Clinical Manifestations and Complications of Benign Prostatic Hyperplasia - Term Paper Example

Benign prostatic hyperplasia (BPH) al affiliation Benign prostatic hyperplasia (BPH) Introduction Benign prostatic hyperplasia (BPH) is a disease that affects the prostate glands. It is associated with the overgrowing of the periurethral prostate glands. One ought to note that this disease is nonmalignant and adenomatous. Due to the nature of the disease, it is known to affect males only and not females. The disease has a number of symptoms including weak stream, urinary frequency, hesitance during urination, nocturia, terminal dribbling, urge inconsistence and incomplete emptying. This paper therefore provides a comprehensive discussion of benign prostatic hyperplasia (BPH), its causes, symptoms and treatment procedures that can be applied to remedy its effects (Bachmann, & Rosette, 2011). Etiology Despite the fact that the common causes of benign prostatic hyperplasia (BPH) are not very clear, it is important to note that experts consider testosterone and other related hormones and major causes of BPH. This is a direct implication that BPH androgens have to present for BPH to occur in a patient’s body. This is evidence by the fact that boys who are castrated do not develop the disease when they age. This is because such people do not produce the hormone testosterone and other related hormones that are closely associated with this condition. It is difficult to prove that the occurrence of BPH is associated with some environmental conditions and lifestyle. However, there may be genetic links to the disease. This is because studies have indicated that sons of men who were previously diagnosed with BPH tend to be more probable to contract this disease. This is an implication of the presence of genetic link to the disease (Bachmann, & Rosette, 2011). The disease only affects males and is proven to affect only the older men. It has not been proven that BPH can affect boys under the age of 20 and it is for this reason that the disease is associated with older men. Pathophysiological processes BPH begins with both the stromal cells and the epithelial cells undergoing hyperplasia. In the process, a number of fibroadenomatous nodules form in the prostate around its periurethral region. The progressive growth of the nodules displaces the fibro-muscular prostate peripherally and the condition progresses. This results into the lengthening and narrowing of the prostatic urethral lumen. As a result, the outflow of urine is gradually obstructed (In Kaplan et al, 2014). Increased pressure, which is associated with bladder distention and micturition, can progress to trabeculation, the formation of cellule and diverticulitis. During the progressive inhibition of urine flow, patients begin to undergo incomplete emptying of the bladder during urination. Statis is then caused as a result of this. On most occasions, statis to the formation of calculus and the infection of the entire prostate system. In the event that obstruction is prolonged, patients can suffer from hydronephrosis in which the entire renal function is compromised. It is worth noting that BPH is associated with the transitional zone (TZ) and the posterior urethral glands (PUG) of the prostate. Early diagnosis of BPH begin at the age of thirty and above in males in the posterior urethral glands. However, the majority of growth takes place in the transitional zone for BPH. On some occasions, the peripheral zone (PZ) of the prostate is also involved during the development and subsequent manifestation of BPH. As opposed to prostatic cancers that occur in the peripheral zone, BPH occurs in the transitional zone of the prostate. This therefore helps medical practitioners from distinguishing BPH from prostatic cancers. Clinical manifestations and complications There are a number of symptoms associated with benign prostatic hyperplasia. However, one ought to note that the symptoms of the disease are categorized as voiding and storage. The voiding symptoms include retention of urine, hesitance, intermittent stream and poor flow. Other symptoms categorized under the voiding symptoms include dribbling and poor bladder emptying. The storage symptoms are quite a number and they include frequency, urgency and urge incontinence. Other storage symptoms are nocturia and nocturnal incontinence. Both the voiding and storage symptoms are classified under the symptoms of the lower urinary tract. There are also other symptoms associated with the obstruction of bladder outlet. These are acute and chronic retention (In Kaplan et al, 2014). Acute retention is associated with the inability of patients to pass urine and a constantly aching pain of the supra-pubic. On the other hand, chronic retention is associated with hemorrhoids, overflow incontinence and hernia. All these symptoms cumulatively result into drowsiness, fits and headache. If not diagnosed and treated in time, BPH can have detrimental effects on patients. It can be progressive to an extent of causing stasis and accumulation of bacteria is the bladder. This can have an effect of causing urinary tract infection (In Kaplan et al, 2014). In addition to that, BPH results in the formation or urinary bladder stones when salts crystallize in the residual urine. Progression of the untreated BPH also causes urinary retention which can either be acute or chronic. During the acute urinary retention, patients become unable to void. One then other hand, chronic urinary retention is associated with the gradual increase in the urinary volume and subsequent distention of the bladder. This can cause bladder hypotonia. The end result of untreated and progressed BPH is renal failure which is also called obstructive uropathy (In Chughtai et al, 2014). Diagnostics A number of procedures can be used to diagnose