Content

Introduction

Prostatic hypertrophy is a very common condition over the age of 50.

It manifests itself as a benign enlargement of the prostate: a small gland present only in men, located below the bladder, which produces part of the seminal fluid (sperm). The increase in the size of the prostate gland normally occurs with advancing age and is determined by various factors, mainly by the effect of hormonal imbalances.

Also called benign prostatic hyperplasia (IPB or BPH from English Benign Prostatic Hyperplasia), can cause annoying disturbances (symptoms) such as, for example, the need to urinate frequently even at night, the low "power" of the jet. If not treated in time, it can worsen to the point of completely stopping urine output (urination). This can lead to urinary tract problems and kidney complications.

It is estimated that a "high percentage of men over 65 years of age suffer from severe urinary disorders related to prostatic hypertrophy." In particular, if the prostate becomes enlarged, it can put pressure on the bladder and urethra (the tube through which urine passes), causing:

  • difficulty starting to urinate
  • frequent need to urinate
  • difficulty in completely emptying the bladder

In some men, the symptoms are mild and do not require special treatment. In others, they are very annoying and greatly affect the quality of life.

Many people worry that having prostatic hypertrophy may increase the risk of developing prostate cancer.This is not true, as this risk does not increase compared to men who do not have prostatic hypertrophy.

Symptoms

Prostatic hypertrophy can manifest itself with urinary disorders that significantly compromise the quality of life.

Consistent enlargement of the prostate can cause difficulty urinating (difficulty urinating) because it compresses the urethra (the last tract of the urinary tract) forcing the bladder to work hard to expel accumulated urine. Consequently, over time, the bladder weakens, becomes less efficient, does not empty completely and the residual urine that remains inside facilitates the appearance of infections or the formation of stones.

The most frequent symptoms (symptoms) are:

  • difficulty starting to urinate
  • reduced or intermittent urine flow
  • effort to urinate
  • need to urinate frequently, both during the day (pollakiuria) and at night (nocturia)
  • feeling of incomplete emptying of the bladder after finishing urination
  • sudden need to urinate, such as to cause incontinence
  • difficulty in completely emptying the bladder
  • possible presence of blood in the urine (hematuria)
  • terminal dripping (a few drops of urine keep coming out)
  • acute retention of urine, that is to say a real "block" of urination (in the most serious cases)

Other complications can be:

  • bladder stones
  • bladder and urinary tract infections
  • kidney damage

Any presence of blood in the urine must be analyzed by the doctor to rule out the existence of other more serious diseases.
It is therefore advisable to consult your doctor if you notice problems or changes, even slight ones, in the usual way of urinating.

Causes

Precisely the causes of prostatic hypertrophy are not known. In elderly men it is believed that the variation of the hormonal balance (andropause) may be important.More precisely, the relationship between androgens and estrogens in favor of the latter could favor the enlargement of the prostate gland.

Hemodynamic factors, i.e. the regulation of blood flow in blood vessels, can also cause a local increase in pressure, could also play a role in inducing an increase in testosterone concentration. This male sex hormone is converted into dihydrotestosterone (DHT), a hormone which could in turn be involved in the increase of prostate cells at the base of the hypertrophy.

Some studies also show a hereditary predisposition to the development of prostatic hypertrophy.

It has been hypothesized, but not yet definitively confirmed, that benign enlargement of the prostate, benign prostatic hypertrophy, may be more common in men with hypertension or diabetes.

Risk factors for prostatic hypertrophy include:

  • aging, Enlarged prostate rarely causes discomfort before the age of 40. Moderate to severe complaints appear in about one third of men from the age of 60 and about half manifest them from the age of 80 onwards
  • family historyhaving a relative, such as a father or brother, with prostate problems increases the likelihood of developing prostatic hypertrophy
  • diabetes and heart disease, studies show that diabetes, as well as heart disease and the use of beta-blocker drugs, could increase the risk of prostatic hypertrophy
  • lifestyle, obesity increases the risk of benign prostatic hypertrophy while physical activity can reduce it

Diagnosis

In case of suspected prostatic hypertrophy, a thorough clinical investigation is important to rule out any other diseases. The family doctor will ask for specific tests, some of which will be performed by a urologist (a doctor who specializes in urinary tract problems).The symptoms of BPH are similar to those of other diseases, including prostate cancer. It will therefore be up to the doctor to exclude them.

International prostatic symptoms score (IPSS) questionnaire

This is the test to calculate the score (IPSS) which allows an objective evaluation of the disorders by answering 8 questions:

In the last months:

  1. how many times have you had the feeling that your bladder was not completely empty after urinating?
  2. how many times have you had to urinate again, less than two hours after your last urination?
  3. how often has it happened during urination that you stop and start urinating several times (urinating several times)?
  4. how often have you found it difficult to postpone (delay) urination?
  5. how many times have you had a weak urinary stream?
  6. how many times have you had to push or strain to start urinating?
  7. How many times did you have to get up during the night to urinate?

