Prostate enlargement (bpb)

Since the past, the term prostate enlargement has been used for all symptoms perceived as voiding disorder in elderly men. However, in the following years, the same complaints were seen in women in the same age group, and this group was evaluated as lower urinary system symptoms (AUSS).
AUSS;While it is well known that it can be accelerated by benign prostate enlargement (BPB) and benign prostate obstruction (BPO), it can also occur due to aging, neurological diseases and non-bladder causes.

Why do some grieving men have abnormal prostatic growth while others do not?
Also, why are some men with large prostatic enlargement symptomatic while others are not?
BPD is a progressive disease and it becomes mandatory to treat one out of every four men over the age of 70, where risk factors have been reported to be increasing age, worsening of symptoms, decreased urinary flow rate and increased prostate volume. While annual prostate growth is 1.6%, this rate is much higher in those with complaints. The mean lower limit of prostate volume is 35 mL.

Risk factors for BPD are age, heart disease, obesity, hypertension, and genetics. In those with a family history, the cause is not fully known, but there is a predisposition to early onset and larger glands.
Androgens, especially DHT (converts to DHT by T 5a reductase in prostatic stromal cells) are required for prostatic development, although the exact metabolism is unknown. Again, the role of estrogens, especially estradiol, is increasingly mentioned in the formation of BPB. Growth factors FGF,EGF,B (TGFB) ), IGF has been shown to be a possible messenger for embryonic reawakening and DHT can also be effective in this way. Apoptosis, also called cell death, can develop hyperplasia simply by disrupting the balance between normal cellular proliferation and programmed cell death.
After these reasons, with the active force application of the prostatic and bladder neck smooth muscle with the enlarged prostate tissue (22% of the smooth muscle in BPB), a decrease in the urinary flow rate occurs with the bladder outlet obstruction. While the initial response of the detrusor to the increased resistance causes higher pressure to overcome the outlet resistance, this leads to cellular and morphological changes in the bladder over time and causes storage symptoms such as frequent urination, urgent urination, nocturnal urination and urinary incontinence. 5 years of disease progression is 35%-40.5%, the risk of urinary retention is 3%-7% in years.
Complications of BPB are urinary retention, urinary infection, hematuria, incontinence, bladder stone, hydronephrosis, and renal failure. Recent studies have not been able to explain the exact cause, but increase in age and BPB also increase the percentage of ED. Detrusor overactivity continues in /3 of them.
Pharmacological agents that cause AUSS are antihistamines, diuretics, Ca channel blockers, tricyclic compounds, sedatives, and cold medications to which α-adrenergic agonists are added.
Diagnosis; In the anamnesis, diseases such as heart failure, HT, DM, neurological diseases, Parkinson’s, MS, Alzheimer’s, drugs used are questioned. IPSS symptom scoring is done. Urodynamic evaluation is performed in patients who require RT, TIT, urea creatinine, PSA, USG/PMRI.
Treatment :

1. Follow up by waiting; watcfull waiting (ww)

2. To remove the physical obstacle (static component) of the enlarged prostate gland in the prostatic urethra, 5 a reductase enzyme inhibitors finasteride / dutasteride are used. (Used in prostates over 30-40 grams, serum psa levels are halved, free psa / total psa ratios do not change.

3. In order to overcome the dynamic component of increased smooth muscle tone in the prostate stroma, a adrenergic receptors facilitate urinary flow by relaxation of prostate smooth muscle and relaxation of the bladder neck.

4. The use of plants or plant extracts in phytotherapy medical treatment. (In this group, the dwarf palm tree called sawpalmetto, the South African stargrass african plum tree, the black meadow called rye gross pollen are the most common uses.

Surgical treatment minimally invasive TUMT and TUNA laser prostatectomy plasma kinetics- bipolar technology and gold standard TURP.

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