The prostate is a gland that is part of the male reproductive system, with a hazelnut shape. It is located in front of the rectum and just below the bladder, surrounding the proximal urethra. It consists of two components: a glandular (alveolar tubule) and a supporting connective tissue stroma divided into three zones. A plant that occupies 25%, a transitional one that occupies 5% and a peripheral one that occupies 70%. Benign prostatic hypertrophy (BPH) occurs in the area surrounding the urethra (transition zone).
GROWTH: between 10 and 20 years, the highest growth occurs, reaching its normal weight of 20gr. Then it remains the same for 25 more years and then begins to increase again.
• At 60 years, 50% have histological changes compatible with BPH.
• At 80 years, 95% have compatible changes.
• 10% of patients debut with acute urinary retention.
• 25% of 80-year-old patients receive treatment for BPH.
The prostatic hypertrophy is an overgrowth of the different components of the normal gland. It is not cancer and does not represent an increased risk of prostate cancer.
Less than half of men with BPH have symptoms of the disease. These are due to compression of the urethra by excessive prostate growth and may appear in each patient with very different growths. It is the so-called prostatic syndrome:
• Slow or delayed onset of urinary flow
• Decreased caliber and force of the jet
• Elongation of the emptying
• Incomplete emptying of the bladder
• Drip after urinating
• Need for effort when urinating
In more advanced stages, another class of symptoms, called irritative symptoms, due to the alteration of the bladder function due to the excessive effort made by the bladder to counteract the obstacle to emptying by a urethral obstruction, and may also occur. These symptoms are more difficult to reverse with the treatment of BPH with BPH cure.
• Sudden and sudden urinary urgency
• Increased urination frequency
• Need to urinate 2 or more times per night
• Painful urination or bloody urine (this may indicate an infection)
Left to its natural evolution, the obstruction caused by BPH ends up overcoming the bladder's excessive effort, producing urinary retention that can occasionally lead to a deterioration of renal function.
Signs and exams
Given the high incidence of this problem after 50 years, it is recommended, from this age, regular consultation with the urologist. Generally, in order to arrive at the diagnosis, the clinic presented by the patient and a simple physical examination is sufficient. This consists of a digital rectal examination, where the doctor can feel the size and shape of the prostate gland, revealing an enlarged and firm prostate. This can also help differentiate BPH and prostate cancer, where the gland is of greater consistency. The diagnosis can be completed with other types of tests, including:
• Tests to quantify the degree of obstruction to the voiding flow.
• Measurement of the rhythm of the urinary flow.
• Studies of the flow pressure.
• Tests to evaluate the bladder and renal function and rule out another associated pathology:
• Intravenous urography or radiography plus ultrasound.
• Urinalysis to verify the presence of blood or infection.
• Urine culture to look for signs of infection.
• Prostate-specific antigen (PSA) blood test in BPH only serves to rule out prostate cancer.
• Cystoscopy to visualize the prostate and bladder if surgery is needed.
The effectiveness of any treatment is measured in two terms: improvement of symptoms and improvement in the analysis of maximum urinary flow.
The prostatic hyperplasia treatment could be divided into three areas:
Medical treatment: alpha-blockers and alpha 5-reductase inhibitors.
Minimally invasive treatment: consist of the placement of prostheses (stents) using endoscopic techniques that allow a greater caliber of the urethra during urination. They are for patients not candidates for more aggressive surgery.
Surgical treatment: radical prostatectomy, TUIP (transurethral incision), TURP (transurethral resection). Most men who undergo this surgery report improvement in the flow of urine and symptoms. The possible complications are impotence, urinary incontinence, retrograde ejaculation (semen that flows in the opposite direction towards the bladder instead of going out through the penis), infertility and urethral stenosis. The percentages of these complications vary depending on the surgical procedure that the patient and the doctor decide is the best.
The choice of the moment of intervention is based on the severity of the symptoms, and their inability to be controlled by medical treatment. The choice of the appropriate technique depends on the size and shape of the prostate. They are objective indications (independent of the symptoms) of surgery:
• Kidney injury due to obstruction (hydronephrosis)
• Bladder lithiasis
• Blood in recurrent urine
• Urinary retention
• Recurrent urinary tract infections
In summary, the choice of appropriate treatment, therefore, is based on the severity of the symptoms, the extent to which they affect the individual's lifestyle and the presence of any other medical condition. Treatment options include "await with careful vigilance", lifestyle changes, drug therapies, and surgical methods.