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Enlarged Prostate

 
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Prostate Enlargement


Prostate enlargement also referred to as adenofibromyomatous hyperplasia, benign prostatic hyperplasia is a health condition in which the male`s prostates increase in size. This involves multiplication of the epithelial and stromal cells leading to formation of discrete nodules that are large in the periurethral area of the prostate. When this happens, it causes compression of the urethral canal by the nodules leading to partial or complete urethra obstruction a condition that alters the normal passage of the urine. This is characterized by high risk of contracting urinary infections, frequent urination, urinary hesitancy, urinary retention and dysuria i.e. pain during urination. Prostate enlargement does not cause cancer or increasing the chances of contacting it, although it elevation the levels of prostate specific antigen due to inflammation and enlarged volume of the organ caused by the urinary canal infection. According to the research, prostate enlargement begins at an age of 30 yrs.
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Signs and symptoms of prostate enlargement
The symptoms of prostate enlargement are grouped into two major classes i.e. voiding or storage. Storage symptoms include: urgency incontinence, nocturia, urinary urgency and frequency. Voiding prostate enlargement symptoms include: dribbling, urinary stream, straining to void and hesitancy. If the condition goes untreated, then it leads to increased chances of urinary canal infections and stasis of bacteria. The salts contained in the urine expelled crystallize leading to formation of urinary bladder stones. Acute or chronic urinary retention may occur also.

Causes of prostate enlargement
The main cause of this medical condition has not yet been understood though it is believed that testes and aging may trigger prostate enlargement. As age goes, the production of testosterone hormone in the blood reduces leaving an elevated level of estrogen which causes this condition as high estrogen levels contained in the gland catalysis the activity of various components meant to promote the growth of cells. Another theory indicates that dihydrotestosterone might be the cause of this health condition, which is a substance obtained from testosterone found in the man`s prostate whose role is to regulate the growth of cells. As men get older, their body becomes unable to produce dihydrotestosterone, a situation that leads to prostate enlargement.

Diagnosis of prostate enlargement
This is carried out through rectal examination, performance of various blood tests and via transrectal ultrasonography. This whole procedure focuses on various symptoms associated with this medical condition. The commonly used diagnoses methods include:
Digital rectal examination: this is the first examination test carried out. It involves insertion of a gloved finger into the patient's rectum by the doctor in an attempt to have a general idea about the condition and size of the prostate gland.

Prostate-specific antigen (PSA) blood test: this procedure involves examination of PSA which is a protein released by prostate gland as men who tend to suffer from prostate enlargement, have elevated levels of this protein.

Rectal ultrasound and prostate biopsy: this procedure involves insertion of a probe in the rectum whose role is to direct sound waves. This allows leads to production of the echo patterns by the sound waves hence displaying the prostate glands image on the screen. Biopsy needle is guided to the doubted tumor using the ultrasound images and the probe to collect a few samples of prostate tissues for further examination.

Cystoscopy: here, a small tube know as cystoscope is inserted via the urethra`s opening in the man's penis after the penile has lost all its sensation. Cystoscope comprises of light and lens system hence enabling the doctor to clearly see the size of these glands.

Treatment of prostate enlargement
Minimal microwave procedures: this is done through a special device that makes use of microwaves to damage and heat the excess prostate tissue. During the procedure, computer-regulated microwaves are sent via catheter by the device, to heat the specified areas of the prostate. A cooling system is used during the procedure to protect the urinary canal. This procedure usually takes duration of one hour.

Water-induced thermotherapy: this refers to use of heated water to kill and damage these excess prostate tissues. It is normally done via placement of a catheter that has multiple shafts in the urethra in a position that enables the resting of treatment balloon in the middle area of the prostate. A computer is used to regulate the water temperatures contained in the treatment balloon to heat the surrounding area. This procedure aims at heating the precise prostate area hence destroying excess prostate tissues.

Medications
The two types of medications mainly used in treating prostate enlargement are:
Alpha blockers such as alfuzosin, silodosin, terazosin, tamsulosin and doxazosin all of which are have been proven effective in dealing with this medical condition this group of medication treats prostate enlargement through relaxation of the smooth muscle found in the neck of the bladder and the prostate hence reducing the hindrance of urine flow.

The second type is 5a-reductase inhibitors such as dutasteride and finasteride. Normally, these medications achieve this function through inhibiting the production of a hormone behind prostate enlargement known as DTH. Antimuscarinics e.g. tolterodine can as well be used in combination with alpha blockers hence reducing the effects of acetylcholine on smooth bladder muscles therefore controlling the signs associated with overactive bladder.

Surgical treatment
There are various surgical procedures used to remove the enlarged tissue without interfering with the tissues found inside and outside the capsule. Types of surgery used include:
Transurethral surgery: this surgical procedure does not require carrying out of any form of external incision. The process begins with giving of anesthesia, followed by insertion of a special device known as resectoscope via the urethra with an aim of reaching the prostates hence removing the obstructing tissue cells each piece at a time. These tissues are then transported by the fluid after which they are eliminated.

Laser surgery: here, a laser fiber is passed into the prostate through the urethra hence vaporizing the enlarged prostate tissues. This is done by the use of cystoscope which delivers energy bursts to the enlarged prostate tissues. These lasers cause shrinking and destruction of the prostate tissues hence resuming to their normal sizes.


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