Question

Jim has been waking up a lot in the might to void his bladder. He noticed that his urine stream is weak and has difficulty starting urination and his bladder does not empty the bladder when he voids his urine. What do you think Jim might be suffering from? Describe where the gland is located and how it might cause this condition. What is this glands function? What are the treatment options for his condition?

Answer 1

☆The condition mentioned is BPH(Benign prostatic hyperplasia)

☆This condition is due to enlargemwnt of prostate gland which is a fibromuscular glandular structure.

It is a walnut sized gland located between bladder and penis.

This gland secretes prostatic fluid(which is alkaline and hence helps in neutralizing vagin-al acidic pH) , a component of semen.

The muscular component of prostate helps to propel semen wit sperm in forward direction.

BPH is caused due to enlargement of medial lobe of prostate. and in terms of zone it arises from transitional zone.

This lobe get enlarged and compresses urethra i.e. narrows prostatic urethra which leads to incomplete evacuation of bladder.

Main pathology is in excessive conversion of testosterone into dihydroxytestosterone and increase smooth muscle tone of prostatic urethra.

Treatments:

1st line:medical management

2 classes of drugs are used

1.alpha adrenergic blocker(acts on dynamic component of prostate-related to smooth muscle tone ) e.g.prazocin tamsulosin

2. 5-alpha reductase inhibitor(acts on static component of bph- related to enlarged prostatic tissue)e.g.finesteride -prevents the conversion of testosterone into dihydrotertoaterone

If there is associated complications then wole go for surgical management

1.TURP:transurethral resection of prostate(gold standard)

2.Milin's retropubic prostatectomy.

3.Freyer's operation.