The term prostatic hyperplasia indicates a pathophysiological event of the prostate gland increasing in size connected to the onset of particular voiding symptoms that affect humans in the course of the aging process.
Despite intensive studies carried out over the past 5 decades, aimed at discovering the causes of prostate growth, there is still no comprehensive report of cause and effect. Conventionally, it comes to benign prostatic hyperplasia (bph) to indicate this process; whether the concept of benignity always requires histological confirmation (biopsy and/or tissue taken during surgery) otherwise the term would be improper and it would be better to speak only of prostatic hyperplasia.
The prostate gland is the deputy to the production of most of the seminal fluid, thus covering a critically important role in male fertility. It is located below the bladder, which is the organ that functions as a reservoir for urine, and completely surrounding a urethral tract, or the conduit which carries urine from the bladder to the outside of the body through urination.
In the majority of the Western male population, usually starting from 30-40 years of age, the prostate gland begins a dimensional growth process, due to a series of individual hormonal changes. The increase in size of the prostate gland is moderately slow and progresses with advancing age of the subject sometimes reaching considerable volumes: from the size of a chestnut, typical of a man at a young age, the prostate may indeed grow as large as a large mandarin.
Symptoms: How can you realize you are suffering from prostatic hyperplasia?
The enlargement of the prostate gland is a common cause for problems with bladder emptying, and consequently creates a series of annoying problems related to urination.
You can have irritative disorders, characterized by the need of having to get up several times at night to urinate (nocturia), having to urinate more frequently even during the day (urinary frequency) or by the need to rush to urinate as soon as you experience the first stimulus (micturition urgency) with occasional urine leakage (urge incontinence).
There may also be interference due to real mechanical obstruction to urination (obstructive), such as the hesitation when you start to urinate (especially in the morning when you wake up), a weak or intermittent urinary stream (sometimes patients report that they fear wetting their shoes while urinating!), the sensation of incomplete bladder emptying (and consequent abdominal tension) as well as the annoying dripping at the end of urination.
Epidemiology: How common is benign prostatic hyperplasia?
Although the process of enlargement of the prostate gland affects the majority of men over 40 years of age, its symptomatic manifestations (irritative and obstructive) are established gradually over time, initially manifesting as occasional inconveniences until they become bothersome, annoying, and shameful problems that can significantly worsen the quality of life.
An important surveillance study conducted in the US showed that the prevalence of prostatic hyperplasia is moderate by 17% in men 50-59 years of age included in this group, 27% in a group of 60-69 years of age and 37% in the 70-79 years group.
European studies have shown that the overall prevalence of prostatic hyperplasia is 11.8%, varying from a minimum of 0.8% in the thirties to a maximum of 32% in the ultra-seventies.
In summary, the prevalence of urinary symptoms of moderately to severely, taking into account more than 65,000 subjects analysed in 17 different international studies completed in the nineties – two thousand men with an average age of 65 years appear to vary from 14% to 43% with a weighed mean value of 37% (more than 1 out of 3 men!!!!).
Diagnosis: How is it diagnosed benign prostatic hyperplasia?
In most cases, a simple conversation with the patient (anamnesis) focused on some specific questions and the visit (digital rectal examination) are sufficient for the specialist to identify a condition of prostatic hyperplasia.
There are other useful tests for the diagnosis of BPH such as blood PSA (prostate specific antigen), Uroflowmetry with evaluation of post-void residual (in order to objectify the urinary flow and to verify any failure to empty the bladder after urination) and transrectal prostate ultrasonography (to precisely evaluate the prostate volume in anticipation of possible unobstructive intervention).
Treatment: How do you treat benign prostatic hyperplasia?
Urinary disorders related to prostatic hyperplasia can often be treated with reasonable success with different types of drugs. Although these are generally well tolerated, however, they are not completely free from side effects, which may include excessive decrease in blood pressure (orthostatic hypotension), temporary loss of ejaculation to the outside and ascent of the sperm into the bladder (retrograde ejaculation), decreased sexual desire and other less frequent side effects.
Although medical therapy has an important role in the treatment of prostatic hyperplasia, when it comes to establishment of a real disorder and urinary obstruction due to prostate enlargement, medications can usually be insufficient and the patient may need an unobstructive surgical intervention.
Historically, the type of surgical approach was to open with a suprapubic incision (adenomectomy). It has later been gradually supplanted by the development of endoscopic techniques, in which access to the prostate is transurethral (TURP – trans-urethral resection of the prostate).
In the recent years, treatment has gradually taken hold in the international field using a new endoscopic technique of prostate laser reduction including the Holmium called HoLEP (Holmium Laser Excision of the Prostate).