How Is Bph Diagnosed And Evaluated
Early diagnosis of BPH is important because if left untreated it can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence. Distinguishing BPH from more serious diseases like prostate cancer is important.
Tests vary from patient to patient, but the following are the most common:
How Common Is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.2
Benign Prostatic Hyperplasia Treatment Devices Market Outlook In
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Oct 03, 2022 —Number of Tables and Figures :155 | The global “Benign Prostatic Hyperplasia Treatment Devices Market“size is projected to reach Multimillion USD by 2028, In comparison to 2021, at unexpected CAGR during 2022-2028 and generated magnificent revenue. The market is segmented on the basis of End-user Industry , By Type , and Geography .
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Surgical Treatment accounting for % of the Benign Prostatic Hyperplasia Treatment Devices global market in 2021, is projected to value USD million by 2028, growing at a revised % CAGR from 2022 to 2028. While Fertility Clinics segment is altered to an % CAGR throughout this forecast period and will hold a share about % in 2028.
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Global Benign Prostatic Hyperplasia Treatment Devices Market: Segment Analysis
COVID-19 IMPACT ON MARKET
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Imaging And Other Investigations
Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is peeing.
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
Using Pads Or A Sheath
Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.
Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing.
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What Is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is a condition in which your prostate grows in size.
Your prostate is a gland that rests below your bladder and in front of your rectum. Its about the size of a walnut, and it surrounds part of your urethra.
Your urethra is a tube that carries urine and sperm out of your body.
BPH isnt cancerous. However, symptoms of BPH may indicate more serious conditions, including prostate cancer.
Natural Treatment For Benign Prostate Hyperplasia
On the other hand, it is very important that the patient with an enlarged prostate modify their lifestyle habits and take into account recommendations such as the following:
- Stay active and avoid leading a sedentary life.
- Take care of your diet and avoid eating large or copious meals.
- Avoid the consumption of alcoholic beverages and stimulant substances.
- Drink plenty of water during the day.
- Urinate whenever you feel like it and dont postpone this moment.
- In the event that urination cannot begin, you must be patient and apply progressive pressure to the abdominal muscles, but in no case should it be done with suddenness or great force.
There are also some natural remedies for benign prostatic hyperplasia that can help relieve symptoms and improve the well-being of the patient. The most recommended are:
- Infusions of nettle, horsetail, horse chestnut or ginger.
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Personal And Family Medical History
Taking a personal and family medical history is one of the first things a health care provider may do to help diagnose benign prostatic hyperplasia. A health care provider may ask a man
- what symptoms are present
- when the symptoms began and how often they occur
- whether he has a history of recurrent UTIs
- what medications he takes, both prescription and over the counter
- how much liquid he typically drinks each day
- whether he consumes caffeine and alcohol
- about his general medical history, including any significant illnesses or surgeries
International Prostate Symptom Score
You’ll be asked to complete a questionnaire to assess your symptoms. Each question has five possible answers that carry a score, and your overall score is used to assess the severity of your symptoms.
The checklist includes the following questions.
Over the past month:
- How often have you had the sensation of not completely emptying your bladder after urinating?
- How often have you had to urinate again less than two hours after finishing urinating?
- How often have you found that you stopped and started again when urinating?
- How often have you found it difficult to postpone urination?
- How often have you had a weak stream of urine?
- How often have you had to push or strain to begin urinating during the course of one night?
- How often have you had to get up during the night to urinate?
After your GP has assessed the severity your symptoms, they’ll aim to rule out other conditions with similar symptoms using certain tests.
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What Are The Warning Signs Of Benign Prostatic Hyperplasia
Your prostate surrounds your urethra. When BPH causes your prostate to grow, it can cause blockage in your urethra. As a result, early symptoms of BPH include:
- Slowness or dribbling when you pee.
- Difficulty starting to pee.
- Kidney damage due to pee backflow from your bladder up to your kidney. The pee backflow increases pressure on your kidney.
What Questions Should I Ask My Healthcare Provider
- How can you tell that I have BPH?
- If I dont have BPH, what other condition might I have?
- What can I do to help reduce the size of my prostate?
- Do I need treatment?
- Whats the best treatment for me?
- What supplements do you recommend?
- Will these supplements affect any other medications or supplements that Im taking?
- Should I see a urologist?
