Risk factors for development of benign prostatic hyperplasia
The prostate is a hormone-dependent organ - its development depends on hormonal environment controlled by the hypothalamic-pituitary-testicular axis. The established risk factors for BPH include age and presence of androgens secreted by testicles.
Race and environment.
It appears that this disorder is more common in Black men, however, this requires further studies. In Mongoloid men BPH incidence is lower, however, it was noted that migration from Asia to western countries increases a risk of the disorder. This implies an importance of environmental factors. This thesis is confirmed by observation that when the western diet is followed, the BPH incidence increases.
It has an effect on prostate hyperplasia incidence. BPH is less common in men eating large quantities of vegetables. Phytoestrogens, such as genistein, has an anti-androgenic effect and is present in vegetables.
There is a genetic disposition for clinically significant BPH. A risk of the disorder increases when at least one of close relatives of a man had benign prostatic hyperplasia.
Signs of prostatic adenoma
The disorder symptoms include pollakiuria, need to urinate during the night, severe pressure on the urinary bladder, or a sense of incomplete emptying of the bladder. Other possible symptoms are a narrowed urine stream, poor and/or broken urine stream, or urinary retention.
Benign prostatic hyperplasia diagnosis is based on detailed interview and evaluation of the symptoms advancement. Next stage includes per rectum examination, urinalysis, urine culture, and serum PSA levels determination.
A doctor in charge of the case may also order diagnostic imaging scan of the urinary system or transrectal ultrasound scan, TRUS. Measurements of post-void residual urine volume or urodynamic testing may also be used to evaluate disease progression.
Treatment of benign prostatic hyperplasia
About 1/5 of patients coming to a doctor for prostatic hyperplasia eventually undergo a surgical procedure. In majority of them initial management is limited to monitoring. However, the symptoms intensify in time, and pharmacological or surgical treatment must be initiated.
When selecting treatment method, the following issues should be considered:
- clinical indications and contraindications related to disease preventions are individual for each patient;
- preferences of patients and their families;
- effectiveness and costs of treatment.
This aims at improving quality of life and ensuring daily comfort for men.
Pharmacological treatment of BPH
Medicines most commonly used for treatment of benign prostatic hyperplasia are alpha-blockers. Their efficacy is mediated by smooth-muscle relaxation in prostate and the urinary bladder neck, resulting in correct urine flow and more effective bladder emptying. Another group of medicines used for treatment of benign prostatic hyperplasia are 5-alpha-reductase inhibitors. They inhibit testosterone conversion into dihydrotestosterone, thus reducing the prostate volume in a long run.
Surgical treatment for benign prostatic hyperplasia
- suffer with complications associated with BPH;
- have not achieved satisfying resolving of symptoms with pharmacotherapy;
- want to discontinue a long-term therapy, and require quick and final cure.
Surgical procedures for benign prostatic hyperplasia
- Transurethral bladder neck electroresection (TURP)
- Transurethral bladder neck incision (TUIP)
- Adenomectomy (surgical resection of prostatic adenoma)
- Laser enucleation of prostatic adenoma
- Laser vaporisation of prostatic adenoma
Surgical procedures are most effective in resolving symptoms of advanced condition and allow restoring correct urine flow. Further treatment is less often required, although they may be associated with more frequent complications versus conservative therapy.