What Is Benign Prostatic Hyperplasia?


Benign Prostatic Hyperplasia or BPH or Benign Prostate Enlargement is a condition when the prostate gland is swollen, but not cancerous. The prostate gland is a small gland located in the pelvic cavity between the bladder and the penis. The prostate gland produces fluid that serves to nourish and protect sperm cells. In the event of ejaculation, the prostate will contract so that the liquid will be released simultaneously with the sperm, to produce semen liquid.

Because the prostate gland is only owned by men, then of course all people with BPH are men. Generally men affected by this condition are over 50 years old. Many people who think that suffering from BPH means having a higher risk for prostate cancer . Apparently this assumption is not true, because until now there is still no link between BPH to increase the risk of prostate cancer.


Symptoms of BPH
Here are the symptoms that are usually felt by people with benign prostate enlargement (BPH):
  • Always want to urinate, especially at night.
  • Pain during urination.
  • Urinary or large incontinence .
  • Difficult to remove urine.
  • Mengejan at time of urination.
  • The flow of urine falters.
  • Remove the urine with blood.
  • Feeling incomplete after urination.
The appearance of these symptoms is caused by pressure on the bladder and urethra when the prostate gland is enlarged.

Consultation to a doctor is recommended if a person feels symptoms of BPH, although mild. Examination is necessary considering there are some other conditions with symptoms similar to BPH, including:
  • Prostatitis or inflammation of the prostate.
  • Urinary tract infection.
  • Narrowing of the urethra.
  • Kidney stones and bladder stones .
  • The scar operation on the bladder neck.
  • Bladder cancer
  • Prostate cancer.
  • Disorders of the nerves that regulate the activity of the bladder.
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Causes of BPH
Actually the exact cause of benign prostate enlargement (BPH) is still unknown. However, this condition is thought to occur because of changes in sexual hormone levels due to the aging process.

In general, the prostate will continue to grow for life. In some cases, the prostate will continue to grow and reach a size large enough so that will gradually squeeze the urethra. The pinched urethra causes the urine to come out, so there are symptoms of BPH as mentioned above.

Some factors that may increase a person's risk of developing BPH are:
  • Less exercise and obesity.
  • The aging factor.
  • Have heart disease or diabetes.
  • Side effects of beta blockers (beta blockers) .
  • Heredity.

Diagnosis of BPH
In diagnosing benign prostatic swelling (BPH), the doctor will ask for symptoms that are felt by the patient first, for example:
  • Is the flow of urine often weak or choked up?
  • How often does the patient feel urination is not completely complete?
  • How often do patients wake up at night to urinate?
  • How often do patients push to start urination?
  • Is the patient often difficult to resist the urge to urinate?
  • Does the patient urinate more than once within two hours?
In order to know the size of the prostate gland physically, the doctor will perform rectal examination.


Further tests
There are several types of advanced tests that can be done to diagnose BPH, including:
  • Urine test. This test is performed if the doctor suspects symptoms are felt by the patient not caused by BPH, but by other conditions, such as urinary tract infections or kidney stones.
  • Prostate biopsy. The doctor will take samples of the patient's prostate tissue for careful examination in the laboratory.
  • Blood test. The component examined in this test is an antigen-specific prostate protein (PSA), a protein produced. If the patient's PSA level is high , then the chances of the patient suffering from BPH will also be large. If these increases occur significantly, then the risk of patients for prostate cancer is also present.
  • Test the smooth flow of urine. In this examination, the doctor will insert a camera-equipped catheter into the patient's urinary tract. Through the monitor, the doctor will be able to see the amount of pressure inside the bladder and how well the organ performs when the patient is urinating.
  • Neurological tests. The doctor will briefly examine the mental health and nervous system of the patient to help diagnose the presence of urinary disorders due to causes other than prostate enlargement.
  • CT urogram. This examination method aims to determine the state of the patient's urinary tract, such as whether there is damage to the channel or whether there is a blockage caused by conditions other than BPH, such as bladder or kidney stone disease.
  • Intravenous Pielography. In this procedure, the doctor injects contrast material through a blood vessel and then takes a picture of the kidney with X-rays, to examine the kidney function and urine flow from the kidney to the bladder.
  • Transrectal ultrasound or ultrasound through the rectum. Through examination using these sound waves, your doctor will get a picture of the prostate gland and surrounding sections in more detail to see if the patient has BPH or other conditions such as cancer.
  • Cystoscopy. The doctor will insert the cystoscope to check the urethral and bladder conditions from the inside.
In addition to ensuring that the symptoms felt by the patient are due to BPH and not caused by other conditions, further tests may also help the doctor provide appropriate treatment.


Treatment of BPH
The handling of BPH varies with each sufferer. The doctor will choose the most appropriate type of treatment based on several factors such as:
  • Patient's general health condition.
  • Level of discomfort felt by the patient.
  • Age of the patient.
  • Prostate size.
Treatment of benign prostatic enlargement (BPH) itself can be grouped into two, namely handling BPH with mild symptoms and treatment of BPH with moderate to severe symptoms.

Light BPH is usually treated with medication, urinary-resistant therapy, and lifestyle changes.


