Benign Prostatic Hypertrophy
The noncancerous enlargement of the prostate is known as benign prostatic hyperplasia (BHP). Probably caused as a result of hormonal changes, the condition usually occurs in males who are over 50 years of age. The swollen gland tends to constrict the urethra, thereby obstructing the flow of urine.
This leads to retention of some amount of urine in the bladder even after urination, which facilitates the growth of bacteria leading to frequent urinary tract infections and increasing the chances of forming stones. In severe cases, the resultant back pressure can cause the infection to go retrograde so as to affect and damage the kidneys.
The urinary symptoms caused by BHP are termed as prostatism. Initially, the patient may experience hesitancy, i.e., he needs to wait for awhile before starting to urinate. He is often left with an unfinished sensation even after passing urine. His frequency of urination increases due to retention of some amount of urine in the bladder each time that he voids urine. He needs to wake up at night to urinate and this begins to disturb his sleep.
The force of the urine stream and the quantity passed reduces and the person needs to strain much to empty the bladder. As the problem worsens, dribbling of urine after passing urine may occur or the individual may pass urine involuntarily because of overfilling of the bladder. Recurrent urinary tract infections and straining hard to pass urine can lead to bleeding in the urine, burning or painful urination, and even fever.
Prostatic enlargement can be diagnosed by a doctor who introduces his finger into the patient's rectum to feel the prostate. Any irregularities in its consistency need to be taken very seriously as this may be indicative of prostatic cancer. If touching the region gives rise to pain, there is every possibility that there is an infection in the prostate. A blood test to estimate the level of the prostate-specific antigen (PSA) is done as this may be indicative of prostate cancer. It is more or less a screening test and is not confirmatory.
In severe obstruction, it is important to rule out any other cause of obstruction. In such cases, endoscopy may be of use to clinch the diagnosis. Ultrasonography will reveal the size of the prostate and can also tell if the kidneys are structurally getting affected. Any formation of stones will also be detected by an ultrasound. To check if the kidneys are functioning properly, blood tests and other specialized investigations may be required to be done.
Treatment of BHP involves the administration of a drug that can cause shrinkage of the prostate. A man who has severe urine retention may have to be catheterized to drain the urine. Antibiotics may have to be given to combat any infection. If the condition worsens, doesn't respond to treatment, or if the kidney functions start deteriorating, surgery is the only way out.
Transurethral resection of the prostate is the commonest procedure, in which the doctor removes part of the prostate by inserting an endoscope through the urethra. In some cases, a laser beam is used to burn the overgrown prostatic tissue. Cutting the abdomen to operate is almost never done these days.
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