Pathology

Causes and Diagnosis of Benign Prostatic Hyperplasia Bph



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The prostate gland is part of the male reproductive system which is a walnut sized gland that is in two sections, enveloped by a thin outer layer of tissue. The prostate gland is situated in front of the rectum and just below the bladder, surrounded by the urethra, which is the channel through which the urine leaves the bladder during excretion.

The prostate gland has two main growth spurts, the first during puberty and again at around 25 years and as a general rule tends not to cause any problems until most men reach the age of 40.   As men age it is common for the prostate gland to enlarge, giving rise to the condition known as benign Prostate hyperplasia (BPH)                 .

More than 50% of men in their sixties and as many as 90% who are in their seventies and eighties have BPH to some degree, with over 4.5 million recorded visits to physician to report problems with their prostate gland.  Most of the complaints are of an obstructive nature with the increasing loss of bladder function.  Many have difficulty completely emptying their bladder, or report bladder weakness or interrupted urine stream, together with urgency, leaking, dribbling and frequency, especially at night.

The majority of men discover BPH themselves and a small number are discovered by their physician during routine checks.  Once suspected, a referral is made to the urologist who will undertake a series of diagnostic tests which includes a digital rectal examination (DRE), Prostate specific Antigen blood test, rectal ultrasound and prostrate biopsy, a urine flow study and a cystocopy.  All of the above are able to give some indication whether surgical intervention is necessary.

DER is usually the first examination to be undertaken.  This involves the physician inserting his finger into the rectum to locate and feel the size and condition of the part of the prostate gland closest to the rectum.

The next test is the prostate specific antigen (PSA) blood test undertaken to check for a specific protein which is released by the prostrate gland if cancer is present. If for any reason cancer is suspected a rectal ultrasound biopsy is undertaken.  This is done by inserting an ultrasound probe into the rectum which project images onto a display screen.  At the same time, using the projected images as a guide to insert a biopsy needle into the prostate gland to take samples for pathological examination and indepth analysis.

Other test includes a urine flow study and a cystoscopy.  The urine flow study involves the patient urinating into a special device which is able to measure the speed with which the urine flows out of the urethra.  A slow speed is suggestive of BPH.

A cystoscopy is a tube with a light at one end, which when inserted into the urethra and bladder, via the penis.  This allows the physician a clear view of the inner structure of the urethra and bladder to enable him to determine the size, location and the degree of obstruction which may present. This procedure can be painful therefore a local anaesthetic is given as standare procedure in an effort to desensitise the penis before the procedure begins.

The symptoms can be treated with drugs, although drugs are not successful in every case, whilst conventional surgery is regarded as too invasive.  This has led to the development of a number of procedures that are effective in relieving the symptoms of BPH which is much less invasive.  One of the latest is known as Interstitial Laser Coagulation, which has a fibreoptic probe that when placed on the prostate gland is capable of effectively destroying prostate tissue.

www.kidney.niddk.nih.gov


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