Benign Prostatic Hypertrophy Vs Hyperplasia

Are Prostatitis And Bph The Same Prostate Gland Problem

Pharmacology – BPH (Benign Prostatic Hyperplasia) NCLEX top 2 missed questions RN PN NCLEX

The answer to this question is yes and no, because both may have some similar health symptoms , but each prostate problem has different causes. Yes, BPH is by definition an enlarged prostate, and no, because the cause is not an infection/inflammation like prostatitis. However, not all enlarged prostates are due to BPH. An enlarged prostate may be caused by BPH, prostatitis, and prostate cancer.

Deterrence And Patient Education

Lifestyle factors such as weight loss or improved diabetic control should be explained to the patient to allow modifiable risk factors to be addressed. This may also translate to reducing the risk of the surgery itself in the future, by reducing anesthetic and post-operative complication risks. Lifestyle measures such as reducing caffeine and timing of fluid intake can also be used as a measure to address specific problematic urinary symptoms.

Those managed with long-term catheters or intermittent self-catheterization should be taught the importance of hygiene and catheter care to prevent urinary tract infections. This may be done with the assistance of dedicated specialist nurses. The provision for managing the catheter in the community should also be made.

Patients with BPH should understand the risks of disease progression before committing to treatment options and should be counseled on alternative management options such as watchful waiting, medical therapy along with any other surgeries available in order to make an informed decision.

Diet And Pathophysiology Of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia is characterized by histologic cellular proliferation of the Transitional Zone of the prostate. Multifactorial and age-related hormonal changes associated with BPH may also lead to the development of lower urinary tract symptoms . Dietary factors can modulate these physiological disturbances. For example, bioactive ingredients and high caloric densities of different foods may affect the sympathetic nervous system and increase prostate smooth muscle tone observed in BPH . High polyunsaturated fat content may also increase the risk of BPH by causing chronic inflammation and subsequent oxidative damage .

Anthony I. Zarka, … Neal C. Dalrymple, in, 2009

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Does Having Benign Prostatic Hyperplasia Increase The Risk Of Prostate Cancer

Research shows that having BPH doesnt increase your risk of developing prostate cancer. However, BPH and prostate cancer have similar symptoms. If you have BPH, you may have undetected prostate cancer at the same time.

To help detect prostate cancer in its early stages, every person with a prostate should get a prostate screening every year between the ages of 55 and 69. You have an increased risk of getting prostate cancer if youre Black or have a family history of prostate cancer. If you have an increased risk of prostate cancer, you should start getting prostate screenings at age 40.

How Are These Conditions Diagnosed

Prostate Artery Embolization As An Efefctive Treatment for Benign ...

If you’re 40 or over, a digital rectal exam may be part of your routine physical, even if you have no symptoms. This is a way for your doctor to feel for abnormalities of your prostate. For the exam, your doctor slides a gloved, lubricated finger into your rectum. It only takes a moment or two, but it allows your doctor to check your prostate for:

Size, firmness, and texture
Lumps or growths
Tenderness or pain

Your doctor may also examine your scrotum and nearby lymph nodes, glands that are part of your immune system. The results of the exam, along with your symptoms and family health history, help determine the next steps. If your doctor suspects an issue, they may refer you to a urologist, a doctor who specializes in the male reproductive system and urinary problems.

A prostate-specific antigen blood test can help detect prostate cancer. PSA is a protein made in the prostate. If you have prostate cancer, you usually have higher levels of PSA in your blood.

But high PSA doesnât necessarily mean you have prostate cancer. Some people have a naturally higher PSA level than others. A few other reasons for elevated PSA include:

Proctitis, a type of inflammation of the prostate
A recent medical procedure, such as prostate surgery or biopsy

Tests To Diagnose Prostate Cancer

These tests can confirm a prostate cancer diagnosis:

Ultrasounduses sound waves to make pictures of your prostate gland.
A biopsyremoves a sample of prostate tissue and checks it under a microscope for cancer.

Which treatments you get for BPH depend on the size of your prostate and how severe your symptoms are.

For mild to moderate symptoms, your doctor might prescribe one of these medicines:

Alpha-blockers relax muscles in your bladder and prostate to help you urinate more easily. They include alfuzosin , doxazosin , and tamsulosin .
5-alpha reductase inhibitors shrink your prostate. They include dutasteride and finasteride .