Quality of life index:

  1. if you were to spend the rest of your life with your current urinary condition, how would you feel?

Each question in the test can be given a value from 0 (mild disturbance) to 5 (important disturbance). The total of the points will indicate the severity of the symptoms:
0-7 mild
8-19 moderate
20-35 severe

Rectal exam

The doctor, wearing a glove, gently pushes the index finger, well lubricated, through the anus until it reaches the rectum in order to palpate, through its wall, the surface of the prostate, which is adjacent, and check for any anomalies. The procedure is slightly annoying, but not painful. It is recommended to perform the examination every year from the age of 50.

Urinalysis

The analysis of a urine sample, with the execution of urine culture, allows to exclude any infections of the urinary tract, or of the bladder, capable of causing disorders similar to benign prostatic hypertrophy.

PSA test

It consists of measuring, by means of a blood test, the amount of PSA (prostate specific antigen), a protein produced by the prostate. Elevated PSA values ​​indicate enlargement of the prostate and must be interpreted correctly to rule out the presence of cancer. However, the PSA test alone cannot provide certainty as its values ​​may also vary due to recent infections. or surgery The test should not be done after having sexual intercourse.

Transrectal ultrasound (TRUS)

It allows to detect the size and possible pressure of the prostate on the urethra and bladder. The execution of the transrectal ultrasound requires that an ultrasound probe is inserted into the rectum (usually with a full bladder) and, through the emission of sound waves, provides a detailed image of the prostate allowing to verify its size and structure. It is an important investigation especially for the purpose of a possible surgery and can also be used to evaluate the possible presence of prostate cancer.

Uroflowmetry

It is a "simple and non-invasive investigation capable of studying and evaluating the flow of urine during its emission (urination). It consists in" urinating in a special instrument (flow meter) similar to a normal toilet bowl but which, in reality, through an electronic technology, it allows to measure the urine flow (the “power” of the jet) moment by moment and to reproduce it in graphic form.

Prostate biopsy

Prostate biopsy is an examination aimed at taking numerous small samples of prostate tissue, subsequently observed under an optical microscope to confirm, or exclude, the presence of a tumor.

UroTAC

Investigation used to carry out an "analysis of the shape and function of the urinary tract.It is performed with a CT scan of the abdomen by injecting iodinated contrast fluid (radioactive dye opaque to X-rays that allows you to view the urinary tract) into a vein. It can be used to check for blockages (kidney stones) in the urinary system or to detect any damage.

Cystoscopy

Investigation aimed at seeing the inner walls of the urethra and bladder. It is used to identify any abnormalities and take tissue samples to be analyzed. The cystoscope (thin, flexible and illuminated tube) is slowly inserted into the bladder through the urethra. The examination is performed under local anesthesia.

Therapy

Treating prostatic hypertrophy helps to reduce disorders, improve quality of life and avoid long-term complications, such as: urinary retention, bladder stones and chronic renal failure.

There are several effective treatments (therapies): drugs, minimally invasive therapies and surgery. To choose the best strategy to follow, the doctor is based on the severity of the disorders (symptoms), their impact in daily life, the size of the prostate, the general health conditions and preferences of the person affected by prostatic hypertrophy, as well as the possible risks and benefits of different treatments Avoid drug therapies without consulting your doctor (read the Hoax).

If prostatic hypertrophy is not treated it can cause episodes of acute urinary retention (not being able to urinate in any way) due to the complete obstruction of the urethra by the enlarged prostate. In this case, only the insertion of a bladder catheter by a healthcare professional will allow the bladder to be emptied.

The three main treatments of prostatic hypertrophy are:

  • lifestyle changes
    in case of mild and moderate ailments it is not necessary to undergo any immediate medical treatment.It will be sufficient to carry out regular checks to check (monitor) carefully the prostate over time. Likely, a lifestyle change, limiting caffeine and alcohol consumption, could also help reduce discomfort.
  • pharmacological therapy
    Medication, associated with a better lifestyle, is usually recommended for the treatment of moderate to severe ailments. This is a long-term therapy which, depending on the case, may be sufficient to reduce the disorders (symptoms). It is based on drugs, which require a prescription. The commonly used are finasteride and dutasteride. They are used to block the effects of a hormone (dihydrotestosterone - DHT) in the prostate and tend to slightly reduce the size of the gland (including 10 and 15%) improving the discomfort. These drugs, especially at the beginning of the treatment, can cause some undesirable effects; among the most relevant: impotence and decrease, or absence, of sperm. In many cases, these effects improve as the body gets used to the drug. It is good, however, to consult your doctor if side effects are worrying. Treatment with alpha-adrenergic blocking drugs (the most common tamsulosin and alfuzosin) can also help relax the bladder muscles, making it easier to urinate. In this case, the most frequent, usually mild, undesirable effects (side effects) are: changes in blood pressure, dizziness and tiredness. Pharmacological treatments usually show their first effects after a few weeks of therapy and it can take several months to achieve maximum results. Their use must always take place under prescription and continuous medical supervision
  • surgery
    surgery is used only in the presence of serious disorders caused by prostatic hypertrophy and in the case of ineffectiveness of drug therapy.In endoscopy, the most common intervention is trans-urethral endoscopic resection of the prostate (TURP). It involves introducing, through the urethra, an instrument (resector) that removes the enlargement (adenoma) of the prostate, excavating a sort of tunnels to facilitate the emission of urine (urination). Performed under general or spinal anesthesia, it is a minimally invasive procedure that requires a few days of hospitalization. Convalescence lasts a couple of weeks, during which it is good to refrain from excessive effort such as, for example, driving vehicles, because they cause vibrations, lifting weights and practicing sports. Still in endoscopy, as an alternative to TURP, other types of interventions can be performed with new laser models, further limiting the invasiveness of the operations. This offers long-lasting results also allowing to reduce: hospitalization times, use of the post-operative catheter (24-48 hours), blood loss even in people at greater risk, post-operative discomfort and irritation. In the case of a large prostate it is necessary to intervene with other surgical techniques such as the "Trans-vesical prostatic adenectomy (ATV) or, endoscopically, with the" Enucleation of the Prostate with Holmium Laser (HoLEP), a surgical technique that uses of the use of a laser fiber through which the "enucleation" of the adenoma is carried out, which will be pushed into the bladder and reduced into small fragments and then aspirated outwards using a special tool)

