The prostate is a man-specific gland that is located below the urinary bladder. It develops from puberty and reaches a size of about 20 grams to fulfill a primarily sexual function. In fact it is responsible for producing substances that make the ejaculate more fluid.
Benign prostatic hyperplasia
The prostate, over time, undergo a series of changes in its structure that increase its size and alter the shape. This modification is a result of the age and the action of the male hormones, known as benign prostatic hyperplasia. Such growth slowly obstructs the exit of the bladder and progressively changes the way of urinating. Thus this obstruction reduces the force of the jet, forces pressure on the muscles of the abdomen to urinate and causes an annoying drip upon completion. Over time, urination becomes short and it is necessary to evacuate the urine in two or three attempts.
Since the bladder works against a resistance can alter its structure and functioning, appearing the urge to urinate (urgency), the feeling of incomplete emptying (tenesmus), the need to get up several times to urinate at night and even the impossibility of urination (urine retention). Urine infections, facilitated by the fact that the bladder never completely empty, or bleeding while urinating (hematuria) may appear at any time. In more advanced cases, the bladder is unable to empty and accumulates large amounts of urine, facilitating progressive deterioration of the kidneys.
Some or several of these symptoms appear, to a greater or lesser degree, in a quarter of 55-year-old males and half of those who reach 75 years. In fact it is estimated that almost one third of all men will need to have surgery at some point in their life to solve the problems that this prostate growth poses.
Diagnosis of Benign Prostatic Hyperplasia
The slow onset and progression of symptoms and the frequency with which they appear make us consider "normal" alterations in the way we urinate. Therefore, we sometimes consult the family doctor or specialist. In addition, it is necessary to say that other diseases such as prostate cancer cause the same symptoms already commented. Therefore, it is considered advisable that men over 45 or 50 years old with voiding symptoms come to their specialist to undergo periodic reviews.
The Committee of Experts on BPH considers it appropriate to carry out a "measurement" of symptoms using a questionnaire already agreed upon by specialists, a rectal examination, as well as blood tests of kidney function and a basic urinalysis. The urologist will recommend, in each specific case, to extend the diagnosis by performing an ultrasound, flowmetry (measurement of urine output per unit of time) or determination of PSA (prostate specific antigen) among others.
Treatment for Benign Prostatic Hyperplasia
There is a wide range of possibilities for the treatment of BPH. In most cases a correct follow-up or use of a pharmacological treatment will be enough to alleviate the problems. However, all specialists agree on the need for surgical intervention in cases of acute retention of urine, urinary tract infections, repeated bleeding, or bladder stones arising from the obstruction.
Apart from these assumptions, the indication of an intervention will derive from the lack of response to the pharmacological treatment and from the alteration that the disease causes in the quality of life of the one who suffers it.
- Drugs that reduce resistance in the bladder neck and in the portion of the intra prostatic urethra (alpha-blockers) that decrease prostate size (alpha reductase inhibitors) are used for medical treatment. or combinations thereof. All of them have a common purpose to reduce the obstruction that prostatic growth causes.
- The surgery is performed by two basic procedures, depending primarily on the size of the prostate.
o In the case of bulky glands it has traditionally been necessary to perform "open" surgery (adenomectomy) for removal. However, laparoscopic enucleation is now being introduced successfully.
o Intervention through the urethra, without the need to perform an external wound (transurethral resection RTU), is reserved for glands of size no larger than 60-70 gr., and consists of removing the prostate fragmented by means of a electric cutting handle. In very specific cases a single longitudinal cut of the prostate and bladder neck (TCP or prostatic trigonocervicotomy) is sufficient. However, transurethral procedures have now been developed from the hand of high energy sources (laser). Holmium laser enucleation is able to successfully treat voluminous prostates with results comparable to adenomectomy. The green laser allows the treatment by means of vaporization of prostates until 100 cc. with safety and good results.
The results of the different procedures indicated are similar, and the risks have to be determined and explained by the specialist for each individual case.