Benign prostatic hyperplasia is characterized by an increase in the size of the prostate. A large prostate compresses the urethra while putting pressure on the bladder, resulting in a frequent need to urinate and various urination problems, as appropriate (lower and intermittent flow, pain, etc.).
Almost all men are prone to benign prostatic hypertrophy as they get older. Indeed, more than 50% of men aged 60 are affected, and 90% of those over 80 years. However, not everyone suffers: about 1 out of every 2 men are bothered by urinary symptoms.
This condition is not cancerous. It does not increase the risk of prostate cancer but does not prevent its development.
This condition is also called “benign prostatic hyperplasia”. Hyperplasia refers to the proliferation of prostate cells. The term hypertrophy, meanwhile, refers to the increase in the volume of the prostate.
The causes of benign prostatic hypertrophy are not clearly identified. There is probably a hereditary predisposition because some families are more affected than others. However, other factors come into play. For example, testosterone and its active derivative, dihydrotestosterone, are known to play an important role.
Also, estrogen, a female sex hormone found in small amounts in humans, may be involved. For the moment, we do not know the exact mechanisms by which they act. It is possible that with age, the prostate becomes more sensitive to these hormones.
The prostate, the genital gland of the size and shape of a chestnut, is located under the bladder (see diagram above). It surrounds the urethra, the channel through which urine and semen are evacuated. Located at the crossroads of the urinary and genital tract, the prostate secretes the nutritive and fluidizable substances of semen.
The weight of the prostate increases between birth and puberty to stabilize towards adulthood; it then reaches from 15 g to 20 g. By the forties, the volume of the prostate tends to increase and continues to grow with age. The prostate can reach 7 times its initial size.
Consequences and possible complications
Men with benign prostatic hypertrophy are more likely to experience one or more of the following problems. However, the majority of them do not suffer.
- UTI: a bladder that does not empty completely favours the proliferation of bacteria. If urinary tract infections occur repeatedly, surgery to reduce the volume of the prostate and unblock the urinary tract may be considered;
- Acute urinary retention in the bladder when the urethra is completely compressed, and it becomes impossible to urinate; which causes acute pain. This is a medical emergency. A catheter is introduced into the urethra to empty the bladder;
- Bladder stones: mineral deposits may occur and cause infections, irritate the bladder wall and obstruct the discharge of urine;
- Distension of the bladder wall: benign prostatic hyperplasia can accelerate the ageing of the bladder wall; with time, it loses tone and contractions are less effective. Sometimes the bladder regains tone after prostate reduction surgery;
- Kidney damage: the chronic retention of a certain amount of urine in the bladder and recurrent urinary tract infections can affect kidney function in the long term.
It is important to consult a urologist in Ghaziabad in case of symptoms. This reduces the risk of severe complications. However, you should know that there is not always a relationship between the symptoms experienced and the volume of the prostate. Indeed, some men have a large prostate without symptoms, while others have a smaller prostate.
With a rectal examination, the best urologist in Ghaziabad can detect an enlarged prostate and follow the evolution. This test is also used to detect the presence of nodules in the prostate and to assess the risk of cancer. A urine test and a blood test to measure the prostate-specific antigen (PSA) level may be performed, as appropriate.
Symptoms of benign prostatic hypertrophy
- Feelings of urination more and more frequent (first nocturnal, then diurnal);
- Urinary jet weakness
- An effort to initiate the first urinary stream;
- Intermittence of the jet (in fits and starts);
- “Late drops”;
- A feeling of not completely emptying the bladder;
- Painful urination;
- The presence of blood in the urine;
- Sometimes a drop in strength to ejaculation.
People at risk and risk factors for hypertrophy
People at risk
- Men aged 50 and over;
- Family history: Men with a close relative who has had benign prostatic hypertrophy would be at higher risk;
- Ethnic origins: This disease is rare in Asians, and more common in Caucasians and Blacks.
