BENIGN PROSTATIC HYPERPLASIA (BPH)

• Benign prostatic hyperplasia (BPH) is a non-neoplastic glandular and stromal hyperplasia of the transition zone of the prostate. It is a common disorder affecting 30 -40% of male population by the age of 50 years
• Sex hormones (androgens, estrogens, and androgen-estrogen imbalance) have been implicated as a key factor in the development of prostatic hyperplasia
• Patients present with symptoms of urinary frequency, urgency, urge incontinence, urinary hesitancy, straining to urinate, sensation of incomplete voiding, and/or haematuria

Hormonal factors 

• Dihydrotestosterone is a potent prostatic growth factor
• Gene amplification of androgen receptors causes increased androgen receptor sensitivity to androgens leading to prostatic hyperplasia
• Estrogens : mainly estradiol is potent stimulators of prostatic hyperplasia

Genetic susceptibility

• Genes involved in the development of BPH include growth factor genes, androgen-regulator genes, apoptosis genes, and androgen-regulated genes

Risk factors

• Aging- About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80
• Family history
• Diabetes and heart disease might increase the risk of BPH
• Lifestyle- Obesity increases the risk of BPH, while exercise can lower the risk

Irritative symptoms

• Urinary frequency
• Urinary urgency and urge incontinence
• Nocturia
• Occasionally dysuria

Obstructive symptoms

• Hesitancy 
• Straining to urinate 
• Poor and/or intermittent stream
• Prolonged terminal dribbling
• Sensation of incomplete voiding
• Often gross haematuria 

BPH in due course can lead to recurrent UTI, urinary retention with bladder hypertrophy, calculi, hydonephrosis and chronic kidney disease

Differential diagnosis

• Prostate cancer
• Prostatitis
• Prostatic abscess
• Other causes of bladder outlet obstruction

• Prostate specific antigen levels (PSA) : >4 indicated co-existent prostate cancer
• ↑ Free PSA levels 
• BUN, Creatinine, Electrolyte levels : indicated in men with high post-void residual volumes 
• Urine analysis and urine culture: to rule out UTI and haematuria 
• Abdominal ultrasound
• Transrectal ultrasound: if prostate cancer is suspected
• MRI : Can be used to differentiate BPH from prostate cancer
• Uroflowmetry: normal maximal urinary flow rate > 15 ml/sec
• Per rectal Digital examination: symmetrically enlarged, smooth , firm, non tender prostate with rubbery or elastic texture 

• Restrict fluid intake before bedtime or before going out
• Avoid/reduce caffeine and alcohol intake
• Severe symptoms of BPH: Transurethral resection of the prostate (TURP)
• Open/laparoscopic/robotic prostatectomy: laparotomic / laparoscropic removal of the entire prostate gland or a part of it in patients with very large prostates (> 75 g)
• Laser ablation, radiofrequency ablation, and microwave thermotherapy are the newest techniques used for prostate tissue resection

Internal medicines

• Varanadi kashaya
• Saptasaram kashaya
• Chiruvilwadi kashaya
• Vaiswanara choorna
• Kanchanara guggulu
• Chandraprabha gutika
• Siva gutika
• Vastyamayantaka ghrita
• Dashamoola hareetaki 

Procedures

• Anuvasana vasti – Pippalyadi anuvasana vasti
• Adho nabhi Pichu – Dhanwantara taila
• Avagaha - Eranda mooladi kwatha