Doctors use surgery to treat severe BPH symptoms:

Learn more: What you need to know about prostate surgery »

Treatments for prostate cancer include:

Active surveillance or watchful waiting: You dont get treated right away. Instead, your doctor watches your symptoms or does regular DRE and PSA tests to check for cancer growth.
Surgery: A procedure called a radical prostatectomy removes the prostate gland and some of the tissue around it.
Radiation therapy: Radiation uses high-energy X-rays to destroy prostate cancer. Youre exposed to radiation from a machine outside your body. Or you can get it through small radioactive pellets or seeds placed inside your prostate.
Cryotherapy: This treatment uses intense cold to destroy prostate tissue.
Hormone therapy: You take medicine to block the male hormones that fuel the growth of prostate cancer.

Which Approach To Choose

If you have to decide which approach is the best option for you, discuss with your doctor the advantages and risks of the different types of surgeries. The decision will depend on the size of your prostate, your age, and your health status.And bear in mind some external factors, such as the availability of the specific technique at your local hospital and the surgeons level of experience that may affect the final decision.

What Risk Factors Are Associated With Bph

As we dont fully understand why BPH occurs, risk factors described by prostate experts and doctors are based on empirical observations. These include:

Being of African or Afro-Caribbean descent
Being overweight
Lack of physical activity
Having erectile dysfunction although it is not clear if it is BPH which is the cause
Family history of BPH

Imaging And Other Investigations

What Is BPH?

Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is urinating.

Abdominal ultrasound examination of the prostate and kidneys is often performed to rule out hydronephrosis and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. Post-void residual volume of more than 100 ml may indicate significant obstruction. Prostate size of 30 cc or more indicates enlargement of the prostate.

Prostatic calcification can be detected through transrectal ultrasound . Calcification is due to solidification of prostatic secretions or calcified corpora amylacea . Calcification is also found in a variety of other conditions such as prostatitis, chronic pelvic pain syndrome, and prostate cancer. For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation. Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume.

Medical conditions

Medications

When To See A Doctor

See your primary care provider if youre having pain, burning, or trouble urinating. They may refer you to a urologist, a doctor who treats urinary health disorders in both men and women. This specialist also treats issues of the male genital system, including prostate problems.

During the exam, the doctor may insert a gloved, lubricated finger into your rectum. This test is called a digital rectal exam . It helps your doctor feel if part of your prostate is swollen or enlarged.

Your doctor may order an ultrasound, which is a scan that uses sound waves to create a picture of your prostate. They may also perform urodynamic tests, which measure your ability to empty your bladder.

How Is Bph Diagnosed

To find out if you have BPH, your provider will:

Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
Ask about your family health history.
Examine you. The exam may include a digital rectal exam of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to check if your prostate is large, tender, or irregular in any other way.
Order medical tests, if needed, such as:
A PSA blood test .
Urodynamic testing to see how well you can hold and release urine.
Cystoscopy to look inside your urethra and bladder.
Ultrasound pictures of your prostate and urinary tract.
A prostate biopsy to diagnose or rule out prostate cancer.

How Is Benign Prostatic Hyperplasia Treated

Treatment options for benign prostatic hyperplasia may include

lifestyle changes
minimally invasive procedures

A health care provider treats benign prostatic hyperplasia based on the severity of symptoms, how much the symptoms affect a mans daily life, and a mans preferences.

Men may not need treatment for a mildly enlarged prostate unless their symptoms are bothersome and affecting their quality of life. In these cases, instead of treatment, a urologist may recommend regular checkups. If benign prostatic hyperplasia symptoms become bothersome or present a health risk, a urologist most often recommends treatment.

What Causes Benign Prostatic Hyperplasia

The cause of benign prostatic hyperplasia is not well understood however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

Another theory focuses on dihydrotestosterone , a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

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What Is Benign Prostatic Hyperplasia

Benign prostatic hyperplasiaalso called BPHis a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a mans life. Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retentionthe inability to empty the bladder completelycause many of the problems associated with benign prostatic hyperplasia.

