Benign Prostatic Hyperplasia

The prostate gland appears only in males. Prostate gland enlargement causes problems with urination in elderly males, who are usually over 60 years old.

What is the prostate gland?

It is a small gland about the size of a walnut and is part of the male reproductive system. The prostate is located just below the bladder and in front of the rectum.

The prostate is surrounded by an initial portion of the urethra (the tube that carries urine from the bladder). In other words, the initial part of the urethra (about 3 cm long) passes through the prostate.

The prostate is the male reproductive organ. They secrete a fluid that nourishes and carries the sperm into the urethra during ejaculation.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, or benign prostatic enlargement, means a noncancerous enlargement of the prostate that occurs in nearly all males.

A benign prostate tumor is a disease of elderly males. As men get older, the prostate gland grows larger. The enlarged prostate presses on the urethra and blocks it, causing problems with urination.

Because of the narrowing of the urethra, the flow of urine becomes slower and less forceful.

What are the symptoms of benign prostate hyperplasia?

Benign prostate hyperplasia (BPH) symptoms usually begin after age 50. By the age of 60, more than half of men experience symptoms of BPH, and about 90% of men between the ages of 70 and 80 do as well.

Most symptoms of BPH begin gradually and slowly worsen over the years. The following are the most common symptoms of a benign prostate tumor:

• Frequent urination, especially at night. This is often a very early symptom

• Leaking or dripping urine at the end of urination is another common symptom.

• slow and weak urine flow.

• Difficulty or straining to start the flow of urine occurs even when the bladder feels full.

• The urge to urinate immediately is one of the most annoying symptoms.

• Aggravation and filtering when urinating.

• Interruption of urine flow. Drops of urine are expelled even after urination, causing the underwear to become wet.

• Incomplete emptying of the bladder.

What are the complications of benign prostate hyperplasia?

Severe BPH can cause serious problems over time in a few patients if left untreated. The following are the common symptoms of a benign prostate tumor:

1- Acute urinary retention: untreated severe benign urinary retention over time leads to a sudden, complete, and often painful blockage of urine flow (acute urinary retention).

These patients are forced to insert a tube called a catheter to drain urine from the bladder. BPH causes poor urine flow and frequent urination, especially at night

2- Chronic urinary retention. Partial obstruction of urine flow for an extended period can cause chronic urinary retention. Chronic urinary retention is painless and is characterized by an increase in the volume of residual urine.

The amount of urine that remains in the bladder after normal urination is called residual urine. Its usual manifestation is incomplete emptying of the bladder or frequent emptying of a small amount of urine (excess urine).

3- Bladder and kidney damage cause chronic urinary retention from stretching of the muscular wall of the bladder. In the long term, the bladder becomes weaker and does not function properly.

The large volume of residual urine increases pressure on the bladder. High pressure on the bladder may push urine back through the ureters and into the kidneys. Eventually, the resulting fullness of the ureters and kidneys may lead to kidney failure.

4-Urinary tract infection and bladder stones: The inability to empty the bladder leads to a risk of urinary tract infection and bladder stones.

How to diagnose benign prostate hyperplasia?

When history and symptoms suggest BPH, tests are then performed to confirm or rule out an enlarged prostate.

1- digital rectal examination

With this examination, a lubricated, covered finger is gently inserted into the patient's rectum to feel the surface of the prostate gland through the rectal wall.

This examination provides the doctor an idea of the size and condition of the prostate gland. In BPH, a digital rectal examination shows the gland is enlarged, smooth, and firm.

When the prostate appears solid, nodular, and irregular, a digital rectal exam suggests the presence of prostate cancer or calcification.

2- Ultrasound imaging

Ultrasound can estimate the size of the prostate as well as detect other problems such as malignancy, ureteral dilatation, kidney issues, and abscesses.

Ultrasound imaging is used to determine the amount of urine remaining in the bladder after urination.

A volume of urine remaining after emptying of less than 50 ml indicates that the bladder has been emptied adequately.

A post-void residual urine volume of 100 to 200 ml or more is considered a significant increase that requires evaluation.

3- Prostate symptom score

The International Prostate Symptom Score, or American Urological Association Symptom Index, helps diagnose BPH.

This diagnostic method involves asking questions about common BPH symptoms to assess urinary issues in men.

The calculated prostate symptom scores determine the severity of the urinary problems.

4- laboratory tests

Laboratory tests do not help diagnose BPH. But it helps in diagnosing associated complications and to exclude problems related to the present pathological manifestations.

Urine is tested for infection, and blood is tested for kidney function.

5- PSA test

It is a blood screening test to detect prostate cancer. The blood PSA test is the most important screening test for diagnosing prostate cancer.

6- Other checks

The various tests that lead to the diagnosis of BPH are urine aspiration examination, urodynamic studies, cystoscopy, prostate biopsy, intravenous pyelogram or CT scan for urography, and retrograde pyelography.