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
Treating Benign Prostate Enlargement
Treatment for an enlarged prostate will depend on how severe your symptoms are.
If you have mild symptoms, you do not usually need immediate treatment. Your doctor will agree with you if and when you need more check-ups.
You’ll probably be advised to make lifestyle changes, such as:
- drinking less alcohol, caffeine and fizzy drinks
- limiting your intake of artificial sweeteners
- exercising regularly
- drinking less in the evening
Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.
Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.
Guidelines For The Treatment Of Benign Prostatic Hyperplasia
Yunuo Wu, PharmDCreighton University School of Pharmacy and Health Professions
Michael H. Davidian, MD, MSAssociate Professor of MedicineCreighton University School of Medicine
Edward M. DeSimone II, RPh, PhD, FAPhAProfessor of Pharmacy SciencesCreighton University School of Pharmacy and Health ProfessionsOmaha, Nebraska
US Pharm. 2016 41:36-40.
ABSTRACT:Benign prostatic hyperplasia is a common disorder in men with an incidence that increases with age. BPH often requires therapy when patients begin to experience lower urinary tract symptoms that affect quality of life. Current management strategies involve lifestyle modifications, pharmacotherapy, phytotherapy, and surgical interventions as indicated. Pharmacists are in the unique position of being accessible sources of healthcare information for the BPH patient population. Understanding the symptoms of this disorder and therapy options will be beneficial for pharmacists who have increased chances to answer BPH-related questions from their patients.
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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.
Acute Complications Of Turp Surgery
Similar to any surgical intervention, transurethral resection of the prostate gland is associated with surgical complications. The patients doctor will discuss with them the possible risks and ways of preventing in advance.
- Temporary difficulties with urination. In the first few days after the operation, the patient will urinate through a catheter.
- Dry orgasm. After prostate surgery, the direction of movement of sperm during ejaculation changes as it retrogrades into the bladder. The process does not affect the achievement of orgasm, though it becomes an obstacle when planning a pregnancy.h
- Erectile dysfunction. The dysfunction develops when nerve endings are damaged.
- A decrease in the level of sodium in the blood or TURP-syndrome. During the TURP, the operating area is washed with a large amount of fluid, which is partially absorbed into the systemic circulation . The factor leads to impaired blood electrolyte levels and can potentially be a life-threatening condition. When using bipolar resectoscopes, the risk of developing this complication is reduced to zero.
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B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions
We will search Ovid Medline, Ovid PsycInfo, Ovid Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials for primary health outcomes published and indexed in bibliographic databases. We will attempt to assess long-term or rare harms with nonrandomized controlled trials and large controlled observational studies if RCTs are not available. Our search strategy includes relevant medical subject headings and natural language terms for LUTS/BPH . These concepts were combined with filters to select trials. We will supplement the bibliographic database search with forward and backward citation searching of relevant systematic reviews and other key references. We will update searches while the draft report is under public/peer review.
We will search for grey literature in ClinicalTrials.gov and to identify completed and ongoing studies. We will search for conference abstracts from the past three years to identify ongoing studies. Grey literature search results will be used to identify studies, outcomes, and analyses not reported in the published literature. Information from grey literature will also be used to assess publication and reporting bias and inform future research needs. Additional grey literature will be solicited through a notice posted in the Federal Register and Scientific Information Packets and other information solicited through the AHRQ Effective Health Care Web site.
C Data Abstraction And Data Management
Data fields to be extracted will include author, year of publication, sponsorship, setting, subject inclusion and exclusion criteria, intervention and control characteristics, sample size, follow-up duration, participant baseline age, race, and AUA/IPSS scores, and results of primary outcomes and adverse effects. Relevant data will be extracted into web-based extraction forms created in Microsoft Excel. Data will be analyzed in RevMan 5.3 software.19 Data will be extracted to evidence and outcomes tables by one investigator and reviewed and verified for accuracy by a second investigator.
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Bph Tends To Progress
Understanding the natural history of BPH is imperative to appropriately counsel patients on management options, which include watchful waiting, behavioral modification, pharmacologic therapy, and surgery.
