BPH or Benign Prostatic Hyperplasia is a disease of males. It is a non-malignant(non-cancerous) enlargement of prostate glands.
Anatomical and Physiological basics of Prostate Gland
Prostate is an exocrine gland about the size of walnut and weight about 7-14gms with median of 11gms it lies below urinary bladder surrounding the urethra with its glandular duct opening in prostatic part of urethra.
It is partly Glandular and partly Muscular. The Glanduloalveolar part produces alkaline prostatic fluid and the Muscular part helps to ejaculate this fluid into prostatic part of Urethra to mix it with sprems produced by testes and form the semen.
Externally it seems to be divided into 4 lobes
- Anterior lobe or isthemus,
- Posterior lobe
- Right and left Lateral lobes
- Median lobe or middle lobe
The cut section of prostate doesnt show distribution as that of lobe pattern as seen externaly also the morphological distribution is different at different age so in pathology its divided into zones rather than studying in lobes.
- Peripheral Zone
- Central Zone
- Transition Zone
- Anterior Fibromuscular zone
Pathophysiology of Benign Prostatic Hyperplasia BPH
As the men age the production of Aromatase and 5 alpha reductase increases.
Both Aromatase and 5 alpha reductase converts Androgens(male hormones) into Oestrogen and Dihydroxytesterone. Which results into reduced levels of testosterone and increased levels of Dihydroxytesterone and Oestrogen. Oestrogen stimulates growth of prostatic cells and Dihydroxytesterone a powerful anabolic hormone synergestically aids in to the action of oestrogen in growth of prostatic cells.
In which not only the stromal cells but also glandular cells undergo hyperpalsia. Although stromal hyperplasia is more predominant than the glandular, contadicting this the lateral and median lobe that have more glandular tissue and they are seen to enlarge more compared to anterior which has comparatively lesser glandular tissue.
BPH is closely associated with malignancy and its usually found in transition zone.
Risk Factors for Benign prostatic Hypertrophy BPH
- Aging
- Genetic and Familial predesposition
- Smoking and alcohol
- Sedentary and Stressful lifestyle
- Obesity and Metabolic syndrome
- Diabetes and hypertention
- Abuse or frequent use of Anabolic hormones and aphrodisiac drugs.
Symptoms of Benign Prostatic Hypertrophy BPH
- Patient typically presents with symptoms of lower urinary tract symptoms like
- Stangury.
- Slow and feeble stream of urine.
- Frequent Urge to urinate.
- Retention of urine.
- Urge to urinate soon after passing it once
- Post void terminal dribbling of urine
- Intermittent stream of urine
- Sensation as if some urine is left back, which he ineffectually tries to clear it up.
- Involuntary passing of urine.
- Nocturnal Enuresis.
- Lack of confidence to hold urine on urge to pass
- May show complications like urinary bladder stones, freqient urinary tract infections which may potentially damage bladder spincter or kidney, retention of urine.
- Bleeding in urination or per rectum is a sign of severity and needs urgent intervention to rule out the cause and need proper eveluation for presence of malignancy
Diagnosis of Benign Prostatic Hypertrophy BPH
- Per rectal examination to check any enlargement in size by palpating prostate per rectum.
- Sonography shows enlarged glands and size shape and echotexture are to some extent helpful indicator of malignancy
- PSA test -Prostate Specific Antigen if elevated it indicates probablilty of malignancy though not specific but many its most of the times elevated in patient with malignancy but it is not specific to it as patients without malignancy also many times shows elevated levels but in maligmamt cases its much more frequent.
- PSA should not be done few days after sonography as its observed that PSA levels tend to alter after sonography.
- Biopsy to rule out malignancy in cases where the USG report shows unusually enlarged prostate or abnormal shape or echotexture or changes in surrounding tissues or elevated PSA levels or in patients with unusual symptoms.
- CT scan may be required in severe cases with complications and or doubt of malignancy.
Homoeopathic Medicines for Benign Prostatic Hypertrophy BPH
- Sabal Serrulata
- Chimaphilla
- Conium Maculatum
- Phytolacca Decandra
- Kalium Muriaticum
- Ustillago
- Baryta Carbonica
- Baryta Muriaticum
- Calcarea Fluorica
