HPB; hypertrophy (hyperplasia) prostatic benign enlarged prostate
Causes, incidence and risk factors
No one knows the actual cause of prostate enlargement. It is believed that factors linked to aging and the testicles themselves may play a role in the growth of the gland. The men who had their testicles removed at an early age (for example, as a result of testicular cancer) do not develop BPH.
Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.
Some facts about prostate enlargement are:
- The probability of developing enlarged prostate increases with age.
- BPH is so common that it has said, “All men will have prostate enlargement if they live long enough.”
- A small degree of prostate enlargement is present in many men over age 40 and over 90% of men older than 80 years.
- We have not identified risk factors other than having normally functioning testicles.
Less than half of men with BPH have symptoms of the enlarged prostate, which can include the following:
- Difficulty starting to urinate
- Weak urine stream
- Urinary dribbling
- Straining to urinate
- Strong and sudden urge to urinate
- Incomplete emptying of the bladder
- Needing to urinate 2 or more times per night
- Urinary retention (inability to urinate)
- Painful urination or bloody urine (this may indicate infection)
Exams and Tests
After taking a complete medical history, your doctor will perform a rectal examination to palpate the prostate gland; Also, you can perform the following tests:
- Urine flow rate
- Analysis of Post-void residual urine to see how much urine is left in the bladder after urination
- Pressure flow studies to measure the pressure in the bladder during urination
- A PIV (X-ray study) to confirm BPH or look for blockage
- Urinalysis to check for blood or infection
- Urine culture to check for infection
- ( PSA ) A blood test for prostate specific antigen (PSA) for prostate cancer
Additionally, you may be asked to complete a form to evaluate the severity of symptoms and their impact on everyday life. The score of this assessment can be compared to past records to determine if the condition is worsening.
Enlarged Prostate Treatment
The choice of treatment is based on the severity of symptoms, the extent to which they affect daily life and in the presence of any other condition. Treatment options include “watchful waiting”, changes in lifestyle, medications or surgery.
If the patient is over 60 years, is more likely to have symptoms, but many men with enlarged prostate have only minor symptoms. Generally, self-care measures are sufficient to feel better.
If a person suffering from BPH, you should have a yearly exam to monitor the progression of symptoms and determine if changes are needed in treatment.
For mild symptoms:
- Also, go to the bathroom when you have the chance, and even if you feel the need to urinate.
- Avoid alcohol and caffeine, especially after dinner.
- Do not drink excessive amounts of fluids at once. Syndicate fluid intake during the day and avoid eating two hours before bedtime.
- Try NOT to take prescription medicines for colds or sinusitis that contain decongestants or antihistamines because these medications can increase BPH symptoms.
- Keep warm and exercise regularly, as cold weather and lack of physical activity may worsen symptoms.
- ) Learn and practice Kegel exercises (pelvic strengthening exercises)
- Nervousness and tension can lead to more frequent urination.
- Finasteride and dutasteride lower levels of hormones produced by the prostate, reduce the size of the prostate gland, increase urine flow and decrease symptoms of BPH. It may take 3 to 6 months before you notice a significant improvement of symptoms. Among the potential side effects associated with the use of finasteride and dutasteride include decreased sex drive and impotence.
- Alpha 1-blockers (doxazosin, prazosin, tamsulosin, terazosin and afluzosin) are a class of medications also used in the treatment of hypertension. These drugs relax the muscles of the bladder neck, allowing easier urination. Two thirds of people treated with alpha 1-blockers show an improvement in symptoms.
- May also be prescribed antibiotics for the treatment of chronic prostatitis (prostate inflammation), which may accompany BPH.Some men note relief of their BPH symptoms after antibiotic treatment.
Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to drugs. Experts suggest a fat-soluble extract of the palm with 85-95% of fatty acids and sterols. However, a well conducted study, published in the February 9 2006 from the New England Journal of Medicine found that the popular herb was no better than placebo in relieving the signs and symptoms of BPH. Further studies are needed. If the person using the saw palmetto and think it works, you should also ask your doctor if you should take it.
Prostate surgery may be recommended if you have:
- Blood in urine appellant
- Urinary retention
- Urinary infections recurring
- Kidney stones
The choice of a surgical procedure is usually based on the severity of symptoms and the size and shape of the prostate gland.
- Transurethral resection of prostate (TURP for short in English): This is the most common surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
- Transurethral incision of the prostate (TURP for short in English): This procedure is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed as an outpatient without need for hospitalization. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, instead of removing the prostate, a small incision in the prostatic tissue to enlarge the outlet opening of the urethra and bladder.
Open prostatectomy: is usually performed under general or epidural anesthesia. An incision through the abdomen or perineal area (ie, through the pelvic floor, including the region from the scrotum to the anus) and then removing the prostate. This is a lengthy procedure that usually requires a hospital stay of 5 to 10 days.
Most men who undergo this surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing counterclockwise into the bladder instead of out the penis), infertility, and urethral stricture (narrowing). Rates of these complications vary depending on the surgical procedure the patient and doctor decide is best.
There is availability of other treatments, such as those that destroy prostate tissue with heat generated by microwaves or lasers. Photo selective vaporization of the prostate (PVP, by its initials in English), one of the newer laser technologies, is typically performed on an outpatient basis and patients return home the same day. Sin embargo, no However, there is no long-term information about this procedure.
However, this technology is not widely available and should take into account the surgeon’s experience. In addition, there are no long term studies of this surgery.
Another form of treatment are the stents prostate.
Men who have had long-standing BPH with a gradual increase in symptoms may develop:
- Sudden inability to urinate
- Urinary infections
- Kidney Stones
- renal Kidney injury
- Blood in urine
Even after surgical treatment, it is possible that over time a recurrence of BPH.
Calling your health care
Call your doctor if you have:
- Less urine than usual
- Fever or chills
- Back, side, back or abdomen
- Blood or pus in urine
Also call your doctor if:
- The bladder is not completely empty after urination.
- You take medications that can cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or adjust your medications without consulting a doctor.
- It took personal care measures for 2 months without relief.