INTRODUCTION

Background of the Study

When the hair becomes grey and scanty when a speak of earthly matter

begin to be deposited in the tunica of the artery and when a white gene

is found at the margin of the cornen at this same period the prostate

gland usually might perhaps say invariably becomes increased in size

(Brodier 1981).

The prostate gland is a fibrous muscular organ that lies just inferior to

the bladder. The normal size is 20g approximately by weight and

contains the prostatic urethra. It is supported anteriorly by the urogenital

diaphragm. The ejaculatory ducts exit at the posterior portion of the

prostate across the vericmontanun a

mount within the prostate gland.

The prostate has a peripheral a central and a transitional zones and

anterior and a prostatic sphincter zone (Mattox 1990).

Benign Prostate Hypertrophy also known as Benign Prostatic

Hyperplasia (BPH) simply is the enlargement of the prostate gland this

develops from the periurethral gland at the site of the medium or lateral

lobes is a histologic diagnosis character.

The prostate increases in size from the age of 40 but no definite

aetiological factors have been identified although lynches do not

develop prostatic enlargement provided that they are castrated before

puberty. Enlargement of the prostate is as a result of hyperplasia of

perineal glandular tissue forming adenoma in the central and middle

lobes which are readily recognizable at cystoscopy. According to

Leveille (2009) BPH is active as a histologic diagnosis characterized by

proliferation of the cellular accumulation and gland enlargement may

result from epithelial and stromal proliferation impaired preprogrammed

cell death (apoptosis) or both. The hyperplasia presumably results in

enlargement of the prostrate that may restrict the flow of urine from the

bladder otherwise known as bladder outlet obstruction (BOO)

The outer zone of normal prostatic tissue is gradually compressed to

form the “surgical capsule” which surrounds the adenomas and the

whole is further surrounded by a tough fibrous capsule through which it

receives its blood supply. This adenomatous prepondernce produces

large discrete nodular hyperplasia with prostates often weighing more

than 100g.

In the presence of infection or fibromuscular hyperplasia the gland is

usually small and a prostatic abscess may form infarcts and the

subsequent oedema may cause transcient enlargement of the gland

sufficient to cause urethral obstruction (Baw et al 1985). It have shown

that out flow tract symptoms in many men may change very little over a

5 years period and they have shown how valuable a urinary flow rate

can be to sort out the significance of obstructive symptoms.

Stones or a thick walled bladder may be noted on the control film and

examination of the full bladder gives valuable information about the

degree of trabculation and the presence of suckles and deverticular from

which an assessment of the degree of obstruction can be made (Marshal

et al 1991). The relief of chronic bladder outlet obstruction (BOD) is

usually followed by an osmotic duresis and increased sodium excretion

due to tubular damage and therefore careful monitoring of urine output

and fluid intake together with frequent estimations of blood urea and

electrolytes is required (Chislom 1982).

According to Moore (2009) the voiding dysfunction that results from

prostate gland enlargement and bladder outlet obstruction (BOO) is

termed lower urinary track symptoms (LUTS) with the following

symptoms:

● Urinary frequency

● Urgency

● Nocturia (getting up at night during sleep to urinate)

● Decreased or intermittent force of stream or a sensation of

incomplete emptying

● Leaking or dribbling of urine

The causes of the disease is not clear several hormones including

testosterone dihydrotestosterone and estrogen are required for BPH to

develop but those hormones alone do not cause the condition. Some

experts believe that a family history of the condition increases a man’s

risk of developing BPH (Brain 2008).

As the adenoma enlarges the urethra becomes obstructed as the lumen

narrows. Initially the bladder is able to compensate for the urethral

obstruction and detruso hypertrophy takes place in order to increase the

voiding pressure and maintain the same flow. This is the stage of

compensated outflow obstruction. If the obstruction is unrelieved further

muscular hypertrophy occurs and the bladder appears coarsely

tribeculated. Gaps occur between the trabecular folds and mucosal

herniation may occur initially as saccules which eventually progress to

deverticular containing chronic bladder outlet obstruction (BOO).

As the bladder decompensate the ditrusol muscles becomes less

efficient and the bladder fails to empty completely. The pressure of

residual urine carries the risk of urinary infection and stone formation.

A large residual urine e.g. greater than 1000mls may lead to progressive

upper tract obstruction. Dilatation of the ureters and perlvic calusal

systems occurs resulting in obstructive renal failure due to atrophy of

nephrons caused by raised intra renal pressure which may in turn

produce metabolic problems.

The implication of this condition in respect of socio economic life of the

individual is very serious and constitutes a serious threat to the individual

contribution in the society.

According to Croatica (2007) study results showed only some BPH

symptoms influence the quality of life. The feeling of incomplete bladder

emptying two urination intervals of less than 2 hours weak urine

stream nocturnal urine frequency and dribbling of urine showed a

significant correlation with quality of life. Data analysis showed the

mean patient age to be 65 years and mean duration of disease

symptoms 8 years. These age group in the society have a lot to

contribute in the socio-economic development. Symptoms like dribbling

of urine constitutes a very serious psychological problems to them which

they feel very shy and contribute there quota to the society or community

they belong.

Jos University Teaching Hospital first start as a general hospital 1973

which the name was later changed to Murtala Mohammed Hospital in

1976 then to JUTH in 1982 as it was leased to the management by the

state government which it took off with the following departments:

● Surgery

● Ophthalmology

● Obstetric and gynaecology (O & G)

● Psychiatric etc

Those patients with the condition of BPH were attended at the surgery

departments under Dr. Yeboah and later by Dr. Ramjil and Dr. Dakum

who are consultant urologists.

The prevalence of BPH among people living in Jos is common as can be

seen by the reported cases in Jos University Teaching Hospital Jos.

Statement of the Problem

Every individual particularly the adult has the basic right to live in his

society and be able to contribute effectively his quota in the

socio-economic development of his society without embarrassment of

any sort from disease condition by affecting is his quality of life (Soldo

2007). In view of this backdrop Jos University Teaching Hospital has

been making frantic effort over the years to find out the predisposing

factors responsible for BPH.

However these complaints are not ascertained through any empirical

study. therefore the problem of the study is the need to find out the

predisposing factors responsible for BPH.

Purpose of the Study

The purpose of the study is to determine factors responsible for BPH

among patients at Jos University Teaching Hospital Jos.

The specific purpose of the study are:

1) To determine the predisposing factors responsible for BPH

2) To determine whether age has influence on the factor responsible

for BPH

Significance of the Study

i) The researcher believes that the findings of the study will be useful

to the management of Jos University Teaching Hospital and

government of the neigbouring states where the patients come

from.

ii) It will assist the hospital in making their health policies

iii) It will assist the hospital in planning

iv) It will be useful to the hospital for teaching and impacting

knowledge to the students.

Research Questions

1) What are the factors responsible for BPH among patients

attending Jos University Teaching Hospital?

2) How does age range have influence on the factors responsible for

BPH?

Hypothesis

There is no significant differences in the mean responses of patients

between the ages 40-60 and 80 years attending J.U.T.H. for the

treatment of BPH.