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Benign
Prostatic Hyperplasia |
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Overview |
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Definition |
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Benign prostatic hyperplasia (BPH) is noncancerous growth of the prostate
gland that gradually narrows the urethra. The clamping effect eventually
obstructs the flow of urine. As a result, the bladder fails to empty completely.
Urine remaining in the bladder stagnates, leaving the patient vulnerable to
infections, formation of bladder stones, and kidney damage. The condition
usually presents itself gradually, via increased difficulty in urinating. Not
infrequently, however, a patient suddenly suffers acute urinary retention,
finding himself completely unable to urinate. BPH rarely causes symptoms in men
under age 40, but affects many males over age 50. Four out of every five men who
reach age 80 develop some symptoms of BPH. Some studies, so far unconfirmed,
suggest that BPH occurs more frequently in married men than single men, and more
often in the United States than in Europe. |
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Etiology |
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So far the causes are unknown. Three major theories involve different facets
of the aging process in men. As men age, the amount of active testosterone in
the blood decreases, resulting in a higher proportion of estrogen in the blood.
Animal studies suggest that this excess estrogen increases the activity of
promoters of cell growth in the prostate. Another theory targets
dihydrotestosterone, a derivative of testosterone that may accumulate in the
prostate and encourage the growth of cells there. The third theory suggests that
cells in parts of the prostate "reawaken" in later life and direct other cells
to grow or to become more sensitive to hormonal growth
promoters. |
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Risk Factors |
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- Age over 50
- Partial urethral obstruction which can escalate to acute urinary
retention as a result of sympathomimetic drugs or alcohol, exposure to cold
temperatures, or a long period of
immobility
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Signs and Symptoms |
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- Need to urinate frequently
- Inability to sleep through the night without getting up to
urinate
- Difficulty starting urine stream
- Decreased strength and force of the stream
- Dribbling after urination
- Blood in the urine, caused by bursting of small veins in the urethra
and bladder
- Burning sensation during urination, sometimes the result of bladder
infections caused by urine backup
- Not infrequently, complete inability to urinate, sometimes after
taking sympathomimetic remedies, leading to a feeling of fullness in the
bladder, followed by severe pain in the lower
abdomen.
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Differential
Diagnosis |
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- Acute prostatitis
- Prostate cancer
- Urethral blockage/stricture
- Neurogenic bladder
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Diagnosis |
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Physical Examination |
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Rectal examination indicates whether or not the prostate is enlarged. Nodules
detected in the examination may indicate cancer. Tenderness suggests
infection. |
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Laboratory Tests |
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- Urine and blood tests serve to differentiate between BPH, infections
such as acute prostatitis, and prostate cancer.
- Analysis of urine sample identifies bacteria, if any, responsible for
infection.
- Blood tests for kidney function eliminate the kidney as a source of
the problems.
- Elevated level of prostate-specific antigen (PSA) in the blood
indicates further evaluation of the patient for prostate
cancer.
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Imaging |
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- Transrectal ultrasound measures the size of the prostate and
indicates whether any abnormalities represent malignancies.
- An intravenous pyelogram reveals any obstruction or blockage in the
urinary tract.
- A cystoscope inserted through the urethra images the prostate and
checks for blockages of urine flow not caused by the
prostate.
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Other Diagnostic
Procedures |
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- Ask the patient to complete a prostate symptoms score
questionnaire.
- Post-void catheterization to determine amount of residual
urine.
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Treatment Options |
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Treatment Strategy |
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The choice among a variety of treatments depends on the age and overall
health of the patient, the extent of prostate enlargement, and its effect on
urination. Several recent studies suggest watchful waiting, rather than any
specific treatment, for patients with mildly enlarged prostates. Regular
checkups monitor the condition's progress and point the way to targeted
treatment when symptoms worsen. Treatment should start once problems become
truly bothersome or present a health risk. The choice among medical therapy,
nonsurgical intervention, or surgery will depend on the extent of the discomfort
and the risk. |
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Drug Therapies |
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- Antibiotics of choice clear up infections prior to BPH
treatment.
- Alpha-adrenergic drugs such as terazosin (Hytrin) and doxazosin
(Cardura) can relieve symptoms by relaxing tissues in the area of the
prostate.
- Finasteride (Proscar) inhibits production of the male hormone
involved in prostate enlargement. It can shrink the prostate in some patients.
However, it can take up to three months to relieve
symptoms.
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Surgical Procedures |
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- Balloon urethroplasty, carried out as an outpatient procedure, widens
the urethra, thus easing the flow of urine. Its long-term effectiveness remains
unclear.
