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 Enlarged Prostate
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Benign prostatic hyperplasia (BPH) is the nonmalignant, uncontrolled growth of cells in the prostate gland. This cell growth usually occurs in the tissue that surrounds the urethra as it passes through the prostate gland to the bladder. As BPH progresses, the gland constricts the urethra and obstructs urine outflow. The bladder no longer empties completely, creating an environment in which infections, bladder stones, and chronic prostatitis may develop. If left untreated, chronic obstruction can lead to the backup of urine into the ureters and compromise kidney function.
The prostate is a walnut-sized gland located beneath the bladder and in front of the rectum. It is surrounded by a capsule of fibrous tissue called the prostate capsule. The urethra (tube that transports urine and sperm out of the body) passes through the prostate to the bladder neck. Prostate tissue produces prostate specific antigen and prostatic acid phosphatase, an enzyme found in seminal fluid (the milky substance that combines with sperm to form semen).
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 Dr. Kahn
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It is difficult to establish incidence and prevalence of BPH because research groups often use different criteria to define the condition. Generally, most men over the age of 50 begin to experience symptoms of the condition.
BPH is a condition of aging. Nearly all men over the age of 50 have an enlarged prostate.
The cause of benign prostatic hyperplasia is unknown. It is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which can be converted to dihydrotestosterone (DHT) and estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause hyperplasia. How and why levels of DHT increase remains a subject of research.
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Body System
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Common symptoms of benign prostatic hyperplasia include the following:
- Blood in the urine (i.e., hematuria), caused by straining to void
- Dribbling after voiding
- Feeling that the bladder has not emptied completely after urination
- Frequent urination, particularly at night (i.e., nocturia)
- Hesitant, interrupted, or weak urine stream caused by decreased force
- Leakage of urine (i.e., overflow incontinence)
- Pushing or straining to begin urination
- Recurrent, sudden, urgent need to urinate
In severe cases of BPH, another symptom, acute urinary retention (the inability to urinate), may be triggered by holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide,
albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.
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Drugs
for simple enlargement of Prostate
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It is a herbal
extract of Saw Palmetto berries. In research studies
it has proven to be useful in improving urinary
symptoms due to simple enlargement of prostate. It
reduces the night time trips to bathroom. The sense of
urgency is also considerably reduced. Its effect on
PSA and size of the prostate is still unknown. 1
tablet 2 to 3 times a day is the usual recommended
dose.
It relaxes the
smooth muscles of the prostate (70% of prostate is made
of smooth muscles). When these muscles become tight, it
becomes difficult to urinate. Flomax relaxes these
muscles. This drug does not shrink the prostate. It
simply relaxes the prostate. Following drugs act similar to Flomax:
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Terazosin 5 mg at bed time.
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Uroxatral (alfuzosin
Hcl) 10 mg once a day
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Doxazosin 4 mg at bedtime
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Proscar (finasteride) 5 mg once a day
This is a unique
drug which acts within the Prostate and blocks the
action of male hormone which is responsible for prostate
enlargement. Therefore prostate gland begin to shrink.
It takes 6 to 12 months to shrink the Prostate. It does
not relax the muscles of the prostate like Flomax.
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Combination of Proscar & Flomax
As it is clear
from the description above, maximum benefit can be
gained by taking the combination of Flomax and Proscar.
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Avodart (Dutasteride) 0.5 mg once a day
It is a newer
drug, which works similar to Proscar but works on two
different areas (receptors)
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SURGICAL
TREATMENT
Open suprapubic Removal of Prostate.
Open Retropubic Removal of Prostate.
These surgical
treatments started in 19th century Vienna,
Austria. The bladder is opened with a surgical cut in
the pubic area. Prostate is quickly removed either from
inside the bladder (suprabubic) or outside the bladder (Rtropubic).
Bleeding is quickly controlled. Frequently there is loss
of one unit of blood and 3 days of hospital stay. Now a
days this technique is only used when prostate gland is
very large (100g or more).
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TURP-Transurethral Resection of Prostate
This technique
was devolved in USA in 1950. University of Pennsylvania
& Michigan played a leading role.
In this technique there is no surgical cut. The
prostate is chipped away through the penis with the help
of a telescope (resectoscope) by using electric cautry.
The complications are much less as compared to open
technique.
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TUNA (Transurethral needle ablation of Prostate)
This
revolutionary method for treating the simple enlargement
of the Prostate has been used in Europe for many years
with excellent results. Recently it was cleared by FDA
for use in USA. This treatment is so good that Medicare
and many other insurance companies have approved it for
office use.
In
this treatment no general anesthesia is necessary, only
sedation and local anesthesia is used. There is no
cutting of the tissues hence. There is no bleeding. This
is the major advance over the previous surgical method
of TURP, which has been used for more than 50 years. The
procedure itself hardly takes 30 minutes. If you
consider the preparations and post procedure time, the
patient can leave the office in 2 hours.
In
this procedure the radio frequency energy is applied to
the enlarged part of the prostate. Hence multiple
lessons are created deep inside the prostate as shown in
the image. When these lessions shrink the urinary canal
opens up. This process takes 8-12 weeks to become
complete. Hence the full benefit of this technique is
appreciated after 8-12 weeks. In this method there is no
alteration of sexual functions, Penile erections and
ejaculation remains normal. In the old technique of
TURP. Patients devolved loss of ejaculation and problems
with erection. Hence the advantages of TUNA are:
1.
No
cutting, no incision, no bleeding.
2.
No
general anesthesia.
3.
Dose
not affects the sexual functions.
4.
Done
in the office, no hospitalization.
5.
Covered
by Medicare and many other insurances.
6.
You
do not need the prostate medications after TUNA.
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Adenocarcinoma of the prostate is the clinical term for cancer that begins as a tumor on the outside of the prostate gland. As prostate cancer grows, it may spread to the interior of the gland. If identified while it is confined to the gland, cancer of the prostate can be treated successfully. The longer prostate cancer is ignored, the greater the chance that it will metastasize (spread), first locally to tissues around the prostate, or seminal vesicles (sac-like structures attached to the prostate), then to other distant parts of the body, such as lymph nodes, bones, liver, lungs, and so on.
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