Benign prostatic hypertrophy (BPH)

Introduction

Benign prostatic hypertrophy (BPH) has been a controversial male reproductive health problem for a very longtime. The disease affects an estimate of 105 million people in the world. Normally, the disease starts after a person turns 40 years. Research has revealed that 50% of males who are above 50years are affected. However, the condition worsens when men reach 80 as 90% of them get affected. BPH is a male reproductive health problem than results in an enlargement of the prostrate. The disease is however not cancerous (Izumi et al. 2013). The disease often impedes the flow of urine among the affected individuals. Some of the most common symptoms of this infection comprise of challenges when starting to urinate and frequent urination (Thiruchelvam, 2014). Other symptoms are lack of ability to urinate and loss of bladder control. In most cases, the infection comes with complication in urinary tract, evidence of bladder stones and severe kidney challenges. The cause of the disease is unclear but there are several risk factors that have been identified. Some of these risk factors are family history, obesity, type 2 diabetes, lack of enough exercise and dysfunction in the erectile system (Chughtai et al. 2016). This research paper explores BPH describing the disease’s pathogenesis, clinical presentation and evaluation, and treatment. 

Pathogenesis

For a very long time, the pathogenesis of BPH has remained unresolved. The pathology of BPH can be evaluated in three stages. The first stage is the prostatitis. Prostatitis entails the inflammation that is seen as a separated infection that mainly affects younger men but it is still evident in recurrent forms among older men. Another category is the benign prostatic hypertrophy and prostatism (Barry et al. 2017). This category of the disease is unusual among men who are under the age of 40 years. The disease is nodular and thus found majorly in the transition area and the peri-urethra section.  At this area, there is usually an enlargement which adds up to the general enlargement. The last category is the cancer of the prostrate. This is a condition that majorly affects the elderly and often not related to BPH. However, studies have denoted that the two conditions coexist together. The cancer during this period often affects the management of BPH. Also, there are three theories that have been created on BPH. One of the theories called the dihydrotestosterone theory (Thiruchelvam, 2014). The theory has been formulated on the basis of malfunction of BPH to advance in men that have been castrated before puberty. Another theory is the embryonic reawakening hypothesis which asserts that that the reawakening of the embryonic induction is capable of the prostatic stroma. The third theory known as the stem cell theory hypothesizes that the developments of the BPH through the rise in the number of present stem cells, clonal expansion and transit cells. In another study carried out by Roehrborn (2008) shows that the disease develops in the periurethral transition zone of the prostrate. Within the transition zone, there are two distinct glands which are immediately after the preprostatic sphincter. The major ducts in the site of transion grow on the lateral zones of the urethral wall at the site of the urethra angulation which is near the verumontanum. Close to the source f the site of transition, ducts are the glands in the zone of periurethral (Corona et al. 2014). They are restricted between the preprostatic sphincter and the route that is parallel to the axis of urethra. Research has found that all BPH nodules grow either in the zone of transition or in the area of periurethral. These transion zones have also been observed to expand with age but their enlargement is not related to those of nodules. The human prostate has a unique feature known as the prostatic capsule. This unique feature plays an imperative role in the growth of LUTS. In a study conducted by Roehrborn (2008) on pathology of PBH among humans and dogs, he found out that dogs are the only other species apart from human beings that develop BPH naturally. Dogs develop symptoms such as bladder outlet obstruction. On the other hand, they do not develop urinary symptoms because canine prostate does not have a capsule. The research insinuates that the capsule transmits the pressure that is found in the tissue enlargement to the urethra and is a cause of the augment in the urethra resistance. From this case, it can be asserted that the clinical symptoms of this disease in men may not only be caused due to age related growth of prostatic size but another cause can be distinct anatomic structure of the human beings glands (Barry et al. 2017).

Clinical presentation

Often, BPH is diagnosed on the basis of history. Clinically, the disease is diagnosed based on the beginning of the symptoms, overall health challenges, individual’s fitness in relation to surgery and how the symptoms are affecting the quality of life of an individual. The disease’s symptoms appear slowly and advance steadily over a period of years. Sexual histories are always considered important since epidemiological researches have indicated that LUTS is an independent risk factor for the disease. A lower urinary tract symptom (LUTS) is the common method used in examining the clinical condition of BPH. Commonly used LUTS are hesitancy in the instigation of the mictrution, a weak force of stream, ceasing and restarting of the stream and terminal dribbling are some of the common used epidemiological mechanisms of ascertaining the presence and extend of BPH infection (Barry et al. 2017).

Patients who do not have any form of dysfunction are often monitored but rather are advised on behavioral modification. Also, behavior modification is applied when there is negative diagnosis of bladder outlet obstruction, renal insufficiency and recurrent infection. Bladder outlet obstruction brought about as a result of BPH is often diagnosed based on LUTS which can be evident either acutely or chronically. The right time to see a doctor for a patient is when a person has urinary challenges (Barry et al. 2017).

Evaluation

Clinical evaluation in the course of examining the degree of the infection is based on the treatment goals. Their clinical evaluation relies on the variety of epidemiological researches which has show evidence of choosing their patients due to drug or interventional researches and offering advice to personal patients. Often, BPH is examined on the basis of LUTS, however, LUTS is sometimes as a result of other causes. While evaluating patients with BPH, clinicians rely on full history of a patient, through physical diagnosis of a patient and relevant examinations (Chughtai et al. 2016).

