Disease Information for Benign prostatic hypertrophy (BPH): Definition

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  • Benign prostatic hyperplasia (BPH) also known as Nodular hyperplasia, Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to the increase in size of the prostate in middle-aged and elderly men; To be accurate, the process is one of hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists; It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate; When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra which interferes the normal flow of urine; It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary retention; Although prostate specific antigen levels may be elevated in these patients, because of increased organ volume and inflammation due to urinary tract infections, BPH is not considered to be a premalignant lesion; Benign prostatic hyperplasia symptoms are classified as obstructive or irritative; Obstructive symptoms include hesitancy, intermittency, incomplete voiding, weak urinary stream, and straining; Irritative symptoms include frequency of urination, which is called nocturia when occurring at night time, and urgency (compelling need to void that can not be deferred); These obstructive and irritative symptoms are evaluated using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH.;

    BPH can be a progressive disease, especially if left untreated; Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infections; Urinary bladder stones, are formed from the crystallisation of salts in the residual urine; Urinary retention, termed acute or chronic, is another form of progression; Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends; Some patients who suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.

    Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate; Often, blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography; These combined measures can provide early cancer detection; Ultrasound examination of the testicles, prostate and kidneys is often performed, again to rule out malignancy and hydronephrosis; More than half of the men in the United States between the ages of 60 and 70 and as many as 90% between the ages of 70 and 90 have symptoms of BPH; For some men, the symptoms may be severe enough to require treatment------------------------------------[Wikipedia Website 2007]------------------------.

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