Benign prostatic hypertrophy
The prostate is part of the male genitourinary system. It is a gland located below the bladder that surrounds the urethra. Its primary function is to produce a significant portion of the seminal fluid that is expelled during ejaculation into the prostatic urethra, thereby assisting with the vitality and mobility of sperm. Throughout a man’s life, the prostate can be affected by various medical conditions, such as prostatitis, benign prostatic hyperplasia, or prostate cancer.
Benign prostatic hyperplasia is a common benign enlargement of the central portion of the prostate in men over 50 years old. This enlargement results in an obstruction of the prostatic urethra, which explains the symptoms associated with this condition: there may be a decrease in the strength of the urinary flow and dripping at the end of urination. The bladder is unable to empty completely, leading to unsatisfactory urination. This also results in increased frequency of urination, especially at night.
In the early stages, the bladder, equipped with muscular walls, tries to counteract this obstruction by contracting more intensely. However, over the long term, this effort may compromise its contraction ability, reducing its ability to fully empty. Chronic urine retention can lead to further complications, such as the formation of stones and bladder diverticula.
DIAGNOSIS
A urological examination, including a digital rectal exam, allows for direct evaluation of the size and consistency of the prostate. This is usually integrated by other instrumental investigations including:
- Ultrasound of the entire abdomen with post-void residual: This not only helps to exclude possible complications such as the presence of stones, diverticula, or dilation of the upper urinary tract, but also provides a clear assessment of the bladder’s ability to empty.
- Transrectal ultrasound: Compared to abdominal ultrasound, this is much more reliable for accurately determining prostate volume.
- Prostate-specific antigen (PSA): PSA is produced directly by the prostate and can be measured with a simple blood test. As an indicator of prostate health, it can increase in various benign and malignant conditions affecting the prostate, including prostatitis, BPH, and prostate cancer. Sexual activity and rectal examination can also elevate this protein. For this reason, PSA is not useful on its own for diagnosis but should always be correlated with the patient’s clinical picture.
- Uroflowmetry: This provides useful information to evaluate the presence and extent of urinary obstruction.
In uncertain cases, the urologist may request further investigations to rule out possible malignant conditions affecting the gland, such as multiparametric MRI or a prostate biopsy.
TREATMENT
The goal of treatment is to reduce the patient’s symptoms and prevent possible complications.
Pharmacological therapy
In the initial stages of this condition, it may be appropriate to control symptoms through medical treatment. The currently available medications fall into two main categories:
- Alpha1-blockers
- 5-alpha-reductase inhibitors
Surgical therapy
In more advanced stages of the condition, when medications are no longer able to control symptoms, surgery may be performed to completely remove the obstruction caused by the adenoma. Currently, there are several possible surgical approaches, both endoscopic and open. The choice is not arbitrary but depends on the specific characteristics of the patient (such as the size of the prostate, possible presence of stones or diverticula) and the surgeon’s preferences.
Although it is a benign condition, BPH is extremely significant from a social and psychological perspective for the patient. It deteriorates the patient’s quality of life, as its symptoms can affect daily activities and sleep. For this reason, it is essential to consult a specialist promptly: early treatment can not only prevent possible irreversible complications in the urinary system but can also significantly improve quality of life and reduce the psychological impact of this condition.
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