Enlarged prostate is also known as benign prostatic hypertrophy, prostate adenoma, and benign prostatic hyperplasia.
According to the most plausible theories, the enlarged prostate is due to aging and the hormonal changes that follow.
The enlarged prostate is responsible for urinary problems, such as dysuria, pollakiuria, nocturia, urgent need to urinate, burning during urination, etc.
Generally, for the diagnosis of enlarged prostate the following are essential: physical examination, medical history, urinalysis, digital rectal examination of the prostate and PSA measurement.
The therapy of the enlarged prostate varies according to the severity of the symptoms present; Among the possible treatments available today, there are both drugs and more or less invasive surgeries.
The enlarged prostate is a disorder that mainly affects men over the age of 50.
The enlarged prostate is a subject for urologists and andrologists, that is, respectively, the doctors who deal with the diagnosis and treatment of diseases of the human urinary tract and the male genital tract, and the doctors who deal with the diagnosis and treatment of diseases of the human urinary tract and the male genital tract. male genital.
What is the prostate and what function does it cover: a brief review
The prostate (or prostate gland) is the unequal exocrine gland of the male genital system, located in the pelvis, just below the urinary bladder and in front of the rectum.
Similar in shape and size to a chestnut (the average weight is about 11 grams), the prostate surrounds the male urethra in the tract of the latter between the internal urethral sphincter muscle and the external urethral sphincter muscle (prostatic section of the male urethra ); the relationship of the prostate with the male urethra, however, is not limited to proximity: the prostate gland, in fact, emits channels, called prostatic ducts, which open onto the male urethra, thus putting the two anatomical structures in communication.
The prostate secretes a part of the liquid component of the sperm (sperm is the fluid containing spermatozoa, which serves for the fertilization of the female oocyte); alkaline in nature and whitish in color, this liquid component has the function of neutralizing the acidic environment of the female vagina, in order to protect the spermatozoa (which would otherwise be affected by the environmental conditions mentioned above) and prolong their life inside the woman's genital apparatus.
To promote the release of its own liquid and mix it with the spermatozoa and the liquid secreted by the seminal vesicles, the prostate uses the prostatic ducts, which, as previously stated, connect it to the male urethra (which represents the conduit through which the "man expels not only urine, but also sperm).
For further information: Male Urethra: Anatomy and Differences from Female Urethra of the prostate gland itself; this increase in the number of cells is the result of a benign proliferation (or benign tumor), which means that the aforementioned cells do not infiltrate the surrounding tissues, as would the cells of a malignant tumor.In medicine, the scientific term that aptly describes an increase in the number of cells in a tissue or, as in the case of an enlarged prostate, an organ is called hyperplasia.
This explains why the scientific literature and the medical community believe that the most correct definition of an enlarged prostate is benign prostatic hyperplasia.
If in normal conditions the prostate is the size of a chestnut, in those suffering from an enlarged prostate the gland in question doubles or sometimes triples its canonical volume.
It should be noted that the volumetric enlargement of the prostate that characterizes prostate adenoma is gradual.
What are the Causes of Enlarged Prostate?
The precise causes of an enlarged prostate are unknown; however, based on some scientific evidence, the medical community believes that benign prostate enlargement depends on aging and the hormonal changes that follow.
The link between enlarged prostate and aging would explain why benign prostatic hypertrophy is particularly common among older men.
Risk Factors of an Enlarged Prostate
Given the "enlarged prostate-aging" relationship, a sure risk factor for prostate enlargement is advanced age; according to some estimates, for a man, the risk of manifesting the symptoms of benign prostatic hyperplasia increases progressively starting from 50 years of age.
On the basis of other scientific studies, in addition to aging, factors such as:
- Familiarity with benign prostatic hyperplasia;
- Overweight / obesity;
- Cardiovascular diseases;
- Diabetes;
- Sedentary lifestyle.
To explain the symptoms of the enlarged prostate is the compression that the prostate gland exerts on the male urethra, as a consequence of its volumetric increase.
