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Benign Prostate hyperplasia BPH signs, symptoms and treatment
The prostate is the largest accessory gland in the male reproductive system.
It is about the size of a chestnut and somewhat conical in shape, and consists of a base, an apex, an anterior, a posterior and two lateral surfaces.
Has an average weight of about 11 grams
It secretes proteolytic enzymes into the semen, which act to break down clotting factors in the ejaculate.
This allows the semen to remain in a fluid state, moving throughout the female reproductive tract for potential fertilisation.
The prostate is positioned inferiorly to the neck of the bladder and superiorly to the external urethral sphincter
Posteriorly to the prostate lies the ampulla of the rectum
This anatomical arrangement is utilised during Digital Rectal Examinations DRE, allowing physicians to examine the gland.
What do the DRE results mean?
Prostate may feel:
Normal - a normal size for age with a smooth surface
larger than expected for age - this could be a sign of an enlarged prostate
Hard or lumpy - this could be a sign of prostate cancer.
The DRE is not a completely accurate test. The doctor or nurse can’t feel the whole prostate.
And a man with prostate cancer might have a prostate that feels normal.
The prostatic ducts
The proteolytic enzymes leave the prostate via the prostatic ducts.
These open into the prostatic portion of the urethra, through openings at each side of the seminal colliculus (or verumontanum);
Secreting the enzymes into the semen immediately before ejaculation.
Zones of prostate gland
The prostate gland is divides into three anatomical zones.
The central zone forms the base of the gland that surrounds the ejaculatory ducts
The peripheral zone is the largest zone making up 70% of the gland and surrounds most of the central zone and partially surrounds the distal part of the prostatic urethra
The transition zone is a small glandular zone that surrounds a portion of the urethra between the urinary bladder and verumontanum
Fibromuscular stroma
This area contains mostly muscular and fibrous tissue and surrounds an inferior portion of the prostate called the apex
Lastly, the prostate is encompassed by a fibrous layer called a capsule.
This is not a real capsule; it rather resembles the thin connective tissue known as adventitia in the large blood vessels.
Prostate enlargement
An enlarged prostate is called prostatomegaly, benign prostatic hyperplasia (BPH) is the most common cause.
BPH refers to an enlargement of the prostate due to an increase in the number of cells that make up the prostate (hyperplasia) from a cause that is not a malignancy.
It is very common in older men.
It is often diagnosed when the prostate has enlarged to the point where urination becomes difficult
Causes of Prostate enlargement
Hormonal changes (increased release of dihydrotestosterone)
Aging
Family history of BPH
Obesity
Sedentary lifestyle
Symptoms of bph
The enlarged prostate may compress the urethra, resulting in symptoms
Weak or interrupted urine flow, difficulty in initiating micturition
Frequent urination (especially at night nocturia)
Urgency to urinate (urinary frequency, urinary urgency,
Poor stream, intermittent urine stream and terminal dribbling of urine).
Straining during urination
Incomplete emptying of the bladder
Painful urination
Sign of bph
Enlarged prostate gland
Increased post-void residual (PVR) volume
Decreased urine flow rate
Blood in the urine (hematuria)
Treatment of BPH
BPH can be treated with 1- medication, 2- minimally invasive procedure or, in extreme cases, 3- surgery that removes the prostate.
In general, treatment often begins with an alpha-1 adrenergic receptor antagonist medication such as tamsulosin have been widely used to alleviate several symptoms associated with BPH, including nocturia.
These agents work by relaxing smooth muscles located in the prostate and around the bladder neck, and consequently reduce resistance to urine flow.
A large study of 3047 males showed statistical improvement in Symptoms of bph with alpha-1 adrenergic receptor antagonist
Moreover, combination therapy with finasteride offered added benefit as compared with doxazosin therapy alone.
Adverse effects of medication
For people with persistent symptoms, surgical procedures may be considered.
The surgical procedure most often used in such cases is transurethral resection of the prostate, in which an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine.
#Benign Prostate hyperplasia BPH signs, symptoms and treatment , Lectures by Dr Alamzeb#
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