BENIGN PROSTATIC HYPERPLASIA (BPH)-Version 1

There are 2 theories to explain BPH.

I. Hormonal theory

• It has been compared to fibroadenosis in female patients.

• As the age advances, the levels of androgens come down. There is a corresponding increase in the oestrogen which stimulates the prostatic gland and produces BPH.

2. Neoplastic theory According to this theory there is proliferation of all the elements of prostate: Fibrous, muscular and glandular resulting in fibromyoadenoma.

SECONDARY EFFECTS OF BPH

I. Urethral changes

• Urethra gets compressed, elongated and gets converted into a narrow, longitudinal slit.

• The effect is more with median lobe enlargement which is due to enlargement of subcervical glands. Lateral lobes enlarge when there is involvement of submucous glands

2. Changes in the bladder

• As a result of obstruction, the bladder musculature undergoes hypertrophy. Very prominent thick bundles of the muscle can be seen, which are called fasciculations or trabeculations.

• In between the fasciculations, there are depressed areas which are called sacculations.

• Since the sacculi are thin, as the pressure increases, herniation occurs outside resulting in diverticuli.

• In the diverticuli, there is stasis of urine resulting in secondary infection and stone formation.

3. Changes in the ureter and kidney

Bilateral hydronephrosis and bilateral hydroureter are the end result of BPH, which may result in renal failure.

 

CLINICAL FEATURES OF BPH

• Frequency, urgency, hesitancy are triad of BPH –

-Frequency: To start with, frequency is present during the day time followed by day and night (5-10 times during the night). It is due to ineffective emptying of the bladder. It results in residual urine in the bladder precipitating cystitis.

- Urgency: As the prostate enlarges there is vesical introversion of sensitive mucous membrane of prostatic urethra within the bladder. This causes the internal sphincter to stretch and prevents contraction. This results in a few drops of the urine trickling down the posterior urethra resulting in an urgent desire to pass urine (urgency).

- Hesitancy: Patient hesitates to pass urine because it is so ineffective due to obstruction.

• BPH with acute retention of urine - This occurs due to postponement of micturition, following alcohol or drugs like mydriatics.

• BPH with chronic retention of urine - Many of the patients present with chronic retention of urine, with painless enlargement of the urinary bladder.

• Haematuria is rare - It is due to congestion of prostatic venous plexuses resulting in hyperaemia and haematuria.

COMPLICATIONS • Stones • Diverticuli • Renal failure • Recurrent urinary tract infection.

DIAGNOSIS OF BPH

Digital rectal examination: Enlarged lateral lobes can be easily felt. Rectal mucosa is free (In an enlarged prostate gland, in case of carcinoma of prostate, the mucosa of the rectum cannot be moved if it has infiltrated into the rectum.)

Grading of prostate is done as follows

I. The prostatic Jobes protrude minimally into the rectal lumen by 1-2 cm, the median sulcus is palpable.

II. Prostatic lobes protrude> 2 cm but < 3 cm into the rectal lumen and the median sulcus is obliterated.

III 3--4 cm protrusion

IV. > 4 cm protrusion of lobes, most of the rectal lumen is filled by the projecting prostatic lobes

 

INVESTIGATIONS

l. Blood urea and creatinine: Raised levels indicate renal failure.

2. Uroflowmetry: The person is asked to void urine from his full bladder into the flowmeter. The flow rate is assessed.

Peak flow rate

• Normal peak flow rate: 20 ml/sec.

• Doubtful peak obstruction: 10 to 15 ml/sec.

• Definite peak obstruction: Less than 10 ml/sec.

• Thus, the degree of bladder outlet obstruction (BOO) can be secured by uroflowmetry in case of BPH.

3. Ultrasonogram: To assess the size and weight of prostate, to assess the residual urine and to look for hydroureteronephrosis, bladder wall changes.

 

 

 

TREATMENT AT DR. SOHAN LAL CLINIC

The integrated POLYCLINIC facility offers patients to select their treatment either from the Department of Homeopathy or from the Department of Medicine.

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