It should be noted that the enlarged prostate is not always symptomatic and, when it is symptomatic, it does not always determine all the aforementioned symptoms: there are, in fact, men with prostate adenoma who do not present any significant disturbance; men with prostate adenoma who present the entire symptomatological picture reported above, and finally, men with benign prostatic hypertrophy who suffer only from some of the urinary problems in question.
Did you know that ...
An enlarged prostate more commonly causes hematuria when it is associated with an "other condition, such as a" urinary tract infection.
Enlarged prostate: how does the symptomatology appear?
Since the enlarged prostate is a gradual onset condition, the related symptoms (obviously in symptomatic cases) tend to present slowly and gradually.
It should be noted, however, that the way in which the enlarged prostate manifests itself varies from individual to individual: for some it can be extremely slow, while for someone else it can be faster.
Enlarged Prostate: Complications
Urinary difficulties resulting from the enlarged prostate compressing the urethra force the patient to force himself to pass urine; in the long run, this effort is highly counterproductive, because it weakens the wall of the urinary bladder, to the point that it is impossible to pass urine.
This condition, which is called acute urinary retention and which is the most important complication of an enlarged prostate, represents a "urological urgency to be treated with the insertion of a bladder catheter, to facilitate urination.
Did you know that ...
Prolonged compression of the urethra due to an enlarged prostate can also impair kidney function, causing kidney failure.
In addition to urinary difficulties, then, the enlarged prostate is particularly dangerous the failure to empty the bladder, as the latter is a phenomenon that favors, due to the stagnation of urine, urinary infections (specifically, male cystitis and pyelonephritis ), prostatitis and bladder stones.
How to notice the complications of an enlarged prostate?
When it degenerates into complications, the enlarged prostate is characterized by symptoms such as:
- Presence of blood in the urine (hematuria);
- Complete inability to urinate;
- Painful urination
- Fever;
- Pelvic discomfort or pain.
Enlarged Prostate and Prostate Cancer
Many men identify an enlarged prostate with prostate cancer or believe that suffering from the former favors the appearance of the latter.
However, this is not the case at all: the enlarged prostate is a benign condition and is in no way a risk factor for prostate cancer (which, instead, is a more clinically relevant condition).
Therefore, in men in whom prostate cancer is added to the enlarged prostate, the latter is not at all related to benign prostatic hypertrophy.
For further information: Prostate Cancer: Causes and Therapy. It serves to exclude that the symptoms are due to a "urinary tract infection (eg: male cystitis, urethritis, pyelonephritis, etc.). It also clarifies the renal function;Sometimes, additional tests are needed to diagnose an enlarged prostate, including:
- Uroflowmetry. It is used to evaluate the urinary flow and the volume of urine emitted during urination. It is a "useful investigation when there is a suspicion of bladder damage."
- Trans-rectal prostate ultrasound, followed by biopsy. This is a test that serves to confirm the enlarged size of the prostate and the exact nature of the enlargement.
It should be noted that in the presence of an enlarged prostate, doctors strongly advocate the adoption of a healthy lifestyle and other habits, in order to improve the effects of therapy and avoid worsening or, in cases of advanced prostate adenoma, complications.
Enlarged Prostate Medications
Medicines useful for the therapeutic management of enlarged prostate include:
- The alpha-antagonists. The alpha-antagonists induce relaxation of the sphincter muscles present before and after the prostatic section of the male urethra, thus facilitating the passage of urine.
Examples of alpha-blocking drugs used in the presence of an enlarged prostate are: alfuzosin, doxazosin, tamsulosin and terazosin.
Main possible undesirable effects related to the use of alpha-antagonists: hypotension, migraine, dizziness, headache and asthenia. - 5-alpha-reductase inhibitors. By blocking the transformation of testosterone into its active form (dihydrotestosterone or DHT), 5-alpha-reductase inhibitors have the effect of inhibiting the hormonal mechanism that appears to induce enlargement of the prostate.