Some factors are suspected to increase the risk of benign prostatic hypertrophy, but none has yet been officially established.
- Scientific evidence that physical inactivity contributes to benign prostatic hypertrophy accumulates. The researchers noticed that physically active men were less often affected;
- Some experts believe that obesity and diabetes are other risk factors, 3 as smoking, high blood pressure, high cholesterol and a diet that is harmful to the vascular system may be. But these are still hypotheses;
- It is possible that middle-aged men who choose to take hormone testosterone therapy to counteract their symptoms of andropause (decreased sexual appetite, less vigorous erections, lack of energy, etc.) are susceptible to an increased risk of benign prostatic hypertrophy in the long term. The use of this type of hormone is still too recent to know if this happens in reality.
Prevention of benign prostatic hypertrophy
Measures to prevent the worsening of symptoms
Men with benign prostatic hypertrophy can, however, try to prevent it from getting worse by:
- Take the time to empty your bladder as much as possible at each urination. Some men have it easier to do it sitting than standing;
- Go to urinate without waiting too much when an urgent desire is felt, not to distend the bladder too much. It is normal that urgent desires are more frequent during cold seasons;
- Schedule times in the day to urinate: every 4 hours, for example. This can help reduce the number of urgent desires when they are frequent;
- Continue to hydrate well, but reduce water and drink intake 1 hour or 2 before a long drive, before bedtime and before a situation where stress is anticipated;
- Reduce your alcohol and coffee consumption. Alcohol increases the volume of urine and reduces the feeling of urination. For its part, coffee would cause a slight swelling of the prostate, which can increase the engorgement of the urinary tract;
- Stay active: Physical activity reduces urinary retention in the bladder;
- Taking diuretic medications, decongestants, or antihistamines (to treat allergies) can increase symptoms. Consumers should talk to their doctor (it is not advisable to stop medication without medical advice).
How can benign prostatic hyperplasia be treated?
Once the diagnosis of benign prostatic hyperplasia is established, the need to use or not a treatment depends on the clinic that the patient presents. We have medications and surgery that can relieve and improve the symptoms that BPH produces.
The urologist in Noida must explain to the patient the different treatment options:
- Observation and periodic reviews.
- Hygienic-Dietetic Treatment.
- Medical treatment.
- Surgical treatment (definitive treatment)
Patients with mild symptoms do not require treatment. In these cases, the annual prostatic revision is sufficient and offers recommendations that can improve your symptoms (decrease the intake of liquids after 6 in the afternoon, go frequently to the bathroom, empty the bladder completely).
Patients with moderate symptoms can improve significantly with medical treatment.
In the Max Hospital, according to the clinical symptoms, the size of the prostate, the PSA and the age of the patient we recommend the most appropriate treatment. The medical treatment of BPH must be individualized for each patient.
The drugs are effective initially, but over time the prostate grows and loses its effectiveness. Then it is necessary to go to a definitive treatment by surgery.
What surgical treatments are available for benign prostatic hyperplasia?
When the prostate grows, the symptoms get worse and they do not respond to the medications, at this moment prostate surgery should be considered to eliminate the hyperplastic tissue and prevent the bladder and kidney from being irreversibly damaged.
The definitive solution of the BPH is the surgical intervention that can be done through the urine duct (endoscopy) or through open surgery
a) Green laser (Green Light XPS) in prostate
The photo vaporization of the prostate with the green laser (Green Light XPS) of high power (180 W) is a very safe technique and is as effective as the traditional surgery of the prostate. The patient is hospitalized for less than 24 hours, goes home without a catheter, and can resume normal activities after 2 days, avoiding efforts. The green laser is recommended for prostates less than 90 grams.
