate, do catheter or the patient is asked to urinate into a uroflometer (tool used to measure the rate of flow of urine). Using ultrasound, we measure the size of the gland and determined the cause of BPH. Sometimes the examination with the endoscope is inserted through the urethra to determine other causes of blockage of urine flow. To find the blockage of urine flow can be done IVP X-ray examination. Urine analysis done to see any blood or infection.
Medication
- Alpha 1-blocker. For example doxazosin, prazosin, tamsulosin and terazosin. These drugs cause relaxation (relaxation) muscles in the bladder so that the patient is easier to urinate.
- Finasterid. Finasterid leads to reduced levels of prostate hormones and eventually decrease the size of the prostate.These drugs also cause increased urine flow rate and reduce symptoms. But it takes about 3-6 months until the occurrence of significant improvement. Side effects of Finasterid are reduced sexual desire and impotence.
- Other drugs. To treat chronic prostatitis, which often accompany BPH, was given antibiotics.
Surgery
Surgery is usually performed on patients who have:
- Urinary incontinence
- Hematuria (blood in urine)
- Retained urine (urine retained in the bladder)
- Recurrent urinary tract infections
TURP (trans-urethral resection of the prostate)
TURP, merupakan pembedahan yang paling sering dilakukan.
Endoskopi dimasukkan melalui penis (uretra). Keuntungan dari TURP adalah tidak adanya sayatan sehingga mengurangi resiko terjadinya infeksi. 88% penderita yang menjalani TURP mengalami perbaikan yang berlangsung selama 10-15 tahun. Impotensi terjadi pada 13,6% penderita dan 1% penderita mengalami inkontinensia urine.
TUIP (trans-urethral incision of the prostate)
TUIP menyerupai TURP, tetapi biasanya dilakukan pada penderita yang memiliki prostat relatif kecil. Sebuah sayatan kecil dibuat pada jaringan prostate untuk melebarkan lubang uretra dan sebuah lubang pada kandung kemih, sehingga terjadi perbaikan laju aliran air kemih dan gejala berkurang. Komplikasi yang mungkin terjadi adalah perdarahan, infeksi, penyempitan uretra dan impotensi.
Open prostatectomy
An incision can be made in the stomach (via the structure behind the pubic bone / and above the pubic bone retropubic / suprapubic) or in the perineum (pelvic floor covering an area of the scrotum to the anus). An Approach through a perineal is rarely used anymore because the incidence of impotence after surgery as high as 50%. This surgery takes time and usually the patient must be treated for 5-10 days. Possible complications are impotence (16-32%, depending on the surgical approach) and urinary incontinence (less than 1%).
Other treatment effectiveness is still in the research is hyperthermia, laser therapy and prostatic stents.
If the level of urinary blockage is still minimal, few things that can still be done is as follows:
- Hot bath
- Immediately urinate, when feeling the need
- Engaging in sexual activity (ejaculation) as usual
- avoiding alcohol
- Avoiding excessive fluid intake (especially at night)
- To reduce nocturia, better reduce the intake of fluids several hours before bedtime
- Patients with Benign Prostatic Hyperplasia (BPH) should avoid cold and sinus medicine sold freely , which may contains decongestant and improve the symptoms of Benign Prostatic Hyperplasia