BPH. Ordinarily, urine culture and urinalysis are done during diagnosis. On some occasions, the levels of serum prostate-specific antigen, also called PSA, are measured during the diagnosis of BPH. Doctors also prefer uroflowmetry for men with either severe of acute symptoms of obstruction. This procedure involves the testing of both the volume and flow of urine. It is important to note that this procedure is always accompanied by bladder ultrasonography which involves measuring the post-void residual volume of the bladder (In Patwardhan et al, 2014). During uroflowmetry, the rate of flow of urine is measured using specialized equipment. A flow or less than 15mL per second suggests obstruction and hence the presence of BPH or prostate cancer. This is because BPH and prostate cancer coexist and hence other tests would have to be done in order to distinguish BPH from any related cancer. In the bladder ultrasonography, on the other hand, volumes of more than 100mL always suggest retention (In Kaplan et al, 2014). The levels of prostate-specific antigens can be tricky to interpret after measurement. The levels of PSA are increased in 30-50% of patients having BPH depending on the size of the prostate and the obstruction degree. Additionally, the levels of PSA are increased in 25-92% of patients having prostate cancer depending on the volume of the tumor. For patients who do not have prostate cancer, the levels of serum PSA of more than 1.5ng/mL suggest a prostrate volume of more or equal to 30mL. In the event that the levels of serum PSA are found to be more than 4ng/mL, a trans-rectal biopsy is advised (Bachmann, & Rosette, 2011). Trans-rectal biopsy is done with the help of ultrasound guidance. This is always done by specialized medical practitioners with the help of specialized equipment. In addition to that, trans-rectal ultrasonography may also be used in the measurement of prostate volume. In addition to the named tests above, further tests can be recommended but only under specialized clinical judgment (In Chughtai et al, 2014). Affected health patterns with specific impacts BPH has a number of effects to patients especially in its progressed stages. Most patients undergo prostate complications as a result of progressed BPH which is not treated in time. There are health patterns affected by BPH. The three most significant health patterns affected by BPH are: Frequent urination Painful urination (Dysuria) Ejaculation problems a) Frequent urination It is important to note that BPH adversely affects the urination patterns of patient. Frequent urination is a common effect of the disease. The prostate is found just below the bladder in the male reproductive system. A patient diagnosed with BPH always has an enlarged prostate. During normalcy, the bladder is more than three times as large as the prostate. However, patients with BPH have their prostates enlarged to the size of the bladder. Enlarged prostate gland is an implication that the enlarged prostate exerts a lot of pressure on the bladder thereby reducing its volume. Frequent urination results from the inability of the bladder to accommodate large volumes of urine. In addition to that, frequent urination in patients with BPH is caused by the constant pressure exerted on the bladder as a result of the enlarged prostate. b) Painful urination (Dysuria) BPH also has an effect of causing painful urination which is also referred to as dysuria. Since BPH results in the enlargement of the prostate gland, then enlarged gland not only exerts pressure on the bladder but also the Cowper’s vesicle and the urethra. The exerted pressure reduces the girth of the urethral lumen. During urination, the patient is then experiences a lot of pain due to the reduced girth of the urethral lumen (In Chughtai et al, 2014). c) Ejaculation problems Patients of BPH also have ejaculatory problems. According to the male reproductive system, the seminal vesicle, the ejaculatory duct and the prostate gland are adjacent to one another. In this way, an enlarged prostate gland as a result of BPH will exert unwanted pressure on both the seminal vesicle and the ejaculatory duct. As a result of this, patients have of BPH may also experience ejaculatory problems. Since the urethra is the passage of sperms during ejaculation and it is also squeezed by overgrown prostate, ejaculatory problems may also be caused by the squeezed urethra (In Kaplan et al, 2014). Conclusion In conclusion, therefore, benign prostatic hyperplasia (BPH) is a medical condition that affects the prostate glands of patients. It makes the prostate gland increase in size thereby causing other health effects like painful urination, ejaculatory problems, frequent urination and incomplete bladder emptying. This disease affects men only and is manifested in older men of thirty years and above. Early diagnosis and subsequent treatment of benign prostatic hyperplasia is important for a number of reasons. It is therefore imperative for patients to be diagnosed with the disease early enough in order to begin treatment through the recommended procedure. There are a number of diagnostic procedures for benign prostatic hyperplasia and only specialized clinical advice is used to recommend a diagnostic procedure. References Bachmann, A., & Rosette, J. J. M. C. H. (2011). Benign prostatic hyperplasia and lower urinary tract symptoms in men. Oxford: Oxford University Press. In Kaplan, S. A., & In McVary, K. T. (2014). Male lower urinary tract symptoms and benign prostatic hyperplasia. In Chughtai, B., In Te, A. E., & In Kaplan, S. A. (2014). Treatment of benign prostatic hyperplasia: Modern alternative to transurethral resection of the prostate. In Patwardhan, S. K., & In Shaikh, A. (2014). Common urologic problems: Benign prostatic hyperplasia : issues in BPH, consensus and controversies. Read More