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Benign prostatic hyperplasia

The prostate is a gland in the male reproductive system. It is located in front of the rectum, just below the bladder, surrounding the urethra, which is the tube that carries urine from the bladder to the outside. Its main function is to produce a viscous fluid that binds to semen to make it fertile.

The most common disease of the prostate is called benign prostatic hyperplasia (BPH). Benign prostatic hyperplasia is a benign tumor of the prostate.

During childhood this gland is small and increases in size until it reaches its normal volume during puberty (12-14 years). From the age of 40 – 50 it can grow rapidly, leading to hyperplasia. Due to this growth, the prostate can compress the urethra, making it difficult for urine to pass and causing alterations when urinating.

Data to take into account:

  • More than 80% of the male population over 50 will receive treatment for benign prostatic hyperplasia at some point in their life.
  • 25% of men over 80 years of age will undergo some type of surgical intervention for benign prostatic hyperplasia.
  • According to data from the World Health Organization, benign prostatic hyperplasia is the cause of mortality in 30 out of every 100,000 people.
  • Benign prostatic hyperplasia ranks third in industrialized countries among the diseases that involve the highest health costs.
  • Seven out of ten European men are unaware of the function of the prostate.

Causes of benign prostatic hyperplasia

The production and development of benign prostatic hyperplasia is due to multiple factors, the most important of which are:

Age

It plays a fundamental role, so that the older the man, the greater the possibility of suffering from benign prostatic hyperplasia. According to studies, 50% of men have benign prostatic hyperplasia between 51 and 60 years, and 90% at 90 years.

Male hormones (testosterone)

Prostate growth is regulated by male hormones. In this sense, patients with bulky benign prostatic hyperplasia present high levels of free testosterone and estrogens in the blood. In the prostate there are receptors that are stimulated by testosterone, producing an enlargement of the gland that compresses the urethra and makes it difficult for urine to pass.

Symptoms of benign prostatic hyperplasia

Benign prostatic hyperplasia causes progressive difficulty in urination due to compression of the urethra.

Symptoms can manifest as follows:

  • Increases the number of times you need to urinate both day and night (nocturia)
  • The usual force of the stream decreases and a drip occurs when you finish urinating.
  • You often have an urgent need to urinate.
  • You have to strain to start urinating ( dysuria )
  • After you urinate, even two or three times in a short time, you have a feeling that you still have urine in your bladder.
  • You cannot urinate and you retain all of your urine.

These symptoms can be quantified and follow the changes that occur in their symptoms over time or after treatment has been established using a test called IPSS.

How is it diagnosed?

Benign prostatic hyperplasia is a disease that begins without presenting symptoms. For this reason, it is convenient that from the age of 50 all men undergo a periodic medical examination to determine the state of their prostate.

It is important to establish an early diagnosis of prostate disorders. This will allow to control the disease in its initial phase and avoid complications.

Your doctor will suspect and diagnose BPH by:

A complete medical history

It consists of some basic questions such as: Do you have to force yourself to start urinating? Have you lost strength in the urination stream? Is the stream intermittent? Do you have a sensation of incomplete emptying of the bladder when you finish urinating? , Do you have to urinate within two hours after the last urination? It will also ask you if you have had a fever , if you have urinated blood, how long have you had symptoms, if you have pain, if you have lost weight or strength.

Physical exploration. Rectal examination

Routinely, the doctor will perform a general physical examination evaluating if there is paleness due to possible anemia, if there is pain in the lumbar area, if a large bladder with retained urine is palpated (bladder balloon) and then he will perform the prostate exploration by rectal examination.

If the patient has benign prostate hyperplasia, the consistency of the prostate will be normal and elastic, with a smooth surface and generalized enlargement; distinguishing itself from a prostate cancer where on rectal examination the prostate is hard, with nodules, enlarged and with an irregular surface; From the differential diagnosis with a possible prostate cancer comes the importance of performing a rectal examination before the onset of urinary symptoms.