Among the 5-alpha-reductase inhibitors used in the presence of an enlarged prostate, finasteride and dutasteride deserve a mention.
Main possible undesirable effects related to the use of 5-alpha-reductase inhibitors: erection problems, retrograde ejaculation and gynecomastia. - Anticholinergics. By inducing relaxation of the bladder muscles, anticholinergics have the effect of reducing the urgent urge to urinate, a typical symptom of an enlarged prostate.
Examples of anticholinergic drugs used in the presence of benign prostatic hypertrophy are oxybutynin and tolteridine.
Main possible side effects related to the use of anticholinergics: headache, dizziness, sleepiness, dry mouth, constipation, dry skin and glaucoma. - Desmopressin. Desmopressin reduces urine production; in the presence of an enlarged prostate, the use of this drug is useful when the patient suffers from nocturia (in such circumstances, in fact, the intake of desmopressin must take place in such a way as to act during the night).
Main possible side effects related to the use of desmopressin: migraine, abdominal pain and nausea
As the reader may notice, drugs against enlarged prostate have a symptomatic effect, whereby symptomatic means that they reduce symptoms and prevent any ongoing worsening of the condition.
Surgical Therapy for Enlarged Prostate
The enlarged prostate requires the use of surgical therapy, when
- The symptoms associated with it are relevant and such as to deeply affect the patient's quality of life, e
- The drug treatment described above was completely ineffective.
Today, the surgical techniques to deal with the enlarged prostate problem are numerous; among the possible surgical approaches available to patients, there are more or less invasive ones (invasiveness is calculated according to the incisions that the surgeon makes on the patient's body to access the prostate).
Some of the main surgical techniques for treating an enlarged prostate are:
- TURP or (transurethral resection of the prostate). It involves the insertion into the male urethra of a particular instrument, called a resectoscope, which, once conducted up to the prostate, allows the surgeon to dissect and remove layers upon layers of excess prostate gland.
- The TUIP (or transurethral incision of the prostate). It is similar to TURP, except that the surgeon makes a couple of incisions on the prostate, rather than dissecting it into layers to reduce its volume.
TUIP is particularly indicated when there are contraindications to other existing surgical procedures. - TUMT (or transurethral microwave thermotherapy). It involves the use of a special electrode, which, once inserted into the male urethra and led to the prostate, allows the surgeon to destroy the enlarged portion of the prostate by means of microwave energy discharges.
- The TUNA (or transurethral ablation with needle). It involves the use of a special resectoscope, which, once conducted to the prostate through the urethral canal, allows the surgeon to destroy excess prostate tissue by means of radio waves.
- Prostatic adenomectomy. It involves the incision of the abdomen in order to reach the enlarged prostate and remove the excess part.
Among the various surgical techniques that exist, it is the most invasive and is reserved for the most severe cases of enlarged prostate.
In all its possible variants, surgical therapy of the enlarged prostate aims to mitigate urinary problems by improving the flow of urine along the prostatic section of the male urethra.
For further information: TURP or Transurethral Resection of the Prostate: What is it?Enlarged Prostate and Lifestyle
A healthy lifestyle and certain habits have a positive effect on the enlarged prostate and its related symptoms.
Specifically, according to doctors, for those suffering from benign prostatic hypertrophy, it is of benefit:
- Regularly practice physical activity, even moderate (therefore, it is good to exclude a sedentary lifestyle);
- Minimize if not avoid the consumption of alcoholic beverages, coffee and sugary carbonated drinks;
- Avoid the consumption of artificial sweeteners;
- Drink limited quantities of water in the evening, so as to avoid feeling the need to urinate during the night (clearly, this habit must be combined with a greater consumption of water during the day, in order to guarantee the body the right amount of water) ;
- Eat more fruits and vegetables;
- Maintain normal body weight and lose weight if necessary;
- Always urinate before leaving the house;
- Urinating effortlessly.
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