In a study conducted by Wu et al (2014) they found out that the scenarios of BPH requiring surgical treatment increases progressively with age. Practice based researches have identified that mean having LUTS are most probably likely to have low progression of its symptoms. Environmental and hereditary aspects have also been identified as factors influencing the development of clinical benign prostatic hypertrophy. Further researches on environmental and hereditary factors have shown that the occurrence of BPH is much lower in Japanese and Chinese men who live in Asia as compared to white populations living in Asia. The same case applies to Japanese and Chinese men living in the U.S. Treatment goals play a crucial role in the character and degree of a patient’s evaluation. Often, clinical evaluation for men with BPH is to identify the extent of the disease’s development and the correct treatment mechanism that can be applied (Corona et al. 2014).                                                                                                                                                                                   

Treatment

A wide range of treatments have been identified inclusive of medications for treating BPH. Also, minimally invasive therapies and even surgeries are used as treatment measures for the disease. The method for treatment is determined by different factors such as the size of the prostate, the age of the patient, the general health of the patient and the degree of discomfort the person is experiencing. Often, medication is the frequently used treatment for mild to moderate signs and symptoms of the disease. Some of the medications for BPH are alpha blockers, 5- alpha reductase inhibitors, combination drug therapy and tadalafil (Chughtai et al. 2016).

Alphas blockers treat by bladder neck muscles and muscle fibers that are found in the prostate thus easing urination. 5- Alpha reductase inhibitors shrink a patient’s prostate by preventing hormonal changes that lead to prostate development. At times, they take even up to 6 months for them to be effective (Wu et al. 2014). Retrograde ejaculation is one of the major side effects that come along this medication. On the other hand, combination drug therapy entails a combination of two medications. For example, a doctor can prescribe the use of alpha blocker and a 5-alpha reductase inhibitor when one medication is not effective. The last medication tadalafil, is used in the treatment of erectile dysfunction but can also be used in treatment of BPH (Chughtai et al. 2016).

Minimally invasive medication and surgical therapy is often used among patients who have symptoms that are moderate to severe. Also, it is employed when medications have failed to relieve symptoms in a patient. When a patient exhibits urinary tract obstruction and bladder stones, they can be treated using surgery therapy (Barry et al. 2017).

Research has identified that medications such as pseudoephedrine, anticholinergics, and calcium channel blockers may not improve the situation but rather worsen the conditions of the disease. The disease is usually diagnosed using symptoms and an assessment conducted after ruling out other possible causes (Thiruchelvam, 2014).

A treatment intervention for this particular disease is through lifestyle changes. Also, the disease can be treated using medications, several procedures and surgery. When an individual exhibits mild symptoms, clinical practitioners always recommend loss of weight, doing exercises and reducing the intake of caffeine (Corona et al. 2014). Severe symptoms are usually treated using alpha blockers. When the patients show no sign of improvement, surgical removal of parts of the prostrate is carried out. Studies have shown that the use of saw palmetto medicine does not help patients suffering from this male reproductive problem (Izumi et al. 2013).

Conclusion

In conclusion, benign prostatic hypertrophy (BPH) is a worrying disease as it affects many male individuals across the globe. According to statistics, the disease affects a lot of people around the world and majorly individuals above the age of forty. There have also been indications that the disease worsens with age. A major symptom of the disease is challenges in urinating. Even though the cause of the disease has not yet been identified, researchers have idenfied several risk factors for the disease. Some of the most recognized risk factors comprise of family history, lack of enough exercise, obesity and type 2 diabetes. Its pathology has been categorized into three stages; prostatitis, the benign prostatic hypertrophy and prostatism and cancer of the prostrate. Clinically, the disease is diagnosed based on history, beginning of symptoms, overall health challenges and individual’s fitness.There are several treatments that have been identified to treat BPH. Many researches denote that even though the disease is so much related to cancer it is not caused by cancer. There is need for more medical interventions to be researched to come up with more interventions that will help BPH patients from the suffering they undergo. However, there is proof that prostate cancer affects the effects of BPH medications.

References

Barry, M. J., Fowler, F. J., O'leary, M. P., Bruskewitz, R. C., Holtgrewe, H. L., Mebust, W. K., ... & Measurement Committee of the American Urological Association. (2017). The American Urological Association symptom index for benign prostatic hyperplasia. The Journal of urology, 197(2), S189-S197.

Chughtai, B., Forde, J. C., Thomas, D. D. M., Laor, L., Hossack, T., Woo, H. H., ... & Kaplan, S. A. (2016). Benign prostatic hyperplasia. Nature Reviews Disease Primers, 2, 16031.

Corona, G., Vignozzi, L., Rastrelli, G., Lotti, F., Cipriani, S., & Maggi, M. (2014). Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions. International journal of endocrinology, 2014.

Izumi, K., Mizokami, A., Lin, W. J., Lai, K. P., & Chang, C. (2013). Androgen receptor roles in the development of benign prostate hyperplasia. The American journal of pathology, 182(6), 1942-1949.

Roehrborn, C. G. (2008). Pathology of benign prostatic hyperplasia. International journal of impotence research, 20, S11-S18.

Thiruchelvam, N. (2014). Benign prostatic hyperplasia. Surgery (Oxford), 32(6), 314-322.

Wu, D. B. C., Yee, C. H., Ng, A. C. F., Chaiyakunapruk, N., & Lee, K. K. C. (2014). Health and economic impact of combination therapy vs. Monotherapy for treatment of benign prostatic hyperplasia in hong kong. Value in Health, 17(7), A812.

 

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