Prostate hypertrophy

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Causes, nature, symptoms, complications 

The cause of prostate enlargement is currently unknown. There is a hypothesis that the hormonal changes taking place over the years may have a significant contribution to increasing the volume of the organ. The symptoms of an enlarged prostate in most cases worsen over time. Belong to them:

Disorders of urination.
The prostate surrounding the urethra, as a result of its enlargement, begins to compress it, narrowing its lumen, which causes problems with urination: It can be manifested by:

- weakening of the urine stream,

- interrupting the urine stream

-feeling that there is urine in the bladder.

Ailments resulting from irritation of the bladder by an enlarged prostate:
Due to its close proximity, the enlarged prostate gland irritates the walls of the bladder, which may result in:

- frequent urination,

- experiencing a sudden, urgent need to urinate.

These symptoms are very bothersome for the patient and significantly reduce the comfort of his life.

An enlarged prostate that has not been treated can lead to a serious complication - urinary retention. It consists in the inability to completely empty the bladder due to a mechanical "obstacle" preventing the flow of urine through the organs of the urinary system. In the case of the ailment in question, it is an enlarged prostate gland which causes local narrowing of the urethra. There are acute (when symptoms occur suddenly) and chronic (when they occur over a long period of time) urinary retention, which may lead to further, serious consequences:

urinary tract infection

obstruction nephropathy (impaired kidney function due to difficulty in draining urine from the urinary tract)

How does the doctor diagnose prostatic hyperplasia?

The first issue that draws the doctor's attention to this problem are the characteristic complaints reported by the patient, discussed earlier. In order to confirm his suspicions as to the diagnosis, the doctor performs additional tests:

- Rectal examination - it is a finger examination of the size and consistency of the prostate through the anus. This procedure also allows for the assessment of the end segment of the gastrointestinal tract in men, which is important in the prevention of cancers of this organ.

- Urine test

- PSA test

- Ultrasound examination of the prostate gland

What does an ultrasound examination look like?

Patients are very often afraid of this diagnostic method because they equate it with transrectal (transrectal) ultrasound of the prostate. This is a misinterpretation, as nowadays the standard examination is similar to an ultrasound examination of the abdominal cavity. The prostate is assessed on the basis of the image of the pelvic organs. During the examination, the head of the apparatus is placed in the area of ​​the lower abdomen. This procedure takes a maximum of 20 minutes.

In addition, valuable information can also be provided by:

- Cystoscopy - involves inserting a speculum through the urethra into the bladder to assess these structures,

- Urodynamic examination - allows the evaluation of the bladder in terms of its function.

Risk factors

The factors that predispose to the occurrence of prostatic hyperplasia include: age, genetic tendencies, and diet. Chronic diseases such as diabetes and cardiovascular diseases also increase the risk of this disease.

Treatment

The choice of treatment method depends on the severity of symptoms and the patient's health. If the disease is not in an advanced stage and the symptoms do not significantly impair the patient's quality of life, conservative treatment is possible. These include lifestyle changes and drug treatment. It is advisable to avoid substances that may irritate the bladder (nicotine, caffeine) and to reasonably limit the consumption of diuretics, e.g. tea. In the treatment of prostate enlargement, drugs are used to relax the smooth muscles of the bladder wall, which will facilitate the outflow of urine. Another group of agents are preparations reducing the size of the prostate. If there is no improvement, surgical treatment is recommended. The most common surgical techniques include:

Transurethral resection of prostate (TURP). It consists in introducing a special electrode through the urethra, the purpose of which is to destroy part of the prostate tissue by the action of high voltage electric current pulses (electroporation). The treatment covers the tissues around the urethra, which reduces its pressure and improves the possibility of urine outflow.

This method is considered effective and safe, which is why it is most often used.

Transurethral incision of the prostate. In the case of slight enlargement of the prostate gland, it is possible to incision the bladder neck to the area of ​​the prostate capsule. This procedure (TUIP - transurethral incision of the prostate) is recommended for a younger man.
Prostate removal:
- using a laser, the transurethral method
- a classic surgical method

Enlargement of the prostate gland is a problem that affects a large proportion of elderly men. Unfortunately, the fact that our population is aging means that there will be more and more patients with this ailment. In order to avoid the unpleasant results of an untreated prostate enlargement, prophylaxis is recommended to cure possible ailments at the earliest possible stage. Periodic examination also allows for the early detection of prostate cancer, which at some stage of development may give similar symptoms as the discussed benign prostatic hyperplasia.

Source:

• Mitterberger M, Horninger W, Aigner F, Pinggera GP, Steppan I, Rehder P, Frauscher F. Ultrasound of the prostate. Cancer Imaging. 2010; 10(1): 40–48.
• Dybowski B, Przezcewkowa resekcja stercza. Przegląd Urologiczny, 2009.
• Welliver C, Helo S, McVary KT. Technique considerations and complication management in transurethral resection of the prostate and photoselective vaporization of the prostate. Transl Androl Urol. 2017 Aug; 6(4): 695–703.