A few other names have been given to this condition. These are senile enlargement of the prostate, adenoma, adenomyoma, benign hyperplasia or hypertrophy and nodular hyperplasia.

Hormonal influence on the prostate

The principal hormone which act on prostate, is testosterone secreted by the leydig cells of the testis under the control of luteinizing hormone (LH)of the anterior pituitary, which is again under the control of luteinizing hormone releasing hormone (LHRH) of the thalamus. An enzyme called 5α-reductase, which is present in high concentration in prostate, converts the 5-dihydrotestosterone (DHT).

Aetiology

Though the pathology has been well established that it is a nodular hyperplasia, but its cause is not known definitely. It is a disease process with a well-defined age incidence. It is essentially a disease of old age.

Two theories have been put forward to indicate the cause of such hypertrophy of the prostate.

The Hormonal Theory

An imbalance between the androgen and estrogen may be the causative factor. It may be that the androgen diminishes as the age advances, while the quality of the estrogen is not decreased equally. So the prostate may have enlarged due to relative predominance of the estrogenic hormone. It is well established that Dihydrotestosterone (DHT) influences growth of prostate.

The Neoplastic Theory

Proponents of this theory are reducing very fast. According to this theory benign enlargement of the prostate is considered to be a benign neoplasm i.e. adenoma or adenomyoma of the gland.

Clinical Features

1. Hesitancy
2. Dysuria
3. Frequency
4. Urgency
5. Hematuria
6. Pain
7. Retention of urine
8. Renal failure
9. Prostatism

Special Investigations

1. Examination of the urine – The urine should be examined for the evidence of infection, blood and for presence of sugar (to exclude diabetes)

2. Examination of the blood – Serum urea, N.P.N. and creatinine should be performed to assess renal function besides the usual blood counts, hemoglobin estimation and E.S.R.

3. Estimation of prostate specific antigen (PSA) – PSA is a glycoprotein, whose function is to facilitate liquefaction of semen. It is now being used as a marker for prostatic disease. It is measured by immunoassay technique and the normal upper limit is about 4nmol/ml. It is more important in the diagnosis of carcinoma of prostate, in which case the level goes up to 15 nmol/ml in localized cancer to 30nmol/ml in case of metastatic cancer. However in benign hyperplasia of prostate the level goes up to 4-10 nmol/ml.

4.Straight X-RAY

5. Excretory Urography

6.Ultrasonography

Ayurvedic approach in management of BPH

BPH can be correlated with mutragranthi or Ashthila one of the type of mutraghata Charak siddhisthana 9/41,42.

Sanshodhan Chikitsa

• Avapidaka ghrutapan- Goghruta should be given before and after meal in a dose of 20-40 mL.
• Avagaha sveda (Sitz bath) for 15 days with warm water or decoctions like Dashamula.
• Matra basti with Varunadi ghruta 30-50 ml for 14 days.
• Yogabasti with alternate til teil and Dashmula kwath.

Sanshamana Chikitsa

Chandraprabhavati, Shilajitvadi vati, Vanga bhasma, Gokshuradi guggula, Varunadi kashaya, Punarnavasava are effective in the management of BPH.

Considering kaphaja nature of Mutragranthi and efficacy of Vanga bhasma in urinary disorder, vanga bhasma can be effective in the management of BPH. In the prescence of urinary tract infection associated with BPH Chandraprabhavati should be given along with varunadi kashaya. Varunadi kashaya also effective in hydronephrosis caused due to obstruction of BPH. In prescence of burning micturation Shwetaparpati should be given.