Benign Prostatic Hyperplasia (BPH) is one of the most frequent pathologies due to the fact that it conditions the life of patients because of all the discomfort it causes them.
This prostatic growth obstructs the exit of urine from the bladder and causes that its emptying does not occur in an effective way. Normally the patient begins to have some symptoms after the age of 45, noticing that the urinary stream becomes thinner or that he/she gets up sometime during the night to urinate.
These symptoms may increase with age, and it is from the age of 50 onwards that they increase in severity, including urinary urgency (urge to urinate) and a significant decrease in the strength of the urinary stream.
However, not all patients notice changes because their bladder compensates for the situation and tries to keep everything unchanged, but there comes a time when the force of bladder contraction fails to compensate and the patient notices more clearly all the symptoms produced by the growth of the prostate.
How do we evaluate patients in the prostate consultation?
The clinical history is the main thing. A good interrogation is basic to understand the patient’s symptoms and to be able to understand where his problems may originate from (not everything is due to prostate growth).
After this, a physical examination is performed in which the genitals are evaluated and a rectal examination is performed, since it provides us with a lot of information.
It is also necessary to evaluate the orifice of the penis through which urine comes out and to rule out that it is not closed.
After the history and physical examination, the patient undergoes more specific tests to gather additional information about the possible origin of the patient’s symptoms.
These tests are:
- Bladder ultrasound: indicates the state of the bladder, if there are tumor lesions or lithiasis (stones) inside the bladder that could cause discomfort and changes in the patient’s voiding pattern.
- Prostate ultrasound: determines the size of the prostate and its weight, which helps us to determine the best form of treatment for the patient.
- Flowmetry: consists of performing a urination in the office in a device that translates the quality of the micturition stream (measured in ml/sec), the type of curve that makes that urination and the time it takes to start and finish it.
- Measurement of the post voiding residue: it defines how much urine remains in the bladder after voiding. Depending on the amount, we will know if the prostate growth is affecting bladder emptying, if the treatment performed has been effective or if it indicates that the patient should be operated on.
How is a patient with urinary symptoms of prostatic origin treated?
In patients with mild symptoms, it is enough to improve their habits and reduce the intake of liquids before bedtime, especially coffee.
In the case of patients with more severe symptoms, treatment can be started to improve both bladder emptying and urinary urgency.
And if the symptoms persist, despite medication and changes in habits, the possibility of surgical resolution will be considered.
What current methods are used?
Today, the so-called transurethral resection of the prostate, although still performed, has been replaced by faster methods, with fewer complications, less bleeding and a high success rate.
Other more current techniques are:
- Holmium laser enucleation of the prostate (HOLEP): consists of removing all the prostate tissue obstructing the patient with a laser shot. It is used for large prostates (usually larger than 80 grams). The functional results are excellent. With this technique a sample is obtained to analyze the extracted tissue.
- Photovaporization with green laser (Green Light): consists of vaporizing all the prostate tissue that obstructs the patient. It is a technique in which the patient practically does not bleed and his recovery is very fast. With this technique no tissue is obtained for analysis. The ideal prostate size for this procedure is a maximum of 60-70 grams.
- Water vapor ablation of the prostate with the Rezüm system: consists of eliminating obstructive prostate tissue with water vapor. It is an ambulatory technique and is performed in 15 minutes. It is used for prostate up to 50 cc. Normally performed in young patients who want to keep the ejaculate.