- Transurethral microwave therapy, performed on an outpatient basis
without anesthesia, uses microwaves to destroy excess prostate
tissue.
- Transurethral hyperthermia, under investigation by researchers, uses
a series of heat treatments to shrink enlarged tissue. The procedure can cause
such side effects as irritation and bleeding of the urethra.
- Prostatic stents, under study in Europe, widen the urethra from the
inside by pushing back prostatic tissue. Used only if other measures cannot be
utilized or are not effective.
- Transurethral resection of the prostate (TURP) is the operation
performed in 90% BPH surgeries. About 5% of patients retain some urinary
incontinence after surgery.
- Transurethral incision of the prostate, a less invasive form of TURP,
widens the urethra by making small cuts in the bladder neck and the prostate.
Its advantages and long-term side effects remain to be established.
- Open prostatectomy, approached through an external incision instead
of the urethra, offers an alternative for a greatly enlarged prostate or in
cases of bladder damage.
- Laser surgery vaporizes obstructing prostate tissue, without causing
as much nerve damage as TURP. Today used
infrequently.
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Complementary and Alternative
Therapies |
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May be very helpful to add to watchful waiting management of BPH. Saw
palmetto is widely used in Europe. Saw palmetto in conjunction with nutrition
may be very effective. |
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Nutrition |
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- Zinc (60 mg/day)—has been shown to reduce
the size of the prostate.
- Selenium (200 mcg/day)—antioxidant
concentrated in the prostate
- Essential fatty acids (1,000 to 1,500 IU one to two
times/day)—anti-inflammatory, for optimum prostaglandin
concentrations
- B6 (100 to 250 mg/day)—reduces the elevated
levels of prolactin found in BPH
- Amino acids glycine, glutamic acid, and alanine (200 mg/day of
each)—provide symptomatic relief
- Avoid alcohol, especially beer, and saturated fats.
- Pumpkin seeds have been used historically to help maintain a healthy
prostate.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Saw palmetto (Serenoa repens)—studies
suggest this can be as effective as Proscar. Dose of 160 mg bid is difficult to
achieve in tea or tincture; extract standardized for 85% to 95% of fatty acids
and sterols is recommended.
- Stinging nettle root (Urtica
dioica)—for BPH stages 1 and 2. Increases urinary
flow and volume. Daily dose of 4 to 6 g of drug or equivalent
preparation.
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use three to five pellets of a 12X to 30C remedy every one to four
hours until acute symptoms resolve.
- Chimaphila umbellata is specific for retention of urine with an
enlarged prostate
- Conium for BPH with a feeling of heaviness in the perineum,
especially with premature ejaculation
- Pareira for urinary retention with BPH, especially with painful
urging or pain in the bladder
- Selenium for BPH with dribbling, impotence, and
constipation
- Thuja occidentalis for BPH, specifically if there is a forked
stream of urine and/or genital
condyloma
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Physical Medicine |
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- Kegel exercises increase pelvic circulation and improve muscle
tone.
- Contrast sitz baths. Fill one basin with hot water, one with cold
water. Sit in hot water for three minutes, then in cold water for one minute.
Repeat three times to complete one set. One to two sets per day, three to four
days per week, increases pelvic circulation and relieves
congestion.
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Patient Monitoring |
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Rectal examination of patients at least annually following prostate surgery.
Encourage postsurgical patients to drink plenty of water to flush the bladder,
eat a balanced diet to prevent constipation, avoid caffeine, heavy lifting, and
straining during bowel movements. |
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Other
Considerations |
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Complications/Sequelae |
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- Patients may also experience bladder stones or
prostatitis.
- Occasionally, scar tissue around the bladder opening or in the
urethra, resulting from surgery, requires treatment within a year of
surgery.
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Prognosis |
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Ineffectiveness of medical treatments may indicate the need for surgery,
which usually offers about 15 years of relief from BPH. Ten percent of men who
undergo surgery eventually need a second operation for enlargement; most of
these patients had their first surgery at an early age. Less than 33% of men
with BPH have occult prostate cancer. |
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References |
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Berkow R, Beers MH, et al., eds. Merck Manual of Medical Information: Home
Edition. Whitehorse Station, NJ: The Merck Publishing Group; 1997.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:201.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:119, 141, 286, 341,
388-389.
Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed.
Rocklin, Calif: Prima Publishing; 1998:480-486.
Prostate Enlargement: Benign Prostatic Hyperplasia. The National
Kidney and Urologic Diseases Information Clearinghouse. NIH publication no.
91:3012.
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
Publishing; 1988:82-84. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |