Benign prostatic hyperplasia is enlargement of the prostate gland produced by a relative increase of estrogen (female hormones) on testosterone (male hormone) that appears with age in men.
Causes of prostatic hyperplasia
The cells of the prostate have receptors with sensitivity to testosterone and estrogens, when the balance varies by age this imbalance stimulates the production of cellular growth factors causing the progressive increase in size of the gland that can be variable depending on other factors.
Other factors predisposing to enlargement of the prostate include obesity, hypertension, carbohydrate intolerance due to insulin resistance and changes in blood fats in people older than 70 years. In these cases the prostate volume is four times higher and faster than in people of the same age without these factors added.
Symptoms of prostatic hyperplasia
As prostate growth is a slow process the symptoms appear progressively, is called prostatism and appear sequentially among them the main are:
- Difficulty urinating
- Low urinary stream
- Need to urinate frequently
- Need to urinate at night
- Need to tighten to get the bladder empty
- The act of urinating is carried out in two stages with a short jet
- Feeling that the bladder does not empty completely
- Difficulty initiating urination
- Drip of urine when finished
- Imperious feeling of urination
Sometimes it can lead to more serious symptoms such as absolute inability to urinate (urinary retention), urinary tract infections, blood in the urine, or impaired kidney function.
The prognosis is unpredictable and variable as it may remain stable or with more acute pictures in outbreaks or progressively increase or sometimes debut with acute urinary retention. In most cases it is a progressive development.
In some cases they improve only by decreasing fluid intake.
As in all cases the symptoms guide the diagnosis, with clear suspicion a rectal examination should be performed. Through this examination the doctor can feel the size of the prostate and know if it is enlarged or not and its consistency to rule out a tumor.
A urinalysis will allow you to know whether or not there is a coexisting urinary tract infection.
An analysis will be performed to evaluate the prostate specific antigen (PSA), substance produced by the prostate that must be within limits, in relation to age and prostate size, to be considered normal. If it is elevated, other examinations will be carried out to check whether or not there is a more serious condition.
Sometimes methods are used to measure the flow of urine, and abdominal ultrasound may be helpful in measuring the size of the prostate and ruling out other diseases in the bladder or the presence of stones inside.
As a drug treatment are used:
Hormones, such as 5 alpha reductase inhibitors (Finasteride). It is used in long periods of 6 months so that its effectiveness is optimum, being able to obtain a reduction of 30% of the volume of the prostate in the majority of the cases. If the effect is expected it is maintained for years.
Selective alpha blockers, such as alfuzosin, doxazosin, tamsulosin and terazosin. These drugs work by relaxing the muscles of the bladder, urethra and prostate gland, improving the difficulty of urinating in more than half of the patients.
Surgery is used in cases of uncontrolled urinary retention, repeated urinary tract infections due to prostatic obstruction, in the presence of blood in the urine from the prostatic adenoma, in cases of bladder stones, or in the presence of diverticula In the study.
Benign prostatic hypertrophy surgery is very effective with the symptoms but has many side effects, so the decision must be very thought out.
In a simplified way, it can be said that there are two surgical procedures: transurethral resection of the prostate and open prostatic Adenomectomy.
Prostate transurethral resection is performed by passing an instrument through the urethra that cuts the prostate through electrical energy, achieving improvements in 70 to 90% of patients.
Prostate Adenomectomy is performed by a surgical incision in the abdomen and therefore has more complications but the success of the intervention is greater than in the other technique since it does not usually require reinterventions.
Other alternative methods are under development. One is dilation of the urethra which is performed by placing a prosthesis in the prostatic urethra, which dilates with an inflatable system. Another method is the destruction of the prostate tissue with needles that emit radiofrequencies, or by hyperthermia and thermotherapy, capable of destroying part of the prostate by heat without injuring the tissues around it.