Benign prostatic hyperplasia (BPH) or benign enlargement of prostate usually occurs in men over fifty years of age; most often between 60 and 70yrs.
The reason for these discrepancies is unknown.
Clinical Features Of BPH
- Frequency- Increased frequency to urination is the earliest symptom.
At first it is nocturnal, the person been obliged to get up to urination twice or more during the night.
Frequent of urination then progresses and is then both by night and by day.
Urgency is added to the frequency in the later stage.Later, as the residual urine increases, frequency becomes more and more in evidence and there is terminal dribbling.
Finally, in neglected cases, frequency is further encouraged by cystitis and polyuria due to renal insufficiency is seen.
- Difficulty in Micturation- The person notices that he must wait patiently for urination to start; it is useless to strain.
- Stream- The stream is variable, often week, tending to stop and start and dribble towards the end of micturation.
- Pain- Pain occurs with swelling of bladder or acute retention of urine. When hydronephrosis commences there may be dull pain in loins with fullness sensation in the rectum.
- Acute retention of urine- It is some times first symptom to compel the patient to seek relief because of the intense pain it produces.Postponement of urination is a common precipitating cause, as also is indulgence in alcoholic liquors, particularly when he goes out of doors on cold night, as congestion of internal organza then tends to occur.
- Retention with overflow- The person complains that urine constantly dribbles away. It is exceptional for him to have noticed the swelling caused by the distended bladder and he experiences no pain.
- Hematuria- A drop of blood at the beginning or end of urination is common.
- Renal or kidney insufficiency- The person presents himself with signs of renal failure.
Benign Prostatic Hyperplasia Diagnosis And Management
- Rectal examination, excretory pyelography and cysto-urethroscopy are some of the investigating means which confirm the diagnosis.
- Examinations of blood- blood urea estimation, a blood count are important indication.
- Ultrasonography done on full bladder confirms the diagnosis.
For managing acute retention-
- Catheterization- it is done by strict aseptic precautions, passing a size 8, 10 or 12F plastic catheter by a non-touch technique.
- Supra-pubic puncture- if catheterization fails.
Indications For Operation And Procedure
- Prostatism.
- Acute retention which is unrelieved by passing catheter.
- Chronic retention.
- Complications- stone, infection and diverticulum formation.
- Hemorrhage.
Nowadays, permanent catheter is rarity. Prostatectomy or more correctly the removal of prostate by one of the four routes is practicable in the great majority of cases.
The prostate can be approached-
- Through the bladder (transvesical).
- Retro-pubically.
- From the perineum or
- Perurethral.
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My dad is at 72 yrs age and suffering from sugar hypertension, one kidney not properly working, presently he is in deep problem of his testis have become very big and swollen. Could you please guide what could be the reason??
Is the swelling painful? Is it hard to feel or stony hard? Does it reduce while he is in lying down position?
There are many causes for testis swelling, such as Hydrocele, Reducible hernia or a tumor. The best thing is, he has to be examined by a surgeon for accurate diagnosis.
My question is do you recommend this surgery for a 93 year old, whose only other alternative is a Supra Pubic Catheter? He has a strong heart with an arrhythmia, early stages of COPD and is now immobile (wheel chair) due to osteoporosis of the hip bones.
I am very concerned about his ability to survive the ordeal.
Catheterisation of the bladder is useful in obstruction of the bladder. There are two techniques, one is trans urethral the other is supra pubic catheterisation. Your patient is 93 yrs of age with COPD, i.e. (chronic obstructive pulmonary disease). He is having arrhythmia, with osteoporosis. These are age related problems.
Supra pubic catheterization is a simple procedure done under local anesthesia, but looking at his condition the best judge is the anesthetist and the surgeon, to decide of the condition while doing the job.
Since trans urethral route of catheterization is not possible, supra pubic catheterization is the only alternative left. With all modern techniques available he will come out of the operation safely.