Friday, April 21, 2017

BPH (BENIGN PROSTATIC HYPERPLASIA) : understanding, symptom, Cause, diagnosis, Treatment and complication

Understanding BPH (Benign Prostatic Hyperplasia)

Benign Prostatic Hyperplasia (BPH) or benign prostate enlargement is a condition that causes the prostate gland to swell, but not cancerous. The prostate gland has a function to produce semen and lies in the hip cavity between the bladder and the penis.
BPH (BENIGN PROSTATIC HYPERPLASIA) : understanding, symptom, Cause, diagnosis, Treatment and complication
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.

Symptoms of BPH

The following symptoms are usually felt by people with benign prostate enlargement (BPH):
  • Always want to urinate, especially at night.
  • 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.
It is advisable to see a doctor if you feel the symptoms of BPH, although mild. Diagnosis is necessary because 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 stone disease 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.

Causes of BPH

Actually the exact cause of benign prostate enlargement (BPH) is still unknown, but it is estimated that this condition occurs because of changes in sexual hormone levels due to the aging process.
In the urinary system of men there is a channel that serves to remove urine out of the body through the penis, or better known as the urethra. And this cross-urethral pathway accidentally passes through the prostate gland. If there is enlargement of the prostate gland, it will gradually narrow the urethra and ultimately the flow of urine is blocked. This blockage will make the muscles in the bladder larger and stronger to push the urine out.
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-blocking drugs.
  • Heredity

Diagnosis of BPH

In diagnosing benign prostatic swelling (BPH), the doctor will ask for symptoms that are felt by the patient first:
  • Is the patient's urine flow often weak or stuttering?
  • How often do patients feel that urination is not completely complete?
  • How often do patients wake up at night to urinate?
  • And 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?
To check the size of the prostate gland physically, the doctor will perform a rectal examination.

Further tests

There are several types of tests that can be done to diagnose BPH diseases, among others:
  • 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.
  • Blood test. The component examined in this test is an antigen-specific prostate protein (PSA), a protein produced by the prostate. If the patient's PSA levels are high, then the chances of patients suffering from BPH are also large. If these increases occur significantly, then the chances of patients for prostate cancer also exist.
  • 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.
  • CT urogram. This examination method aims to determine the state of the patient's urinary tract, such as whether there is damage to the canal, or whether there is a blockage caused by conditions other than BPH, such as bladder or kidney stone disease.
  • Transrectal ultrasound or ultrasound through the rectum. Through examinations that use these sound waves doctors will get a picture of the prostate gland and surrounding parts in more detail, to determine whether the patient has BPH or other conditions such as cancer.
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

Treatment of benign prostatic enlargement (BPH) is grouped into two, namely the handling of BPH with mild symptoms and treatment of BPH with symptoms of moderate to severe.
For mild cases BPH is usually treated with medication, urinary-resistant therapy, and lifestyle changes. The lifestyle changes in question are:
  • Start exercising regularly, such as walking up to an hour each day.
  • Begin to reduce or stop consuming caffeine and liquor.
  • Finding the right medication schedule to avoid from nocturia or increased frequency of urination throughout the night.
  • Start getting used to not drinking anything two hours before bedtime to avoid nocturia or urinating all night.
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 reduced sperm count, impotence, and risk of infant defects if you impregnate women 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. For more serious side effects, both of these drugs are at risk of causing hypotension or low blood pressure, even fainting .

Treatment to resist urination

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.

Treatment of BPH with severe symptoms

The only way to deal with BPH with moderate to severe symptoms is through surgery:
  • Open prostatectomy operation. 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 prostate transurethral surgery, open prostatectomies are rarely used today.
  • Transurethral prostate resection surgery (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 retrograde ejaculation, ie sperm will not flow through the penis but into the bladder.
  • Transurethral 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 is less risky in causing retrograde ejaculation.

BPH Complications

Benign prostate enlargement (BPH) can sometimes lead to complications resulting from the inability of the bladder to empty the urine. Some complications that may arise include:
  • Urinary tract infection.
  • 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

According to the study, the risk of developing benign prostate enlargement (BPH) can be prevented through the consumption of foods rich in fiber and protein, and low in fat. Also avoid the consumption of red meat. 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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