In a randomized trial, men with moderately symptomatic BPH underwent either surgery or, in the control group, watchful waiting. At 5 years, the failure rate was 21% with watchful waiting vs 10% with surgery . In the watchful-waiting group, 36% of the men crossed over to surgery. Men with more bothersome symptoms at enrollment were at higher risk of progressing to surgery.
In a longitudinal study of men with BPH and mild symptoms , the risk of progression to moderate or severe symptoms was 31% at 4 years.
The Olmsted County Study of Urinary Symptoms and Health Status Among Men found that the peak urinary flow rate decreased by a mean of 2.1% per year, declining faster in older men who had a lower peak flow at baseline. In this cohort, the IPSS increased by a mean of 0.18 points per year, with a greater increase in older men.
Though men managed with watchful waiting are at no higher risk of death or renal failure than men managed surgically, population-based studies have demonstrated an overall risk of acute urinary retention of 6.8/1,000 person-years with watchful waiting. Older men with a larger prostate, higher symptom score, and lower peak urinary flow rate are at higher risk of acute urinary retention and progression to needing BPH treatment.,
Two Mechanisms: Static Dynamic
BPH is a histologic diagnosis of proliferation of smooth muscle, epithelium, and stromal cells within the transition zone of the prostate, which surrounds the proximal urethra.
Symptoms arise through two mechanisms: static, in which the hyperplastic prostatic tissue compresses the urethra and dynamic, with increased adrenergic nervous system and prostatic smooth muscle tone . Both mechanisms increase resistance to urinary flow at the level of the bladder outlet.
The static component of benign prostatic hyperplasia and lower urinary tract symptoms, with hyperplasia leading to urethral compression.
The dynamic component of benign prostatic hyperplasia. The bladder outlet and prostate are richly supplied with alpha-1 receptors , which increase smooth muscle tone, promoting obstruction to the flow of urine. Alpha-1 adrenergic blockers counteract this effect.
As an adaptive change to overcome outlet resistance and maintain urinary flow, the detrusor muscles undergo hypertrophy. However, over time the bladder may develop diminished compliance and increased detrusor activity, causing symptoms such as urinary frequency and urgency. Chronic bladder outlet obstruction can lead to bladder decompensation and detrusor underactivity, manifesting as incomplete emptying, urinary hesitancy, intermittency , a weakened urinary stream, and urinary retention.
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Other Invasive Surgical Procedures
Transurethral Incision of the Prostate
In TUIP, the surgeon makes only one or two incisions in the prostate, causing the bladder neck and the prostate to spring open and reduce pressure on the urethra. TUIP is generally reserved for men with minimally enlarged prostates who have obstruction of the neck of the bladder.
TUIP is less invasive than TURP, has a lower rate of the same complications , and usually does not require a hospital stay. More studies are still needed, however, to determine whether they are comparative in long-term effectiveness.
In simple prostatectomy, the enlarged prostate is removed through an open incision in the abdomen using standard surgical techniques. This is major surgery and requires a hospital stay of several days. Simple prostatectomy is used only for severe cases of BPH, when the prostate is severely enlarged, the bladder is damaged, there are many stones or one large stone in the bladder, or other serious problems exist. Some people need a second operation because of scarring. Side effects of simple prostatectomy can include erectile dysfunction and urinary incontinence. This surgery can be performed through an incision in the lower abdomen or keyhole incisions for robot-assisted laparoscopy.
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What Are The Treatments
Treatments may range from “watchful waiting” or medical therapy to minimally invasive therapies or surgery. Medication taken orally provides relief of symptoms for a significant proportion of men with BPH.
Surgery may be recommended if the patient has refractory urinary retention or any of the following secondary conditions: recurrent urinary tract infection, recurrent gross hematuria, bladder stones, renal insufficiency, or large bladder diverticula.
The range of treatments is wide and includes both conventional and newer procedures such as TUMT and TUNA.
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What Is The Prostate
The prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a mans fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.
Symptoms Of Benign Prostate Enlargement
The prostate is a small gland, located in the pelvis, between the penis and bladder.
If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.
