Management of Benign Prostatic Hyperplasia (BPH):

Benign Prostatic Hyperplasia (BPH):

Introduction:
The prostate gland is the male organ most commonly afflicted with either benign or malignant neoplasm. BPH is the most common benign tumour in men, and its incidence is age-related. The peculiarity of the Prostate gland is that, in old age when most of the organs regress in the size; where as it enlarges and causes trouble. As Hadenoch (1970) put it, BPH occurs in saints and sinners, fat and thin, persons with large families and monks, postman and prime-minister. This is a very apt description of how the prostate gland spares none in its aging process. By virtue of its position, where it guards the outlet of urinary bladder; when it enlarges, it obstructs the urinary passage leading to not only back pressure effect of the bladder like – trabeculations and diverticula formation but also on the upper urinary tract. Later on, the ultimate renal damage is detrimental to life.

Clinical Features (Symptoms):
To facilitate taking a history, it is helpful to divide the symptoms into-
1) Symptoms due to mechanical obstruction.
2) Those superimposed by infection.
3) Those caused by Uraemia.
4) Symptoms related to sexual activity.

But it can also be divided into:

Obstructive Symptoms:
1. Weak urine stream: Diminution of the calibre & force of the urine stream.
2. Hesitancy: Hesitancy in initiating urination.
3. Terminal dribbling: Inability to terminate micturition without post voids dribbling.
4. Sense incomplete emptying of the bladder
5. Occasionally urinary retention.

Irritative symptoms:
1. Frequency of urination
2. Nocturia,
3. Urgency and
4. Overflow incontinence develops
Diagnosis of BPH:
It is based on general, systemic and local examination followed by supportive investigations.
General Examination:
To document the decrease in size and force of the urine stream, the physician should observe the patient voiding prior to examination. In the general physical examination, the following finding may suggest the presence of severe obstruction –

• Weight loss evidence or oedema of hands and face.
• Pallor
• Cardiomegaly and pulmonary oedema.
• A mass in the lower abdomen.

Rectal Examination:
This carries tremendous importance in diagnosing BPH. This examination should be performed gently with a well lubricated gloved index finger and 360 degree digital exploration. At first, any pathogenesis in the lower anal canal should be ruled-out. There after the prostate should be palpated giving due attention to its size, consistency, shape, rectal mucosa, median groove, mobility, surfaces, upper border of prostate etc.
Hyperplasia usually produces a smooth, firm or elastic enlargement on Bi-manual examination, intra vesical lobes may be felt sometimes and occasionally the presence of residual urine may be appreciated.
Urine Examination:
Routine microscopic and cultural studies, midstream sample should be collected.
Blood Examination:
Routine haemogram, Blood urea, Serum creatinine, Serum acid phosphatase, Serum alkaline phosphatase are needed to assess Anaemia, Renal function and to exclude the Carcinoma of Prostate.
Skiagraphy:
1. Plain X-ray of KUB region.
2. Intravenous Urography
3. Cystography.
4. Ultrasonography
5. Cystourethroscopy.
Urodynamic Evaluation:
1. Residual urine volume.
2. Mean urine flow rate (Normal 15 ml/sec)
3. Cystometry.
Biopsy of the Prostate:
PSA (Prostate Specimen Antigen) studies
Treatment of Benign Prostatic Hyperplasia (BPH):
This can be classified into following heads:
Medical management of BPH:
Alpha blockers: Phenoxybenzamine, Prazocin, Terazocin, Doxazosin, Tamsulosin
5-alpha reductase inhibitors: Finasteride
Phytotherapy: It refers to the use of plants or plant extracts for medicinal purposes. The use of phytotherapy in BPH has been popular in Europe for years and its use in the USA is growing as a result in patient-driven enthusiasm. Several plant extracts have been popularized, including the saw palmetto berry, the bark of Pygeum afticanum, the roots of Echinacea purpurea and Hypoxis rooperi, pollen extract and the leaves of the trembling poplar.
Surgical management of BPH:
Ideally in case of Frequency of urination and/or urgency of urination occur, then and then patient has to go for surgical management, i.e.
Transurethral resection of the prostate (TURP);
Transurethral incision of the prostate (TUIP);
Open simple prostatectomy: Simple retropubic prostatectomy, Simple suprapubic prostatectomy
Minimally invasive therapy of BPH:
Laser therapy;
Transurethral electrovaporization of the prostate;
Hyperthermia;
Transurethral needle ablation of the prostate;
High intensity focused ultrasound;
Intraurethral stents;
Transurethral balloon dilation of the prostate
Ayurvedic Management(treatment) of BPH:
It is very much famous nowadays and giving tremendous relief in the symptoms of BPH.
One should follow the ‘Ayurvedic life style’ (The Do’s and Don’ts) (As per given on the home page of this site).
Also, here is an effort to collect different Ayurvedic formulations in context to BPH i.e.
Churna (Powders): Punarnava churna, Gokshur churna, Rasayana churna
Kwath (Decoctions): Varunaadi kwath, Dashmoola kwath, Gokshuradi kwath, Punarnavaashtak kwath, Trinpanchmoola kwath, Triphala kwath
Vati (Tablets): Chandraprabha vati, Gokshuradi Guggulu, Tab. Neeri , Tab. Prosteez, Cap. Rencal, Cap. Ural BPH