Benign prostatic hyperplasia

BPH redirects here, It can also refer to the Break Permitted Here character in the C1 control code set.

Benign prostatic hyperplasia (BPH) also known as Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to the increase in size of the prostatein middle-aged and elderly men. To be accurate, the process is one of hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists (who should know better!). In BPH, the prostate grows larger and presses against the urethraand bladder, interfering with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infectionsand urinary retention. There is remarkably little correlation between BPH symptoms and the presence of prostate cancer.

Symptoms

Urinary symptoms of hesitancy, sensation of incomplete voiding and frequently passing small amounts of urine are all suggestive of BPH in middle-aged and elderly men. Due to the incomplete voiding, there is stasis of bacteriain the bladder residue and an increased risk of urinary tract infections.

A small proportion presents with urinary retention, in which inadequate amounts of urine are passed and the bladder distends greatly. Untreated, this leads to a decrease in renal functionand hydronephrosis(obstructive uropathy).

Diagnosis

Rectal examination(palpation of the prostate through the rectum) may reveal a markedly enlarged prostate. It is dependent on the skills of the doctor.

Often, blood testsare performed to rule out prostatic malignancy: elevated prostate specific antigen(PSA) levels suggest prostate cancer. It has to be borne in mind that rectal examination can increase PSA levels in patients without malignancy.

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

Epidemiology

More than half of the men in the United States between the ages of 60 and 70 and as many as 90 percent between the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.

Treatment

Alpha blockers(α₁-adrenergic receptorantagonists) (such as doxazosin, prazosinand tamsulosin) and certain antiandrogenssuch as the 5α-reductase inhibitors(finasterideand dutasteride) are used, often together, in suppressing the symptoms.

There is also some evidence of the efficacy of Serenoa repens (saw palmetto) preparations in alleviating BPH symptoms. A systematic reviewof evidence found comparable efficacy to finasteride. (Wilt et al., 2002)

If medical treatment fails, transurethral resection of prostate(TURP) surgery may need to be performed. This involves removing (part of) the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, some of which have not been around long enough to fully establish their safety or side effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what's left. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), TransUrethral Microwave ThermoTherapy (TUMT), ethanol injection, and others are studied as alternatives.

See also

• Prostate cancer
• Urinary retention

References

• Wilt TJ, Ishani A, MacDonald R, (2002). Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002 (3), CD001423. (Medline abstract)de:Benigne Prostatahyperplasie

es:Hipertrofia benigna de próstata fr:Hypertrophie bénigne de la prostate ja:?????? vi:U x? ti?n li?t tuy?n

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Benign+prostatic+hyperplasia Wikipedia article Benign prostatic hyperplasia.