Prevention

In the prevention of prostatic hypertrophy the general rule is: what is good for the heart is also good for the prostate. Proper nutrition is a fundamental starting point because it regulates intestinal function and avoids both the appearance of chronic constipation and diarrhea, irritating to the prostate.

It is advisable:

  • practice regular, moderate exercise such as, for example, walking 30 to 60 minutes a day
  • follow a healthy diet, rich in fruit and vegetables. Among the recommended foods, tomato: the lycopene contained within it, in fact, has beneficial properties in protecting the health of the prostate
  • limit the consumption of fatty foods and red meats
  • moderate, especially for those who already suffer from frequent prostate irritation, the use of foods that inflame it such as: chilli, beer, sausages, spices, pepper, cheeses and fried foods
  • contain or eliminate the intake of alcoholic beverages
  • avoid drinking too much water, or other fluids, in the evening to reduce the need to urinate at night
  • always try to empty your bladder completely: It may be helpful to urinate while sitting
  • drink at least two liters of water a day, in small and frequent sips, over the course of 24 hours

Prevention for benign prostatic hypertrophy is more important than ever to prevent it from progressing and causing blockages and damage to the bladder that make surgery necessary.

Useful tips

To help reduce the complaints (symptoms) caused by an enlarged prostate, you should try to:

  • decrease the consumption of beverages in the evening, do not drink anything for an hour or two before going to bed to reduce the likelihood of waking up during the night to urinate (nocturia)
  • anticipate the time of taking drugs with diuretic activity (which result in an increase in urine production), to avoid having to get up during the night to urinate
  • limit the use of alcohol and caffeineBy increasing urine output, they can irritate the bladder and worsen ailments
  • reduce the use of decongestant drugs and antihistamines, these medicines help to narrow the bundle of muscles around the urethra that controls the flow of urine, making it more difficult to pass
  • try to urinate as soon as you feel the urgeA very long wait could strain the bladder muscle too much and cause damage
  • try to urinate at regular intervals, every four to six hours during the day. This can be particularly useful in cases of severe frequency and urgency of the urge to urinate
  • follow a healthy diet, in fact, obesity is associated with an enlarged prostate
  • stay active, physical inactivity contributes to urinary retention. Even a small amount of daily exercise can help reduce the problems caused by prostatic hypertrophy
  • try to limit exposure to low temperatures, the cold, in fact, can cause retention and increase the urge to urinate

Natural remedies

In the event that you decide to resort to remedies of "natural" origin, it is important, and necessary, to inform your doctor. In fact, no phytotherapeutic extract for benign prostatic hypertrophy should be taken without medical supervision as some herbal or fruit products could increase the risk of bleeding or interfere with pharmacological treatments already in place. It should also be considered that some of these "remain" they contain phytohormones and are real drugs.

Bibliography

Mayo Clinic. Benign prostatic hyperplasia (BPH) (English)

NHS. Benign prostate enlargement (English)

San Raffaele Hospital, Milan. Hypertrophy of the prostate

Humanitas Research Hospital. BPH

Humanitas Mater Domini. Benign prostatic hypertrophy (BPH)

Biomedical Campus University of Rome. Benign prostatic hypertrophy: useful information for patients

Italian Auxological Institute - IRCCS. Prostatic hypertrophy

Niguarda Hospital. Prostate cancer

In-depth link

Umberto Veronesi Foundation. Magazine. Benign prostatic hypertrophy: the enemy is inflammation

Umberto Veronesi Foundation. Magazine. What to do for a healthy prostate?

Emilia Romagna region. Regional health and social agency.BPH. Benefits and Risks of Available Medicines

Italian Society of Urology (SIU). BPH

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