The prostate gland is a small gland of a walnut on the bottom of a man's bladder , which controls the production of sperm by the testes . Prostate gland consists of two lobes and enclosed by a tissue capsule.
Benign prostatic hyperplasia is excessive growth of prostate cells are not malignant . Enlarged prostate due to prostate cells to multiply beyond normal conditions , typically experienced by men aged over 50 years and the incidence increased 90 % in men aged 80-85 years.
There are several theories explaining the cause of benign prostatic hyperplasia :
Theory of DHT ( dihydrotestosterone). Testosterone with the help of the enzyme 5- alpha reductase is converted into DHT which stimulates the growth of the prostate gland .
Reawakening theory . This theory is based on the ability of stroma to stimulate the growth of epithelial so enlarged prostate gland .
The theory of stem cell hypothesis . Stem cells will develop into aplifying cells. These cells will develop into a transit cell that depends absolutely on androgen , because there are androgens , these cells will proliferate and produce normal prostate growth .
The theory of growth factors. These growth factors made by stromal cells under the influence of androgens . The existence of over-expression of epidermal growth factor ( EGF) or fibroblast growth factor ( FGF) and or a decrease in expression of transforming growth factor- beta ( TGF - beta), it causes an imbalance in the growth of the prostate and produce prostate enlargement .
Symptoms of benign prostate enlargement can be divided into two groups .
- Symptoms of irritation , consisting of frequent urination ( frequency), in a hurry to urinate ( urgency), urinate at night more than once ( nocturia), and difficult to hold urination ( urge incontinence).
- Symptoms of obstruction , consisting of weak urine stream , the end of urination has not been felt empty ( incomplete emptying ), a long wait at the beginning of urination ( hesitancy), should be straining when urinating ( straining) urination discontinuous ( intermittency ) , and time of urination that eventually elongate into urinary retention and incontinence occur because of overflow .
Diagnosis was established from anamnesa which include complaints of symptoms and signs of obstruction and irritation . Touche Rectal examination was then performed to feel the prostate gland . With this examination can be known of prostate enlargement , consistency , pain, and the state of the surface of the prostate .
Blood tests for prostate cancer screening ( measuring levels of prostate specific antigen or PSA ). In patients with BPH , PSA levels increased by approximately 30-50% . If an increase in PSA levels , it is necessary to do further tests to determine the patient also suffered from prostate cancer .
Other tests commonly performed urology physician as follows :
- Rectal Ultrasound and Prostate Biopsy
If there is suspicion of prostate cancer, this test was done, by capturing the sound waves are directed into the prostate. Echo patterns were recorded to determine the presence or absence of tumor. - Urine Flow Study
The doctor asks the patient to urinate into a special tool to measure how fast the urine flows. Reduced flow is suspected as benign prostate hyperplasia. - Cystoscopy
In this test, the doctor inserts a small tube through the urethra, which contains a lens and lighting system that helps doctors to see inside the urethra and bladder.
Management of BPH include:
Watchful Waiting ; performed in patients with minor complaints in a way only observation without treatment .
Drug therapy ; Drugs to reduce an enlarged prostate gland and expedite the flow of urination is finasteride (5 mg / tablet ) as a barrier to the production of hormones that stimulate dehidrotestosteron Prostate gland enlargement . Drugs alpha - blockers to inhibit the production of adrenaline , so it can lower blood pressure and helps relax the smooth muscle that circles the Prostate . Alpha - blockers are often used is prazosin - HCl (1-2 mg / tablet ), Doksazosin (1-2 mg / tablet ), and ( terazosin - HCl (1-2 mg / tablet ).
Open simple prostatectomy ; Indications for performing this action is when the size of the prostate is too large , over 100g , or when accompanied diverticulum or bladder stone .
Minimally Invasive Therapy
- Transurethral resection of the prostate ( TUR - P) : Eliminate the adenomatous part of the prostate that cause obstruction by using resektoskop and electrocautery .
- Transurethral incision of the prostate ( TUIP) : Performed on patients with moderate to severe symptoms and small prostate size .
Laser therapy ; Technique include Transurethral laser-induced prostatectomy ( TULIP) is performed with the aid of ultrasound , Visual coagulative necrosis , Visual laser ablation of the prostate ( VILAP), and interstitial laser therapy.
Therapy tools
- Microwave hyperthermia : adenoma tissue is heated through a device that is inserted through the urethra or rectum to a temperature of 42 - 45 ° so that coagulation is expected to occur .
- Trans urethral needle ablation ( TUNA) : The tool is inserted through the urethra that has two needles . needle is inserted into the adenoma and the needle will release heat , resulting in coagulation along the needle sticking in prostate tissue.
- High intensity focused ultrasound ( HIFU) : Through a probe placed in the rectum that emits ultrasound energy with high intensity and focused.
- Intraurethral stent : Are devices that are placed in endoscopic prostatic fossa to maintain the lumen of the urethra remains open.
- Transurethral baloon dilatation : Performed by inserting a catheter that can dilate the prostatic fossa and bladder neck.
Hormonal therapy
The therapy is given to men middle age and elderly to deal with complaints of andropause . During treatment by a doctor , testosterone administered in the form undarkanoat compound (4 mg / capsule ). The goal is to control the balance of hormone therapy hormone testosterone that can help resolve complaints of prostate disorders .
Dietary supplements that can help overcome the enlargement of the prostate gland . One of them is a supplement to the main content of saw palmetto . Based on the results of research , saw palmetto produces a kind of oil , which together with the androgen hormone can inhibit the action of the enzyme 5- alpha reductase , which plays a role in the process of conversion of testosterone into dehidrotestosteron (causes BPH ). The result , the prostate gland is not getting bigger .
