Benign prostatic hyperplasia or nodular hyperplasia is a condition in which there is an increase in the size of the prostate. The formation of large nodules within the periurethral region causes partial or complete obstruction of the urethra.
Benign prostatic hyperplasia is a physical condition, wherein the infected, enlarged prostate interferes with the normal flow of urine. It is characterized by hyperplasia of the epithelial cells and prostatic stromal. The result is urinary hesitancy, dysuria, or frequent urination. The formation of nodules within the periurethral region increases the risk of urinary tract infection, due to urine retention.
The condition is treated by elevating the prostate-specific antigen levels, but the organ inflammation can result in a premalignant lesion if neglected. Normally, adenomatous prostatic growth is observed in males over 30 years of age. More than 50% males develop this condition by 60 years, with only 40% cases displaying clinically-significant symptoms.
- Androgens play a major role in the onslaught of the condition in question. They may not be directly responsible, but they do support its progression. It is observed less in castrated males.
- A metabolite of testosterone, called dihydrotestosterone, plays a critical role in prostatic growth when synthesized in the region by the action of 5α-reductase, a type 2 enzyme. The enzyme binds to nuclear androgen receptors and triggers epithelial and stromal cell growth factors.
- Estrogens also play a vital role in the etiology.
Signs and Symptoms
The symptoms manifest within two clinically segmented categories: ‘storage’ or ‘voiding’. Storage signs and symptoms include:
- Compelling need for frequent urination
- Urgency incontinence
The voiding symptoms include:
- Hesitancy prior to urination
- Weak urinary stream
- Intermittency or the stream starting and stopping intermittently
- Need to strain while urinating
- Dysuria or a burning sensation while urinating
Medical intervention evaluates the storage and voiding symptoms to assess the severity and stage of the condition. The infection can be progressive if left untreated. Retained urine results in stasis of bacteria within the bladder. This, in turn, increases the risk of urinary tract infection. Another development is the formation of urinary bladder stones due to residual urine being concentrated with crystallized salts. As acute and chronic urinary retention increases, the bladder distends. The condition, if neglected, could result in a complete renal failure or obstructive uropathy.
- This disorder can be diagnosed with the help of microscopic examination of the prostate tissues.
- There are immunohistochemical techniques that help to categorize the normal non-neoplastic (NNT) prostatic tissue, benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN), and prostatic adenocarcinoma (PCA).
- The Hryntschak procedure or transvesical prostatectomy procedure involves the removal of the prostate tissue through the bladder, with the help of a metal instrument.
- Rectal examination, ultrasound, ultrasonography, and blood tests are also performed to identify BPH.
The treatment options include:
- Decreased fluid intake before bedtime.
- Reduced or complete cessation of alcohol consumption.
- Complete cessation of caffeine consumption through coffee or colas.
- Timetabled voiding schedule.
- Medication such as alpha blockers or α1adrenergic receptor antagonists like doxazosin, tamsulosin, terazosin, and alfuzosin, and 5α-reductase inhibitors.
- Saw palmetto fruit extract.
- Herbal medicines such as Hypoxis rooperi or African star grass, pygeum, or the extract of Prunus africana, Cucurbita pepo or pumpkin seed, and Urtica dioica or the root of the stinging nettle.
Patients who do not respond favorably to medical management are considered for surgery. The three common surgery types include:
Transurethral microwave thermotherapy (TUMT): In the transurethral microwave therapy surgery, a urethral catheter is inserted into the intraprostatic region of the urethra. The control box managed externally is used to energize and heat the prostate tissue via microwave radiation. The resultant necrosis takes around six weeks to reabsorb damaged tissue.
Transurethral needle ablation (TUNA): Transurethral needle ablation uses radio frequency energy to trigger necrosis of the prostatic tissue. The TUNA device is inserted to deliver the radiated energy through two needles, one inserted within the urethral wall and the other into the prostate.
Transurethral resection of prostate (TURP): This surgery involves removal of the infected prostate through the urethra.
Transurethral electrovaporization or TVP, laser TURP, and VLAP or visual laser ablation are other treatment alternatives. All three surgery types are conducted under general anesthesia. So, if you feel any kind of abnormality while urinating, go to your doctor immediately.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.