Benign prostatic hypertrophy (BPH)
PATHOLOGIES
Benign prostatic hypertrophy (BPH)
THE PROSTATE
The prostate is a gland present only in the male, weighing about 20 grams, located in the pelvis below the bladder; in the center it is crossed by the first portion of the urethra, a small duct that carries urine from the bladder to the outside during urination.
The function of the prostate is to produce most of the seminal fluid, which is poured into the prostatic urethra during ejaculation. It is therefore an essential organ for male reproductive function. Conversely, the prostate does not participate in the function of penile erection and orgasm.
This gland can undergo various pathologies, the most frequent of which are inflammation (prostatitis), enlargement also called benign prostatic hypertrophy (BPH) and prostate cancer.
BENIGN PROSTATIC HYPERTROPHY (BPH)
Benign prostatic hypertrophy is a rather common disease and affects people over the age of 40-50.
It is an enlargement (adenoma) of the central part of the gland, which causes a change in the caliber of the prostatic urethra which crosses it with a consequent obstacle to the outflow of urine to the moment of urination.
This is the reason for the urinary symptoms experienced by patients with BPH. In fact, the most frequent symptoms include difficulty urinating, hypovalidity of the urinary stream, urinary urgency and the need to urinate frequently, even during the night.
The disease is progressive, in the sense that over time a progressive enlargement of the gland corresponds to a worsening of the symptoms. However, there is not always a close correlation between prostate size and symptoms, in the sense that there are also asymptomatic subjects with a very large prostate, as well as subjects with a small prostate who complain of very obvious symptoms.
In the initial phase of the disease, the bladder is able to compensate at least partially for the obstruction because, being the bladder wall made up of several muscle layers, it can contract with greater force, allowing urine to overcome the obstacle. Over time, however, the bladder tends to wear out and begins to fail its task, causing difficulty in urinating and the possible stagnation of urine in the bladder which can cause the onset of urinary tract infections, due to the presence of bacteria in the bladder. bladder.
If this condition is not resolved, functional damage to the bladder may result which, in extreme cases, may lead to the need to resort to definitive bladder catheterization.
DIAGNOSTIC INVESTIGATION
For the diagnosis of this pathology we have several tools available:
• Rectal examination: allows you to palpate the prostate directly and appreciate its size and consistency (a hard or uneven prostate can suspect a tumor of the same ).
• PSA (prostate specific antigen) dosage: PSA is a protein produced by the prostate necessary for correct function of the seminal fluid. It is measured in the blood after a normal blood sample. Usually in patients with BPH its value is slightly increased. However, it should be noted that when the PSA is increased, it is also essential to exclude the presence of prostate cancer.
• Trans-rectal ultrasound: a probe is inserted into the rectum and thanks to this it is possible to directly visualize the prostate and the adenoma, and define I specify the dimensions and the possible presence of suspicious areas for tumors or in any case pathological.
• Uroflowmetry and Urodynamic Testing: allow to evaluate the behavior of the urinary tract during urination. They give information about the extent and speed of the urine flow, the function of the bladder, and other parameters useful for quantifying the patient’s symptoms. At the end of these tests, it is also possible to evaluate the post-voiding residue, i.e. the amount of urine that remains in the bladder at the end of urination, which in healthy subjects is null, while in patients with BPH or functional damage to the bladder muscle it can reach even very high values.
• Urine test: allows you to highlight both any ongoing urinary tract infections and the presence of blood which can be an indicator of other pathologies.< /span>
THERAPY
The goals of therapy for benign prostatic hypertrophy are the resolution of urinary symptoms, the prevention of bladder and kidney damage and, overall, the improvement of the patient’s quality of life.
When the disease is in the initial stage with irritative symptoms and without a clear urinary obstruction, medical therapy can be used, using drugs that act on the urinary disorders described above. Three categories of medicines are available today:1. Plant extracts such as Serenoa Repens (Permixon , Profluss);
2. Alytic drugs, such as Alfuzosin (Alfuzosin DOC, Mittoval or Xatral), Silodosin (Urorec or Silodix); Tamsulosin (Omnic or Pradif)
3. 5alpha-reductase inhibitors, such as Dutasteride (Avodart) and Finasteride (Proscar, Prostide).On the other hand, when the disease is characterized by a clear urinary obstruction, surgery is indicated, in order to both resolve the patient’s complaints and, more importantly, protect bladder and kidney function.
The operation consists in the removal of the adenoma, i.e. that part of the prostate that is responsible for the obstruction.To do this, various surgical techniques can be used.
• Transurethral resection of the prostate (TURP): an instrument is inserted into the urethra, it goes up to the prostate and the central part of the gland, responsible for the obstruction, is resected using a diathermic loop. This technique is usually used for prostates weighing up to 80g. She is burdened by moderate bleeding and requires the maintenance of a bladder catheter for 3-4 days.
• Holmium laser enucleation of prostate adenoma (HoLEP): it is a method similar to the previous one, with the important difference that the adenoma is not resected, but is detached from the prostatic capsule using a laser. This technique is used today for prostates weighing up to 300g and is associated with numerous advantages: reduced bleeding, maintenance of the bladder catheter for 24-72 hours and reduced hospital stay.
• Trans-vesical adenomectomy (ATV): through a cut below the navel, the prostate is reached, the adenoma is detached from the prostatic capsule and removed. This is a traditional surgical technique that is typically used by surgeons not expert in the Holmium laser method; currently this approach is reserved exclusively for very large prostates. It is necessary to keep the bladder catheter on for 4-6 days during which the patient is often bothered by the pain associated with the abdominal incision and the bladder catheter itself. It is also associated with the need for postoperative blood transfusions in about 10% of cases. Following the introduction of the Holmium laser technique, this technique has been largely abandoned.
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Book the first visit or a specialist consultation at the office closest to you.
For patients residing abroad, it is also possible to request a first remote consultation, using the contact form.
Florence | Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 – Florence (FI)
Telephone: 055 570224
Florence Castello | Villa Donatello
Via Attilio Ragionieri, 101
50019 – Sesto Fiorentino (FI)
Telephone: 055 50975
Prato | Studi Medici Life
Viale della Repubblica, 141
59100 – Prato (PO)
Telephone: 0574 583501
Milan | Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 – Milan (MI)
Telephone: 02 480801
Dr. Andrea Cocci
urologist and andrologist
The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.
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