Prostate adenoma is found above all with advancing age, as a consequence of the physiological aging process, as a result of hormonal changes or other concomitant pathologies.
The initial manifestations of this pathology include increasing difficulty in urinating (dysuria) and increased daytime (pollakiuria) and nocturnal urination (nocturia). These signals should act as an alarm bell and prompt the patient to undergo a clinical examination. accurate, also important to exclude any pathologies that occur with a similar symptomatological picture (including prostate cancer). Also, if neglected, the enlarged prostate can compress the urethral canal, causing it to partially obstruct and interfere with the ability to urinate. Prostate adenoma can thus cause a series of long-term complications, such as urinary retention, bladder stones and chronic renal failure.
Treatment depends on the extent of the condition and may include various pharmacological or surgical options, with the aim of improving the patient's symptoms and quality of life.
What is the prostate?
The prostate (or prostate gland) is a small exclusively male organ, which belongs to the reproductive system, located just below the bladder. Its main function consists in the production of a part of the seminal fluid, thus helping to preserve the vitality of the spermatozoa. More specifically, the prostate gland partially surrounds the first part of the urethra (duct that carries urine outside the body during urination), like a donut, at the neck of the bladder and merges with the two ejaculatory ducts passing through it.
Precisely because of this position and the relationships described with nearby organs, the enlarged prostate can cause problems with urination, ejaculation or defecation.
benign) coincides with an enlarged prostate, not associated with tumor formations. At the origin of this condition there is, in fact, a benign proliferation, therefore not cancerous. As such, the increase in the volume of the prostate is caused by the growth in the number of prostate cells that compress the surrounding tissues (especially at the level of the prostate). "prostatic urethra), without infiltrating them.
Prostate adenoma: synonyms and terminology
Prostate adenoma is commonly known as benign prostatic hypertrophy (BPH) or enlarged prostate. More correctly, the condition is also referred to as benign prostatic hyperplasia, as the volumetric enlargement of the prostate is due to an increase in the number of cells that make up the prostate. same organ.
it tends to develop from the peripheral area of the prostate).Under normal conditions, the prostate generally has a size and shape similar to that of a chestnut, with the base facing upwards (attached to the lower surface of the bladder) and the apex facing downwards. Over the years or the presence of some pathologies, the prostate can enlarge, then increase in volume.
In people suffering from prostate adenoma, in the absence of treatment, the gland can exceed its normal size by up to two or three times.
What Causes Prostate Adenoma?
The causes of prostate adenoma are not yet fully known, but it is now established that at the base of the pathology are involved some alterations typical of aging.
In fact, with advancing age, the prostate spontaneously tends to change its consistency and volume, in response to hormonal variations and numerous growth factors that stimulate the benign proliferation of prostate cells.For example, the release of small amounts of estrogen and the increase in dihydrotestosterone (or DHT, the metabolite of testosterone) seem to favor the onset of prostate adenoma.
Risk factors
Prostate adenoma is a very frequent alteration, which accompanies the normal aging process, therefore it is found mainly in older men. In particular, this condition begins to develop after the age of 40 and manifests itself mainly after the age of 50.
The incidence of prostate adenoma increases proportionally with advancing age, reaching its maximum levels in the eighth decade of life. It is estimated, in fact, that between 70 and 80 years of age this pathology affects up to 80% of male population.
In addition to age, predisposing factors for prostate adenoma include:
- Familiarity;
- Other concomitant diseases, such as obesity, cardiovascular disease and diabetes;
- Physical inactivity.
Note
Urinary symptoms of an irritative and obstructive type that occur in prostate adenoma can also occur in the presence of bladder problems, urinary tract infections or prostatitis (inflammation of the prostate). These disorders can also be the signal of much more serious pathologies, such as prostate cancer.For this reason, it is always advisable to contact your doctor for the most appropriate tests for your case.
Prostate adenoma: possible consequences
In the context of prostate adenoma, the narrowing of the urethra and urinary retention are responsible for problems with the correct flow of urine: the patient must exert an abdominal thrust to be able to expel them and empty the bladder.