This can affect how you pee and may cause:
- difficulty starting to pee
- a frequent need to pee
- difficulty fully emptying your bladder
In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.
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Trans Urethral Prostate Resection Surgery Procedure And Post
Drug therapy for the prostate adenoma is effective in a limited number of patients, in the early stages of the disease. In other cases, preference is given to surgical techniques. According to the CNO , surgery operations are the most common and preferred method of surgical treatment of benign prostatic hyperplasia.
The essence of the method is that under the control of optics with the help of an electric rod through the lumen of the urethra, the adenoma tissues are cut in layers into the lumen of the bladder. Then the resulting chips are removed by a special pump . The duration of the operation, as a rule, does not exceed 1.5 hours. Anesthesia regional or anesthesia.
With a smooth course of the postoperative period, patients are discharged from the clinic 3-4 days after the intervention, and after 7 days they can start working . In recent years, a new modification of the prostate TOUR has appeared the so-called bipolar TOUR . The technique of the operation remained mostly the same, but thanks to the use of new equipment, it was possible to reduce the number of complications and narrow the range of contraindications to prostate cancer. The latest modification of the TUR is the bipolar plasma vaporization of the prostate gland-an exclusive development of OLYMPUS . This technique allows removing adenomatous prostate tissue almost bloodlessly and quickly enough.
What Are The Signs And Symptoms Of Bph
- Urinating 8 or more times each day
- A feeling of not fully emptying your bladder when you urinate
- An urgent need to urinate that you could not put off, or urinating again within 2 hours
- Being woken from sleep because you needed to urinate
- Trouble starting your urine flow, or a need to push or strain to get it to start
- Urine that stops and starts several times when you urinate
- A weak urine stream, or dribbling after you urinate
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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:
No Treatment Or Watchful Waiting
For those with mild cases of BPH, where symptoms are tolerable, treatment may not be necessary. In these cases, the patient must still be monitored to ensure their problem does not worsen. Monitoring involves keeping an eye on the BPH symptoms, the size of the prostate, and regular blood tests. Limiting fluids in the evening, avoiding caffeinated drinks, alcohol, and spicy foods may minimize symptoms.
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The Ar And Growth Factors
Growth factors are chemicals that cause cells to act in a number of ways, mainly either to proliferate or to undergo apoptosis. They include keratinocyte growth factor , epidermal growth factor , fibroblast growth factor and IGF, all of which promote proliferation whereas TGF-1 treatment results in apoptosis .
Within the prostate, growth factors are normally released by the stromal cells and maintain prostate cellular homeostasis through autocrine and paracrine pathways , as seen in the very earliest stages of human prostate development, where stromal factors determine cell fate . An alteration in the balance of cellular homeostasis is at the core of BPH development. Activation of the AR leads to the increase in growth factors responsible for proliferation. For example, in BPH fibroblasts expressing AR, FGF-2 and FGF-7 are overexpressed . TGF-1 induces the differentiation of fibroblasts into myofibroblasts in the stroma and regulates the epithelial cells response to IGF-1 mediated by the stromalepithelial cell axis , resulting in the hyperplasia linked to BPH.
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:
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Cno Culturally Sensitive Care
Nurses should try to improve their skills in providing patient-centered care understanding how their patient culture and beliefs affect the nurse-patient relationship. The nurse must also understand how biopsychosocial needs and cultural background relate to health care needs. There are values considered most important in nursing care, such as patient well-being and patient choice. Nurses are responsible for listening to, understanding, and respecting the values, opinions, needs, and ethnocultural beliefs of their patients. By integrating these elements into the care plan, nurses support patients by achieving their specific health goals.
Nurses are also responsible for obtaining informed consent for any treatment offered. It is the nurses responsibility to determine the patients understanding of the treatment, to ensure that they have the necessary information to make an informed decision. When there are concerns that a decision to care for a patient negatively affects them, nurses work with the patient to explain the risks associated with the choice, allowing them to make an informed decision. The therapeutic nurse-patient relationship is based on meaningful communication between them. When some barriers exist, it is the nurses responsibility to use the necessary strategies and skills to ensure that the patient is an informed partner in providing care.