Benign Prostatic Hypertrophy
Problems with the prostate are very common in men in western countries and one of the main ways in which they can present is Benign Prostatic Hypertrophy (BPH). The prostate is a walnut-sized gland that is part of the male reproductive system. It is located below the bladder (the organ that stores urine) and surrounds the top portion of the tube that carries urine out of the body (the urethra). The prostate gland makes fluid for semen, which transports sperm during ejaculation.
BPH is abnormal growth of the gland typically seen in aging men and often responsible for various degrees of urinary problems. The condition is not malignant – it won’t invade other tissues – but the gland is becoming larger than normal. The prostate gland surrounds the urethra, which descends from the bladder through the penis, and can block the flow of urine when enlarged. BPH is an almost universal phenomenon in men as they age, beginning at around 45 years old and continuing until, by age 70, 90% of men have an enlarged prostate. Due to this enlargement BPH is the leading cause of urinary outflow obstruction in men.
Some researchers have suggested that BPH typically indicates low levels of male hormones. An abnormally high activity of the enzyme that converts testosterone to dihydrotestosterone (DHT), 5-alpha reductase, is usually seen in BPH. DHT may be more potent stimulator of prostate cell growth than testosterone, and is also considered to be a factor in male pattern baldness. High levels of oestrogen may also factor in the disease progression.
Symptoms of BPH
The primary signs and symptoms are general problems with urination. With a gradual progression, signs usually include: urinary frequency, urinary urgency, nocturia (needing to get up at night to urinate), hesitancy with decreased force of stream, terminal dribbling (the final phase of urination as slow drips), sensation of incomplete emptying, overflow incontinence or total retention, burning on urination, chills and fever which indicate infection has set in (due to the urine staying in the bladder), and possibly a palpable distended bladder. During a digital rectal examination the prostate gland will feel enlarged, rubbery, often with loss of median sulcus. The median sulcus is a vertical groove in the heart-shaped gland which tells the examining doctor that the gland is NOT enlarged or swollen.