What Are The Symptoms Of Bph And Prostate Cancer

BPH and prostate cancer have similar symptoms, so its sometimes hard to tell the two conditions apart. As the prostate grows for any reason, it squeezes the urethra. This pressure prevents urine from getting down your urethra and out of your body. Prostate cancer symptoms often dont start until the cancer has grown large enough to put pressure on the urethra.

Symptoms of both BPH and prostate cancer include:

an urgent need to urinate
feeling the urge to urinate many times during the day and night
trouble starting to urinate or having to push to release urine
weak or dribbling urine stream
urine flow that stops and starts
feeling like your bladder is never fully empty

If you have prostate cancer, you might also notice these symptoms:

painful or burning urination

Lower Urinary Tract Symptoms

Symptoms of benign prostatic hyperplasia include a constellation of symptoms that are often progressive, known collectively as lower urinary tract symptoms :

Urinary frequency

Pain and dysuria are usually not present. Sensations of incomplete emptying, terminal dribbling, overflow incontinence Types Urinary incontinence is involuntary loss of urine some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many… read more , or complete urinary retention Urinary Retention Urinary retention is incomplete emptying of the bladder or cessation of urination. Urinary retention may be Acute Chronic Causes include impaired bladder contractility, bladder outlet obstruction… read more may ensue. Straining to void can cause congestion of superficial veins of the prostatic urethra and trigone, which may rupture and cause hematuria. Straining also may acutely cause vasovagal syncope and, over the long term, may cause dilation of hemorrhoidal veins or inguinal hernias.

Primary Differences Between These Conditions

What Is BPH? – Symptoms and Treatment Options

Similarities make it harder to know which conditions the man has. There are significant differences that can be used as part of the diagnostic protocol. The main reason for identifying the differences is due to the various treatment options available.

The main difference between the two conditions lies with the underlying mechanism of action. This is the mechanism that causes the prostate to become enlarged.

Benign prostatic hyperplasia refers to an increase in the number of cells that make up the prostate gland. The condition leads to cells dividing at a more rapid rate. This leads to an excess of prostate cells in the gland. The gland expands in size as more cells make up its tissue.

With benign prostatic hypertrophy, there is no increase in the number of cells in the patients prostate gland. Thus, no acceleration in the cellular division is detectable in patients with hypertrophy of the prostate gland. Instead, the individual cells already present in the prostate gland become larger than they are meant to be.

Both of these conditions cause an enlargement of the prostate gland. The conditions both cause the gland to push against the urethra, which can cause a restriction in urine flow. Several other complications can also develop. These can affect the lower urinary system in the male patients body.

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When Is Bph Treatment Necessary

The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.

If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.

Inadequate bladder emptying resulting in damage to the kidneys
Complete inability to urinate after acute urinary retention
Incontinence due to overfilling or increased sensitivity of the bladder
Recurrent severe hematuria
Symptoms that trouble the patient enough to diminish his quality of life

What Are Some Of The Complications Of Bph

In general, BPH is a relatively benign condition even if severe symptoms are present. However, complications can occur and these bring about secondary problems which may sometimes be serious:

Cystitis / Bladder infections / UTIs. If incomplete emptying of the bladder is present, a residue of urine forms in the bladder and this sump will have a tendency to become infected. Hence, although it is rare for a younger man to suffer from a urinary tract infection or cystitis, it is not so uncommon in one older and when this occurs, it would normally suggest BPH
Acute retention of urine. This may be seen in both previously diagnosed or undiagnosed BPH. Decreasing ability or inability to urinate, increasing discomfort, abdominal swelling, tenderness and pain are the key signs. The introduction of a catheter into the bladder brings about quick relief
Chronic retention of urine. Sometimes, a man does not know that he has a problem with his prostate despite the fact that he has difficulty urinating. Over time, urine builds up and the bladder becomes desensitised. This allows even more urine to build up in the bladder and over months or years, a backflow of urine into the kidneys can damage these important organs in the body
Hernia. Prolonged and repeated straining when urinating can lead to breaks in various parts of the abdominal wall.

Transurethral Vaporization Of The Prostate

Transurethral vaporization of the prostate includes bipolar electrosurgical vaporization or laser vaporization techniques. At laser vaporization, a tube called a cystoscope is inserted into the urethra, and laser energy is used to burn away prostate tissue.