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Urethral Lift Procedure And Thermal Vapor Therapy
The prostatic urethral lift is a method to mechanically reshape the prostate by applying tiny implants that help tuck the gland to the side, opening the urethra so that urine flow can be improved. Implants consist of two tiny bars of stainless steel held together with a surgical suture. The bars rest on either side of the prostate, holding it out of the way. The implants can be left in the prostate indefinitely.
The largest prospective, randomized controlled study of the prostatic urethral lift, published in European Urology Supplements, yielded promising results. International Prostate Symptom Score remained improved by 36%, quality of life remained improved by 50%, and urine flow remained improved by 44% from baseline. The retreatment rate was 2% to 3% per year over five years. Symptom relief occurred within nine days, and patients sexual function was preserved.
The prostatic urethral lift procedure was approved by the FDA in 2013, and Dr. Tabatabaei and others at Mass General were the first to offer this procedure to patients under local anesthesia. They continue to follow their patients in a registry to evaluate long-term outcomes of the procedure. Mass General clinicians are also working with industry partners to develop a next-generation device to make the procedure even less invasive, and they are refining criteria to evaluate which patients are most likely to benefit from the treatment.
History And Physical Examination
In men with bothersome lower urinary tract symptoms, a history should be performed to establish the severity of symptoms, evaluate for causes other than BPH , and identify contraindications to potential therapies. The American Urological Association Symptom Index is a validated seven-question instrument that can be used to objectively assess the severity of BPH.6
| Clinical finding |
|---|
| Prostate cancer | Mechanical obstruction |
Symptomatic men should have a digital rectal examination to assess the size and contour of the prostate.6 Prostate volume predicts the response to finasteride therapy. Finasteride is more effective if the prostate volume is greater than 40 mL8 . A palpable nodule suggests prostate cancer and requires biopsy. Abnormal sphincter tone suggests a neurologic abnormality, which may contribute to urinary symptoms.6 Cognitive or ambulatory impairment may exacerbate incontinence problems.
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Sidebar 1 Bph Case Report
Chief Complaint: LF is a 64-year-old white male presenting with fatigue and sleep pattern changes that have lasted over the past several years. He believes his poor sleep habits are due to frequent nighttime urination, occurring three to four times per night. He denies drinking any fluids in the evening. LF also complains of difficulty starting a stream, especially in public restrooms, and notes that this stream has become weaker over time. He also feels that it takes him longer to completely empty his bladder. He admits to âgoing a little in his shortsâ after urinating and confirmed postvoid dribbling. He experiences some mild urgency but denies dysuria. He also confirms knowledge of all of the bathroom locations in his office building.
Past Medical History:LF denies blood in his urine, a past history of STDs, or other UTIs. He reluctantly reports difficulty keeping firm erections during sexual intercourse compared to when he was younger. However, he maintains that this issue is not one of his major concerns.
Family History: Negative family history of prostate cancer
Social History: Nonsmoker, no illicit drugs, mild alcohol consumption
Physical Examination: Male pattern baldness
Vital Signs: WNL
⢠Niacin 1,000 mg 1 daily
⢠Cinnamon tablet 1 daily
What Is An Enlarged Prostate
An enlarged prostate is when your prostate gland becomes larger than normal. It’s also called benign prostatic hyperplasia or BPH for short. Benign means not cancer. And hyperplasia means too much cell growth. BPH isn’t cancer and it doesn’t increase your risk of getting prostate cancer.
Usually, the prostate gland continues to grow during adult life. That’s why BPH is the most common prostate condition in people over age 50. As the prostate gets bigger, it may press against the bladder and pinch the urethra. This can slow or block the flow of urine out of your bladder.
Over time, the bladder muscle may become weak from trying to pass urine through a narrow urethra. When this happens, your bladder may not empty completely when you urinate. A narrowed urethra and weak bladder cause many of the urinary problems you may have with BPH.
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Lower Urinary Tract Symptoms
Lower urinary tract symptoms are divided into two categories: storage symptoms and voiding symptoms.
The course and severity of these symptoms can vary greatly.. They mainly affect older men, with prevalence increasing with age: on average, 50% of men over 60 years of age and 80% of men over 80 years of age experience LUTS caused by BPH . For this reason, symptomatic BPH is regarded as one of the most common disorders in men and, because it is widespread, one that has significant socioeconomic impact . Apart from increasing age, risk factors include metabolic syndrome , obstructive sleep apnea, and thyroid dysfunction .
