Tips and recommendations for benign prostatic hyperplasia

The prostate is a gland of the male reproductive system located between the rectum and the urinary bladder that is responsible for producing prostate secretion, which is part of the composition of seminal fluid and to which it provides enzymes and nutrients for sperm, among other components.

The prostate consists of two areas, a peripheral one called the capsule and a more internal one that is organized around the urethra. When cells proliferate in this central area, the prostate enlarges and compresses the urethra, making it difficult for urine to flow out. This fact is what is known as benign prostatic hyperplasia or prostatic adenoma.

How is it produced?

Benign prostatic hyperplasia affects most men to a greater or lesser degree throughout their lives. Between 80% and 95% of men over 80 years suffer it.

It is considered that the stimulus of androgens is what makes the proliferate prostate tissue and therefore increase the size of the prostate. The prostate begins to increase in size towards the fourth decade of life and with the passage of time this increase in size and the proliferation of the tissue accelerate. The balance between estrogen and testosterone levels also appears to influence the development of benign prostatic hyperplasia.

Symptoms

When the prostate begins to enlarge the patient does not have any symptoms. As the prostate tissue that surrounds the urethra grows, the pressure exerted on it increases, so that the detrusor muscle, in charge of contracting the urinary bladder to facilitate the exit of urine during urination, must exert more force to overcome the urinary bladder. pressure from the urethra and allowing urine to flow out.

As the prostate grows and the urethra is put under more pressure, the detrusor has to exert more force, with which in the long run the muscle fibers lose their contractile capacity and the emission of urine becomes difficult. It is at that moment when the symptoms of benign prostatic hyperplasia are established. The patient refers a delay in starting urination despite wanting to urinate. By decreasing the emptying capacity of the bladder, the stream of urine comes out with less force and its caliber also decreases. The urination time is lengthened, at the end there is a drip and sometimes the patient is left with the sensation that the bladder has not been completely emptied. The set of these symptoms is what is known as prostate syndrome and is a consequence of this difficulty in overcoming the pressure that the enlarged prostate exerts on the urethra.

If it is not remedied, the prostate continues to grow and the bladder cannot empty, with which the symptoms described above worsen. In addition, symptoms of bladder irritation appear, such as frequency, nocturia, urgency or urgency to urinate.

If the urethral duct narrows due to external compression, there may come a time when the detrusor cannot overcome the pressure and cannot empty the bladder, so that urine accumulates in it, leading to acute retention. urine.

If the obstruction persists, the failure to properly empty the bladder can lead to retrograde involvement of the ureters and reach the kidney, producing obstructive renal failure.

Diagnosis

Benign prostatic hyperplasia should be suspected in anyone who present the symptoms described previously: delay in the onset of urination, decreased caliber and force of the urine stream, sensation of incomplete emptying, dribbling after urination and symptoms of bladder irritation.

It is essential for the diagnosis to perform a correct exploration of the patient that includes digital rectal examination. This simple maneuver will allow us to appreciate the size, consistency and relief of the prostate and differentiate it from a possible prostate carcinoma. In benign prostatic hyperplasia this is seen homogeneously enlargedIt is not painful to the touch and its consistency is rubbery, without indurated areas (which would suggest a possible source of prostate cancer).

Ultrasound will allow the size of the prostate to be assessed, which will allow better programming of the surgical approach if it has to be carried out.

In the blood test, no specific alterations of benign prostatic hyperplasia appear. The prostate specific antigen (PSA) does not usually exceed 4 ng / liter and there is no correlation between prostate size and PSA levels. If it is elevated, it is more likely to think of possible prostate cancer, especially if the levels exceed 10 ng / liter.

It is advisable to carry out a urodynamic study to assess the magnitude of the obstruction of the urinary tract, which will allow for more evidence to choose a conservative or surgical treatment, as well as to monitor the treatment.

Treatment

Treatment of benign prostatic hyperplasia can be medical or surgical depending on the severity of the symptoms. When these are not very limiting, pharmacological treatment will be started.

Phytotherapy, drugs containing plant extracts such as seem to work with mild symptoms, although it is not known exactly by what mechanism.

The alpha blockers (doxazosin, alfuzosin, tamsulosin, ...) act by relaxing the musculature of both the prostate and the neck of the bladder, reducing resistance to urine output. They do not alter PSA levels, but can cause hypotension.

The hormone therapy allows to decrease the production of a form of testosterone that is necessary for prostate growth. It improves symptoms but alters PSA levels (which can mask possible prostate cancer) and can lower libido and alter erectile function.

Surgery is the best option for patients who have not responded to medical treatment or have severe symptoms, such as hematuria, recurrent infections, urinary retention episodes, or kidney involvement. The surgical approach can be through a transurethral resection, through the urethra, or with open surgery, depending on the size of the prostate to be removed. It should be said that in these surgical acts the prostate capsule is not removed, the external area of ​​the prostate in which prostate cancer usually occurs, so that the patient may suffer from this disease in the future.

Today there are other resection techniques based on the use of laser or radiofrequency that are applied through the urethra and that present good results. These techniques may be advisable for young patients, due to the lower risk of impotence or incontinence that they entail, or for patients taking anticoagulants, since the risk of hematuria with these techniques is lower than with open surgery or transurethral resection of the prostate.

Precautionary measures

There are few preventive measures regarding benign prostatic hyperplasia. However, keep a proper urination habit, that is to say, trying not to retain urine unnecessarily, it allows to keep the detrusor in shape, which will facilitate urination and delay the appearance of symptoms in case of suffering from prostatic hyperplasia.

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