How to write an essay on Benign Prostatic Hyperplasia (Solved)

Benign prostatic hyperplasia (BPH) is a common condition that mostly affects older men. Histologically, BPH is characterized by the proliferation of smooth muscle and epithelial cells within the prostatic transition zone (Lerner et al., 2021). Affected individuals may experience challenges with voiding because of the presence of discrete nodules in the periurethral zone of the prostate gland (Lerner et al., 2021). Because of the difficulties to void and emptying the bladder, affected individuals may experience other complications like bladder distention and instability of detrusor muscle that warrant treatment.

Epidemiology

Clinical BPH is a condition that affects men and its prevalence increases after the age of 40 years. The prevalence of the disease for those aged 65 years and above is about 60% with only 8% of the population likely to be affected in their 40s (Lim, 2017). BPH is observed to be the common cause of lower urinary tract symptoms in affected individuals. Regarding the aspect of the race, there are no significant differences between black, Asian, and white individuals developing the disease. However, the risk of black men getting the disease is high in the United States compared to white men (Lim, 2017). There is a strong genetic component of BPH whereby over 60% of affected individuals have a heritable form of the disease. Other causes of the disease include modifiable lifestyle factors like diet, physical activity, and alcohol intake (Lim, 2017). Additionally, metabolic conditions like diabetes high lipids, and obesity are observed to contribute to the build-up of the disease.

Morbidity

Given that BPH is treatable, the mortality and morbidity rate is low worldwide. Supporting evidence shows that some individuals may experience complications after surgery, especially men of advanced age (Lerner et al., 2021). To address this challenge, conservative treatment is encouraged for older adults and strict checks on hematocrit and albumin should be done for those that must undergo surgery.

Pathophysiology

The pathophysiology of BPH is related to various factors including the androgen pathway, age-related tissue remodeling, and inflammation (Madersbacher et al., 2019). The growth of the prostate gland is stimulated by the testosterone hormone released by the pituitary gland and the regulation of this hormone is dependent on the presence of androgen receptors and key enzymes like 5a-reductase (Madersbacher et al., 2019). Alterations in androgen receptors are observed to cause prostate enlargement. During aging, prostate tissue remodeling causes hypertrophy of prostate basal cells and inflammation that increases the size of the prostate gland (Madersbacher et al., 2019). The enlargement of the prostate causes periurethral compression and bladder outlet obstruction.

Presentation

A focused medical history for patients with BPH should include the analysis of the symptoms on the aspects of onset, timing, exacerbating, and relieving factors (Lerner et al., 2021). Commonly observed are lower urinary tract symptoms that include increased frequency and urgency of urination, straining, hesitancy, and prolonged micturition.

Diagnosis

The diagnosis of BPH is based on history and physical examination. The patient should be evaluated for the severity of lower urinary tract symptoms using tools like the American Urological Association Symptom Index (Lerner et al., 2021). Urinalysis can help clinicians to detect infection, hematuria, or metabolic disorders like glycosuria (Lerner et al., 2021). The prostate-specific antigen (PSA) may be used to predict prostate volume and ultrasound can be used when surgical interventions are the most likely course.

Management 

BPH is initially managed using the watchful waiting strategy whereby individuals are counseled on behavioral and lifestyle modification. Patients with bothersome urinary symptoms are given medications like alpha-blockers and antimuscarinics to relax smooth muscles and prevent bladder obstruction (Lerner et al., 2021). Surgery is recommended for patients with renal insufficiency caused by BPH and recurrent UTIs, or for patients that are unwilling to use other therapies.

 

 

References

Lerner, L. B., McVary, K. T., Barry, M. J., Bixler, B. R., Dahm, P., Das, A. K., … & Wilt, T. J. (2021). Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE PART I—initial work-up and medical management. The Journal of Urology, 206(4), 806-817.

https://www.auanet.org/guidelines/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

Lim K. B. (2017). Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology, 4(3), 148–151. https://doi.org/10.1016/j.ajur.2017.06.004

Madersbacher, S., Sampson, N., & Culig, Z. (2019). Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: A mini-review. Gerontology, 65(5), 458-464. https://doi.org/10.1159/000496289

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