Benign prostatic hyperplasia

1. What is benign prostatic hyperplasia?
2. Prognosis of the disease
3. Symptoms
4. How is it diagnosed?
5. What are the causes?
6. Prevention
7. How is it treated?
8. Who is in charge of treatment?

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, also known as enlarged prostate gland, consists mainly of an enlargement of the prostate gland, which is common as men get older.

This enlargement of the prostate gland generates the appearance of annoying urinary problems, such as a blockage of the flow of the bladder, problems in the kidneys, urinary tract or bladder.

Prognosis of the disease

Benign prostatic hyperplasia is not a serious disease; in fact, it is believed that prostate enlargement does not increase the risk of prostate cancer.

However, enlargement may involve a number of complications:

• Inability to urinate, i.e. urinary retention. A catheter may be used to empty the bladder. In some cases, surgery is necessary.
• Urinary tract infection: the inability to completely empty the bladder may increase the risk of urinary tract infection.
• Bladder stones: due to the inability to empty the bladder.
• Bladder damage – by not emptying, the bladder can become stretched and weakened, preventing the bladder from contracting properly.

However, most men with hyperplasia will not manifest the above complications.

Symptoms of benign prostatic hyperplasia

Individuals with hyperplasia may experience a number of symptoms. Their severity varies, although the tendency is for symptoms to worsen over time.

Some common symptoms of this disease are:

• Frequent urination
• Increased frequency of urination during the night
• Difficulty starting urination
• Weak urine flow
• Dribbling after urinating
• Inability to completely empty the bladder.

Occasionally, the above symptoms are accompanied by urinary tract infection, inability to urinate and the presence of blood in the urine.

Benign prostatic hyperplasia is not a serious disease.
is not a serious disease

Medical tests for benign prostatic hyperplasia

There are different tests to diagnose hyperplasia. They are as follows:

• Digital rectal examination
• Urinalysis
• Blood tests
• Blood tests for prostate-specific antigen: this antigen is a substance produced in the prostate, and when the prostate increases in size, so do the levels of antigen.

In turn, there are additional tests that can help this enlargement:

• Urinary flow test
• Post-void residual urine test
• 24-hour voiding diary

In case the disorder is estimated to be more complex, it is recommended:

• Transrectal ultrasound
• Prostate biopsy
• Urodynamic and pressure flow studies: consists of the insertion of a catheter through the urethra until the bladder is reached. The pressure in the bladder is measured, and thus it is known how the muscles work.
• Cystoscopy

What are the causes of benign prostatic hyperplasia?

It is normal for the prostate to progressively increase in size over the years. However, in a large group of men, this continuous growth enlarges the prostate to the point of causing some symptoms that can impair and influence the quality of life of the sufferer.

Although the exact origin of this enlargement is not known, it is believed to be due to the balance of sex hormones over time.

In turn, there are some risk factors for prostate gland growth:

• Aging
• Family history
• Diabetes
• Heart disease
• Obesity

Can benign prostatic hyperplasia be prevented?

The best way to prevent hyperplasia is to avoid risk factors. Obviously, you cannot avoid getting older or fight against family history, but you can maintain a healthy lifestyle that, together with regular exercise, allows the patient to be at an adequate weight.

Treatment of benign prostatic hyperplasia

There are various ways of dealing with hyperplasia, although the treatment chosen will vary depending on the patient’s characteristics: age, health and size of the prostate, as well as the level of discomfort suffered.

If symptoms are tolerable, treatment can be postponed until symptoms worsen.

• Medications: there are medications that help to moderate the presence of symptoms, and are used when the patient suffers mild and/or moderate symptoms. Some of them are alpha blockers, 5-alpha inhibitors, a combination therapy of drugs at the same time, in case separate drugs are not effective. Tadalafil is also used, although this drug is used more to treat erectile dysfunction.

The other option is through surgery or minimally invasive therapies. There are several types:

• Transurethral resection of the prostate: this involves inserting an endoscope into the urethra and then removing all but the outer part of the prostate. Normally, this treatment quickly relieves symptoms.
• Transurethral incision of the prostate: after inserting an endoscope into the prostate, the surgeon will make a couple of incisions in the prostate to facilitate the passage of the urethra. This surgery is a great option when the patient has a small prostate.
• Transurethral microwave thermotherapy: an electrode is introduced through the urethra into the prostate, and once it reaches the prostate, needles are placed, which will pass radio waves to eliminate the excess prostate tissue that impedes the passage of urine.
• Laser therapy: consists of the application of a high-energy laser that removes the excess material from the prostate. Symptom relief is achieved almost immediately and has almost no side effects. There are two types of laser therapy: ablative and enucleative procedures.
• Open prostatectomy: an incision is made in the lower abdomen to remove tissue. It is performed when the prostate is very large and/or there is damage to the bladder.
• Prostate elevation: special plates are used to compress the sides of the prostate, increasing the flow of urine.
• Embolization: the blood supply to the prostate is blocked, reducing its size.

At the same time, it should be noted that almost any procedure that requires touching the prostate can cause side effects, such as the following:

• Retrograde ejaculation
• Temporary difficulty urinating
• Bleeding
• Erectile dysfunction
• Incontinence (in rare cases).

What specialist treats benign prostatic hyperplasia?

The specialist in charge of treating prostate hyperplasia and its variants is the Urology specialist.