Drugs
The most frequently used BPH drugs are dutasteride and finasteride . Drugs that reduce the size of the prostate and relieve symptoms of BPH work by inhibiting the effects of the hormone dihydrotestosteron. However, the use of these two drugs should not be arbitrary and should be through the instructions of the doctor because it has serious side effects. Some of the side effects of dutasteride and finasteride are the decrease in the sperm quantity, impotence, and risk of infant defects if the patient impregnates the woman while undergoing treatment with both of these drugs.

In addition to dutasteride and finasteride, other commonly used BPH drugs are the alpha blockers, such as alfuzosin and tamsulosin . These alpha blockers are usually combined with finasteride. This drug is able to accelerate the rate of urine by relaxing the muscles of the bladder. Side effects that may occur after consuming alfuzosin and tamsulosin is the body weakness, headache, and the decrease in the quantity of sperm. While the more serious side effects of these two drugs is the risk of occurrence of hypotension (low blood pressure) or even fainting .

In addition to the above drugs, doctors can also prescribe erectile dysfunction drugs, such as tadalafil, to handle cases of prostate enlargement that causes sufferers to experience erectile dysfunction.


Refractory therapy
This therapy is done under medical guidance. In this therapy patients will be taught how to resist urination at least within a two-hour lag between each urination, including being taught how to regulate breathing, diverting the mind to urinate, and muscle relaxation.

Lifestyle changes
The lifestyle changes in question are:
  • Start exercising regularly, such as walking daily for half an hour.
  • Begin to reduce or stop taking caffeine and liquor.
  • Looking for the right medication schedule to avoid from nocturia (increased frequency of urination throughout the night).
  • Start getting used to not drinking anything two hours before bedtime to avoid nocturia.
While the way to handle BPH with the severity of moderate to severe symptoms is through surgery, namely:
  • Transuretral prostate resection (TURP). The procedure is done with the help of a device called a resektoskop aims to lower the pressure on the bladder by removing excess prostate tissue. Side effects of TURP surgery are swelling of the urethra. Therefore patients who undergo TURP usually will not be able to urinate normally for two days and should be assisted by using a catheter. This tool will be removed by the doctor after the urethra condition is restored. In addition to side effects, TURP surgery can also cause complications of ejaculation retrog r ade, the sperm will not flow through the penis but into the bladder.
  • Transuretral prostate vaporization (TUVP). The purpose of this procedure is similar to TURP. But in TUVP, the part of the treated prostate will be destroyed and not cut. If the destruction of prostate tissue in the TUVP procedure is aided by a laser beam, then the method is called photovaporization (PVP).
  • Transurethral microwave thermotherapy (TUMT). The doctor will insert a device that can transmit microwaves to the prostate area through the urethra. The microwave energy of the device will destroy the inside of the enlarged prostate gland, thus reducing the size of the prostate and expediting the flow of urine. This procedure is generally only done for BPH which is not too large and only temporary, so it is often needed TUMT replicate.
  • Transurethral needle ablation (TUNA). The doctor will stick the needles in the patient's prostate gland, then radio waves will be passed on the needles. In effect, prostate tissue that blocks the flow of urine will heat up and destroyed. Just like TUMT, this action is only temporary so that repeat therapy is required.
  • Transuretral prostate incision (TUIP). This procedure uses the same tool as TURP, the resectoscope. But in TUIP, the doctor will expand the urethral tract so that the urine can flow smoothly by making a wedge in the junction muscles between the bladder and prostate. The side effect of this procedure is the same as TURP, ie the patient will not be able to urinate normally for a certain time and should be assisted by using a catheter. This procedure has a lower risk of causing retrograde ejaculation.
  • Open prostatectomy. In this procedure, the doctor will lift the prostate directly through a wedge made on the abdomen. This procedure was originally regarded as the most effective procedure for treating severe BPH cases. But as other methods emerge, such as transuretral prostate surgery, open prostatectomy is rarely used today.
  • Holmium laser enucleation of the prostate (HoLEP). The purpose of this procedure is the same as TURP, which is to lower the pressure on the bladder by removing excess prostate tissue. Inside HoLEP, excess prostate tissue will be removed by a laser beam from a special device inserted through the urethra.
  • Prostatic urethral lift implants. The purpose of this procedure is to relieve symptoms of urinary disturbance by blocking prostate enlargement from blocking the urethral tract using a small implant. Compared with TURP or TUIP, the risk of side-effects in the form of sexual dysfunction and tissue damage in the prostatic urethral elevator implants procedure is considerably smaller.

BPH complications
Benign prostatic enlargement (BPH) can sometimes lead to complications resulting from the inability of the bladder to empty the urine. Some of the possible complications that may arise include:
  • Urinary tract infections .
  • Bladder stone disease.
  • Acute urinary retention or inability to urinate.
  • Bladder and kidney damage.
These complications may arise if benign prostate enlargement is not treated effectively.


Prevention of BPH
The risk of benign prostate enlargement (BPH) can be prevented through the consumption of foods rich in fiber and protein, as well as low in fat. Here are examples of foods with high fiber content:
  • Green beans
  • Brown rice
  • Wheat
  • Broccoli
  • Cabbage
  • Radish
  • Spinach
  • Apple
Here are examples of foods with high protein content:
  • Fish
  • Egg
  • Soybeans
  • Low-fat milk
  • Chicken breast
  • Cheese

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