Blood and urine tests

Blood: To determine creatinine levels that assesses kidney function and PSA.

Urine: Sediment to check for blood and a culture to rule out a urine infection .

Abdominal and transrectal ultrasound

With the abdominal we evaluate the state of the kidneys, urinary tract and bladder. With the transrectal we assess the size, volume, shape and structure of the prostate.

Intravenous urography

Injecting a contrast into the blood, its expulsion through the urinary tract is visualized, examining whether or not there is retention, seeing the bladder wall and the elevation of the bladder floor due to the growth of the prostate.

Prostate biopsy

It is performed only if there is a suspicion of prostate cancer from digital rectal examination, elevated PSA, or abnormal vision on ultrasound or urography .

It is not necessary to perform all the tests on all patients, sometimes only a good medical history, examination and laboratory tests are necessary to make the diagnosis.

Treatment of benign prostatic hyperplasia

There are various treatments that go from conservative depending on the lack of symptoms with periodic reviews with a series of non-invasive tests such as:

  • A blood test
  • an ultrasound
  • a routine urinalysis
  • and a flowmetry

We can also start a medical treatment or finally opt for the surgical option.

Medical treatment

There are several pharmacological principles that reduce or relieve the symptoms of prostatism:

  • Phytotherapy: it is a treatment based on natural plant extracts, especially Serenoa repens and Pygeum africanum, which are rich in sitosterol and mepartricin. They are treatments practically free of side effects and although the World Health Organization recommends carrying out more long-term studies to really quantify their effectiveness, the truth is that it will improve the symptoms of many patients.
  • Secondly, there are alpha blockers, a pharmacological family that acts by decreasing resistance to urine output from the bladder and improving the contractility (ability to contract) of the detrusor muscle (bladder muscle). Although substances of this family have been developed that have high uroselectivity (specific activity on the urinary system), they can have side effects on the cardiovascular and ophthalmic system, so they should always be prescribed and controlled by your urologist.
  • Lastly, there are 5 alpha-reductase inhibitors, an enzyme that transforms testosterone into its active principle, dehydrotestosterone and that reduces the symptoms of large prostates and also reduces the complications of benign prostatic hyperplasia such as hematuria and the possibility of having an acute retention of urine. The use of this compound is especially effective in large prostates. It is a drug that must also be prescribed by your urologist and its efficacy and side effects must be controlled, which are fundamentally andrological in nature, producing alterations in libido in ejaculation and erection in some patients.

Surgical treatment

Surgical treatment is an alternative measure to pharmacological treatment.

Basically two types of interventions are carried out although there are different possibilities described within these.

On the one hand, the endoscopic treatment called transureteral resection of the prostate. Electrocoagulation is usually used for this procedure, although other techniques also considered acceptable by the World Health Organization but that are not really used have been described, such as electrovaporization, the use of laser for thermovaporization and laser coagulation, and laser coagulation. use of microwaves. All seek to reduce the prostate volume to facilitate the exit of urine through the urethra.

On the other hand, the so-called “open” surgical treatment consists of retropubic or suprapubic adenomectomy. Through this surgery and by opening the abdomen, the prostate adenoma that obstructs the bladder outlet is removed, respecting part of the prostate called the peripheral prostate and the prostatic capsule.

How can I avoid it?

Going to your doctor for an early diagnosis before age 50 or when symptoms begin. This will allow to control the disease in its initial phase and avoid complications.

Living a healthy life: avoid alcohol, coffee and spices; perform physical exercise; not present constipation ; avoid a sedentary life.

You should think that you may have a prostate problem when:

  • Increase the number of times you need to urinate, both during the day and at night.
  • Decrease the usual force of the stream and a drip occurs when you finish urinating.
  • You often have an urgent need to urinate.
  • You must strain to start urinating.
  • After urinating, even 2-3 times in a short time, you have the feeling that you still have urine in your bladder.
  • You cannot urinate and you retain all of your urine.

If you have any of these symptoms, see your GP, he will inform you.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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