Epilobium Parviflorum And E Angustifolium
Epilobium species, commonly known as willowherbs or fireweeds, are perennial herbaceous, mostly hemicryptophyte plants, members of the evening primrose family . The aerial parts of the plant are used as herbal tea or in combination with other herbal substances in herbal medicines. Based on long-standing use, some Epilobium species, including E. angustifolium L. and E. parviflorum Schreb., can be used for the relief of LUTS of BPH, such as difficulty starting urination or a frequent need to urinate . The European and North American traditional uses include treatment of BPH, prostatitis, bladder, and kidney diseases, and other urinary tract associated problems, while based on American traditions, it can also treat diarrhea and other gastrointestinal diseases, cough, various skin and mucosa diseases, bodily injuries, and pain .
Plant materials of the Epilobium genus are especially rich in polyphenols including flavonoids , phenolic acids , and tannins but some steroids, triterpenoids, and fatty acids were also isolated from them .
3.2.1. Preclinical Studies
3.2.2. Clinical Studies
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How Is Bph Treated
In some cases, in particular where symptoms are mild, BPH requires no treatment. At the opposite extreme, some men require immediate intervention if they cannot urinate at all or if kidney/bladder damage has occurred. When treatment is necessary, many men will simply require daily medication. If this fails to completely treat the symptoms, or if there are signs of damage from BPH, the doctor may recommend minimally invasive endoscopic surgery . Or, in some cases, traditional surgery may be recommended.
- Drug treatment: The FDA has approved several drugs to relieve common symptoms associated with an enlarged prostate, including drugs that inhibit the production of the hormone DHT and drugs that relax the smooth muscle of the prostate and bladder neck to improve urine flow.
For surgery, there are many procedures to choose from, and the choice depends largely on your specific prostate anatomy, and surgeon preference and training. These procedures all have a common goal of widening the urethral channel as it passes through the prostate. Procedures include the following:
What Are The Types Of Prostate Surgery For Benign Prostatic Hyperplasia
Several minimally invasive surgeries may be used for benign prostatic hyperplasia. These include:
GreenLight laser: Photoselective vaporization of the prostate is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is surgical treatment performed in the operating room under general anesthesia.
Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.
Water vapor therapy : Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local nerve block.
UroLift®: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local nerve block.
Prostatic artery embolization: This approach uses catheters to deliver agents that block blood flow to the prostatic artery to reduce symptoms of BPH by shrinking tissue. This prostate procedure uses local anesthesia and doesnt require a hospital stay.
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What Causes Benign Prostatic Hyperplasia
Healthcare providers and medical researchers arent sure what causes BPH.
One theory is that, as you age, the amount of testosterone in your body decreases . At the same time, your estrogen levels remain the same. These hormone changes may cause your prostate cells to grow. However, people who take supplemental testosterone may develop or worsen BPH.
Older men and people AMAB also have higher levels of dihydrotestosterone . DHT is a more potent form of testosterone that increases the size of your prostate.
Figure : Urethral Lift Procedure Before And After
Images from inside the urethra of a patient before and after the prostatic urethral lift. On the left, the urethra is compressed by the prostatic hyperplasia. On the right, after the implants have been inserted, the urethra has opened up, thus relieving the symptoms of BPH.
“These two treatments are really perfect for patients who don’t have a very large prostate and seek a treatment that doesnt have long recovery or significant side effects. They are also ideal for patients who respond to medical therapy but do not want to continue medications because of side effects, or for whom the medications aren’t working well,” says Shahin Tabatabaei, MD, director of the Prostate Health Program at Massachusetts General Hospital.
Typically, medications can treat patients with mild symptoms, and surgery is usually reserved for patients with severe symptoms and cases where the prostate is very large. That makes the urethral lift procedure and thermal vapor therapy appealing to a middle group of patients who may not respond well to medication but arent ready for an invasive surgery.
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How Is Benign Prostatic Hyperplasia Diagnosed
Your healthcare provider will review your medical history, ask you questions and perform a physical examination. Part of the physical exam involves a digital rectal exam.
During a digital rectal exam, your healthcare provider will carefully insert their gloved digit into your rectum. Theyll feel the edges and surface of your prostate, estimate the size of your prostate and detect any hard areas that could be cancer.
Your healthcare provider may also order:
- A survey to evaluate the severity of your symptoms.
- A urine flow test to measure the speed of your pee stream.
- A study to detect how much pee remains in your bladder after youve finished peeing.
- A cystoscopy to look into your bladder.