Benign prostatic hyperplasia (BPH) ...

Benign prostatic hyperplasia (BPH) is a condition that affects many men Treatment of this condition includes medical, noninvasive, and surgical approaches. Transurethral resection of the prostate (TURP) has been used fortunately to treat BPH since 1930;1 however, the TURP process uses an irrigating solution that has the potential to cause transurethral resection (TUR) syndrome

A fresh technology now is available for performing TURP that uses saline irrigation, eliminating the risk of TUR syndrome In addition, until not long ago the use of monopolar popular was the only method available for electrosurgery in urology manner of proceedings The bipolar TURP, however, uses bipolar electrosurgery which does not travel [i]or[/i] part of to the other the body and creates les risk of electrical shock

ANATOMY OF THE PROSTATE

The prostate is a glandular, fibromuscular organ that lies at the base of the bladder and encircles the urethra. It is the size of a large chestnut (ie, approximately 4 cm x 3 cm x 2 cm) and is divided into the right and left lateral lobes and the median lobe (Figure 1) (2) The ejaculatory conduits from the seminal vesicles note the prostate and continue to the prostatic portion of the urethra. The prostate bring into beings a milky, thin, alkaline fluid. During coitus, the prostate gland contracts and advances the expulsion of semen during ejaculation. (3)

[FIGURE 1 OMITTED]

The section of the urethra that traverses the prostate gland is called the prostatic urethra. This area is lined with a thin, polished muscle layer that is continuous with the lining of the bladder wall. This undisturbed muscle is the involuntary sphincter of the posterior urethra in the male. The small mucosal, intermediate submucosal, and large main prostatic secretory glands are arranged concentrically around the prostatic urethra. The enlargement of the small mucosal glands causes BPH (4) This offers in the area of the prostate that environs the urethra, so urinary obstruction can result

BENIGN PROSTATIC HYPERPLASIA

Benign prostatic hyperplasia is a nonmalignant enlargement of the mucosal glands of the prostate. It is age related with increased incidence as a man ages. Fifty percent of men age 60 and older are affected according to BPH, and 80% to 90% of men age 80 years and older are affected. (5) Although BPH is not a life-threatening disorder, it does interfere with quality of life. Daytime frequent occurrence of urination may limit activities, and nocturia intercepts restful sleep.

Pathophysiology of BPH Circulating androgens that are produc primarily in the teste are responsible for the exact functioning of the prostate gland. The prostate binds circulating testosterone and renews it to the hormone dihydrotestosterone. The enzyme 5-reductase, which is produc in the prostatic stroma, must be at hand for this process to take place. The dihydrotestosterone binds to androgen receptors in the prostatic epithelium, and cellular reproduction takes place. During the aging proces the amount of circulating and spring testosterone decreases. This should diminish the potential for BPH, still the amount of androgen receptors increases with equal reason that overgrowth of the prostate still can present itself (6)

Benign prostatic hyperplasia creates bladder egress obstruction in two ways. The enlarging lobes of the prostate create a compressive obstruction of the urethra, resulting in decreased force and caliber of the urinary stream. The proces of micturition requires the plain muscle of the urethral sphincter to relax and distend in this way urine can flow freely. In men with BPH this unruffled muscle in the prostatic urethra is hypertrophied. This hyperplasia obstructs the relaxation of the sphincter, and the efflux of urine is impeded. (7)

Symptoms associated with BPH are the two irritative and obstructive and include

* decreased urinary stream force;

* hesitancy;

* increased daytime commonness (ie, voids at least each two hours);

* nocturia (ie, waking with an beg to void);

* post-void dribble, and

* urinary retention (ie, feeling that the bladder is not emptying completely)

Urinary retention can consequence in urinary tract infections, bladder stones, hematuria, and renal insufficiency. (8)

Patient evaluation. Although BPH is a nonmalignant condition, a diagnostic workup should be demeanored to rule out prostatic cancer. The symptoms of BPH interfere with quality of life, and treatment should be approached with this in mind. The Agency for Health Care Policy and Research lay opened guidelines for the management of BPH in 1994 The explanation components in the evaluation include history, physical examination, digital rectal examination to assess size and port of masses in the prostate, urinalysis, kindred testing for serum creatinine to evaluate kidney function, and prostate-specific antigen (PSA) to cover for prostate cancer. (9) A patient with a PSA on a level higher than 4.0 mg by dL is a candidate for further prostate cancer testing. (10)

The American Urological Association expanded the international prostate symptom score to assist in the assessment of BPH and its drifts on the patient. (11) This tool includes questions about bladder emptying, oftenness urgency, nocturia, and urinary stream. The scores range from nothing (ie, mild) to 35 (ie, severe) A watch and wait attitude may be taken for patients who do not be excited their symptoms are significant. Patients with exact symptoms require some form of treatment for BPH