The photo vaporization of the prostate is done through the urethra and laser energy vaporizes the BPH that compresses the urethra. This allows a very important improvement in the symptoms
b) Prostate Vaporization
The plasma kinetic energy is a technological breakthrough that allows to vaporisation and elimination of the benign prostatic tissue that obstructs the urine duct. It is performed with a cystoscope through the urethra and vaporization of the prostate occurs through an applicator. This novel technique produces an immediate relief of symptoms. It is recommended for prostates with less than 90 grams.
The main advantages of this technique are:
- Bleeding is scarce
- Stay at the Hospital 24-45 hours
- Bladder catheter 24 to 48 hours, depending on the size of the prostate
- Good voiding calibre immediately after removing the probe
c) Prostate TURP
It is called transurethral resection of the prostate because an appliance is inserted through the urethra (the tube through which urine exits). Without the need for an incision, multiple fragments of benign growth of the prostate are removed through this device.
Prostate TUR is a technique that is widely used, with good results, but with some complications. The prostate TUR presents some disadvantages with respect to the green laser and the vaporization of the prostate with plasma kinetic energy:
- TURP usually produces bleeding during and after surgery. For this reason, it is necessary to leave a scrubbing system and approximately 15-20% of patients need a blood transfusion.
- It is necessary to leave a bladder catheter for about 5 days.
- In patients taking anti-aggregates (aspirin and others) or anticoagulants, there is a greater risk of bleeding.
- It can present complications such as urinary incontinence (1 – 4%) or impotence (10 – 15%).
The great advantage of green laser and prostate vaporization over classical TUR is that they offer the same good results as prostate TURP but with fewer complications (minimal bleeding, bladder catheter 24 hours, the shorter hospital stay).
d) Enucleation of HBP by Laser Holmium
This technique allows operating through the urethra (without the need to open) very large prostate, greater than 100 grams. These very large prostates are usually operated on by open surgery which is much more aggressive and presents a very annoying postoperative period.
The enucleation of the BHP by means of Holmium Laser allows for nuclear of the benign growth that denominated adenoma. It is to do the same as open surgery but without opening. This adenoma after enucleation is pushed towards the bladder and with the help of a special instrument is fragmented and the fragments are extracted through the urethra.
This treatment with Holmium Laser is a breakthrough: it allows one to treat prostates greater than 100 grams, the bleeding is minimal, the stay in the Hospital is of 24-48 hours, the probe stays of 2 to 3 days, and the postoperative discomforts are minimal.
e) Open Surgery
An incision is made below the navel, and the hyperplastic tissue (prostate adenoma) is removed. Open surgery (Adenomectomy) is reserved for large prostates.
It presents a very annoying postoperative period (spasms), it usually bleeds and needs a transfusion in more than 50% of the cases, and the hospital stay is from 6 to 7 days.
Open surgery is being displaced by enucleation by Holmium Laser.
The indication of surgery (when necessary) and especially the performance of prostate surgery should be practised by an experienced urologist. Dr Shailendra Goel has extensive experience (more than 30 years) in the performance of Prostate Surgery.
At the Max Hospital, in prostates less than 100 grams, we recommend performing a green laser or plasma kinetic vaporization. In prostates greater than 100 grams we propose enucleation with Holmium Laser. However, the treatment must always be individualized and adapted to the circumstances of each patient.
Tips about your prostate
- Every man over 50 years should review annually his prostate, erection, and sexual desire (Integral Health of the Man). If there is a family history of CaP, the 1st revision should be done at 40 years of age. The best urologist in Noida is the most suitable specialist for this complete review.
- An adequate prostate revision allows differentiating between malignant (cancer) or benign (HBP) growth.
- Prostate cancer diagnosed early can be cured.
- There are very effective medical and surgical treatments for Benign Prostatic Hyperplasia.
- The vaporization of the prostate with a green laser is an excellent option to eliminate the prostate tissue and produces an immediate relief of the symptoms.
- Enucleation of HPB with Holmium Laser is an excellent treatment for large prostates.
- In well-located and low-risk prostate cancers Focal Treatment allows only the area of the prostate where the cancer is removed.