Because of this overwork, the bladder wall tends to gradually weaken and, over time, it is even possible to reach acute urinary retention, or the inability to urinate. A "prolonged obstruction of the urethra can even compromise renal function, causing an organ "failure".
Attention! Urinary retention is a "urological emergency, which requires the placement of a bladder catheter.
Another complication to consider is the incomplete emptying of the bladder, which determines the stagnation of a residual urine in which bacteria can proliferate and settle any crystalline aggregates. For this reason, prostate adenoma exposes to a greater risk of urinary infections, prostatitis, pyelonephritis and stones due to the crystallization of salts in the post-voiding residue.
Warning signs
In the "context of" prostate adenoma, the manifestations that should not be underestimated, which should lead to requiring prompt medical intervention, include:
- Total inability to urinate;
- Painful, urgent and frequent urge to urinate, with fever and chills;
- Blood in the urine;
- Severe discomfort or pain in the lower abdomen and urinary tract.
For the correct evaluation of prostate adenoma, some specific clinical tests are necessary, including:
- Urinalysis with urine culture;
- Dosage of PSA (prostate specific antigen) in the blood;
- Digital rectal exploration of the prostate (palpation of the prostate through the rectum).
The PSA is used to evaluate the possibility that a malignant tumor is present, while the rectal examination provides information on the volume and consistency of the gland. The urinalysis, on the other hand, allows to verify the renal function or to exclude the presence of infections urinary, capable of producing symptoms similar to that of prostate adenoma.
To determine the extent of the disease, the patient may be subjected to more in-depth examinations, such as:
- Uroflowmetry: measures the speed of the urinary flow and the volume of urine emitted during urination, thus providing an idea, albeit rough, of any damage to the bladder;
- Trans-rectal prostate ultrasound, followed by biopsy: it allows to confirm or exclude the presence of a malignant tumor and is a useful tool for evaluating the correct volume of the prostate, especially important for any surgical intervention.
The major problems of using drugs for the treatment of prostate adenoma are associated with possible side effects. These include erectile deficits, retrograde ejaculation and gynecomastia for 5-alpha-reductase inhibitors, while hypotension, migraine, dizziness, headache and asthenia are common among users of alpha blockers. Depending on the case, drugs may be sufficient to control the patient's symptoms and slow the progression of prostate adenoma, but it should be noted that the effectiveness of these tends to decrease with the "long-term use.
In a similar way to 5-alpha-reductase inhibitors, albeit with modest efficacy, some phytotherapics also act, such as the extracts of Serenoa repens and African Pigeo.
Surgery
When drug therapy is ineffective, surgical therapy is used. The choice of the type of procedure to undergo the patient is essentially based on the size of the prostate adenoma.
To remember
The suitability or otherwise of the various surgical techniques is mainly influenced by the extent of the prostate adenoma; in general, the greater the increase in glandular volume, the more invasive the operation will be.
The most used technique for the treatment of prostate adenoma is transurethral endoscopic resection (or TURP). As the name suggests, it is a reduction of the prostate performed by endoscopy, ie without incisions. In practice, a special instrument is introduced into the urinary canal through the penis to slice the prostate adenoma. In this way, the internal part of the enlarged prostate can be removed.
If the size of the prostate is excessive, however, it is necessary to proceed with an open surgery, called adenonectomy. This "surgery involves the" removal of the entire prostate adenoma by means of a "trans-vesical or retropubic" skin incision.
Partial or total surgical removal of the prostate can lead to some complications for patients. Among these, the one that generally worries patients the most is the risk of erectile dysfunction. However, according to recent studies this risk is to be considered null or even lower than in patients who choose not to undergo surgery. A very frequent adverse effect after surgery is, however, retrograde ejaculation; in practice, during ejaculation the seminal fluid, instead of escaping from the urethra, flows back into the bladder, causing infertility.
To treat prostate adenoma, it is possible to resort to alternative techniques, less invasive, but of variable efficacy. These procedures aim to destroy part of the glandular tissue without damaging what will remain in place. For this purpose, depending on the method used. , laser rays (as in the HoLAP procedure), radio waves (transurethral ablation with radiofrequencies or TUNA), microwaves (eg TUMT or transurethral thermotherapy with microwaves) or chemicals are concentrated, directly inside the prostate.
