Benign prostatic hyperplasia

The Prostate Gland

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue., the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.                                

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) also known as benign prostatic hypertrophy (technically a misnomer), benign enlargement of the prostate (BEP), and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate.

Signs and symptoms

Benign prostatic hyperplasia symptoms are classified as storage or voiding.

Storage symptoms include urinary frequency, urgency incontinence, and voiding at night (nocturia).

Voiding symptoms include urinary stream, hesitancy (needing to wait for the stream to begin), intermittency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present. These storage and voiding symptoms are evaluated

BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infection. Urinary bladder stones are formed from the crystallization of salts in the residual urine. Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients that suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.

Cause

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.

A newly discovered venous route by which free (active) testosterone reaches the prostate in extremely high concentrations, promoting the accelerated proliferation of prostate cells, leading to the gland's enlargement. The study suggests that BPH is caused by malfunction of the valves in the internal spermatic veins manifesting as varicocele, a phenomenon which has been shown to increase rapidly with age, roughly equal to 10-15% each decade of life.

Most experts consider androgens (testosterone and related hormones) to play a permissive role. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age.

Diagnosis

Urinary bladder and hyperplastic prostate (BPH) visualized by Medical ultrasonography technique

Micrograph showing nodular hyperplasia (left off center) of the prostate from a transurethral resection of the prostate (TURP). H&E stain.

Microscopic examination of different types of prostate tissues (stained with immunohistochemical techniques): A. Normal (non-neoplastic) prostatic tissue (NNT). B. Benign prostatic hyperplasia. C. High-grade prostatic intraepithelial neoplasia (PIN). D. Prostatic adenocarcinoma (PCA).

Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe.

Often, blood tests are performed to rule out prostatic malignancy: Elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography. These combined measures can provide early detection.

Ultrasound examination of the testicles, prostate, and kidneys is often performed, again to rule out malignancy and hydronephrosis.

Screening and diagnostic procedures for BPH are similar to those used for prostate cancer. Some signs to look for include:
      ·         Weak urinary stream

      ·         Prolonged emptying of the bladder
·         Abdominal straining
·         Hesitancy
·         Irregular need to urinate
·         Incomplete bladder emptying
·         Post-urination dribble
·         Irritation during urination
·         Frequent urination
·         Nocturia (need to urinate during the night)
·         Urgency
·         Incontinence (involuntary leakage of urine)
·         Bladder pain
·         Dysuria (painful urination)
·         Problems in ejaculation

CASE

This is a case of a man who was 40yr old. He came to me with complaints of difficult, frequent urination < night. Incontinence of urine, urgency of urine, he advised for USG: KUB prostate.  

On 29/04/10 prescribed following medicines.

A] PAREIRA BRAVA  Q

B] CICUTA V 30

On02/05/10 came with USG report was enlarged prostate and its wt was 32 gm.

A] PROSTONUM

B] DIGITALIS 30

C] SELENIUM 200

On 17/05/10 prescribed two doses of SYPHILLINUM 1M

ON 02/06/10 Repeated same remedy as 02/05/10 for one month.

On 05/07/10 He came with improvement in frequent urination.

Repeated remedy for one month. Advised USG on 03/08/10

He came on 02/09/10 with no symptoms. USG [ normal study of KUB and prostate, wt 20 gm]

                                                                    CURED

 Dr. G. S. Bhatnagar

D.H.M.S. B.H.M.S.

Research officer

Sewa Mandir

Mobile: 9829978284

E-Mail: sewamandir@usa.net, drgsbhatnagar@gmail.com