Enlarged Prostate

What is Enlarged Prostate?

Benign prostatic hyperplasia (BPH), or prostatic hyperplasia, is a condition characterized by an enlarged prostate. This organ is responsible for producing the fluid that, together with the spermatozoa, constitutes the semen.

Prostate enlargement happens to almost all men as they age, and is a fairly common problem after the age of 50. As the gland grows, it presses on the urethra and causes problems with urination and the bladder as well.

An enlarged prostate is not cancer and does not increase the risk of prostate cancer.

Causes

The exact cause of prostate enlargement is still unknown. Factors related to aging and the testicles themselves may play a role in the growth of this gland.

Natural prostate growth occurs in most men as they age. In many of them, the growth is so large that it begins to block the passage of urine through the urethra. Another hypothesis raised by doctors for prostate growth is the changes in the balance of sex hormones that happen in men over the years.

“Some patients have changes in the levels of a testosterone substrate, a hormone called dihydrotestosterone. These patients with different levels of dihydrotestosterone normally have a larger and faster benign growth of the prostate compared to others”, explains Dr Vishal Patel.

Symptoms

Prostate gland enlargement tends to gradually get worse over time. Symptoms of an enlarged prostate include:

• weak urinary stream
• Difficulty urinating
• Urinary retention
• burning when urinating
• Feeling of heaviness in the lower abdomen
• Recurrent urinary tract infections
• urine bleeding
• Stopping the flow of urine when it has already started
• Increased frequency of urination at night (nocturia)
• Need to strain to urinate
• Not being able to completely empty your bladder.

The size of your prostate, however large it may be, is not necessarily an indication that your symptoms will be worse. Some men with slightly enlarged prostates may experience significant symptoms, while other men with greatly enlarged prostates have minor urinary symptoms.

In some men, symptoms eventually stabilize and may even improve over time.

Diagnosis

The diagnosis of prostatic hyperplasia is carried out through anamnesis, that is, the patient’s clinical history — his complaints, symptoms and family history. After that, the doctor will perform a digital rectal exam to examine the prostate. Physical examination is often enough to make the diagnosis. The following tests, however, may also be performed:

• urine flow rate
• Urine residue test to find out how much urine remains in the bladder after urinating
• Pressure flow tests to measure pressure in the bladder as you urinate
• Urinalysis to check for blood or urinary tract infection
• Urine culture to check for infection
• PSA (prostate specific antigen) test to detect prostate cancer
• Cistoscopia.

In addition, the patient may be asked about the severity of the symptoms and their impact on their daily life. The score can be compared with previous records to determine whether or not the disease is getting worse.

Risk factors

Age and the genetic component are the main established risk factors for prostatic hyperplasia. With aging, the gland tends to grow due to hormonal changes in men.

Other risk factors include:

• Having diabetes or heart disease
• Family history or prostate problems
• Be over 50 years old
• Obesity.

Prostate gland enlargement rarely causes signs and symptoms in men younger than 40. By age 55, about one in four men have some signs and symptoms of an enlarged prostate. By age 75, about half of men report some symptoms related to the problem.

Treatment

The choice of treatment is based on the severity of the symptoms, the extent of the impact on your daily life and the presence of any other possible illness. Treatment options include “watchful waiting”, lifestyle changes, medication and, if necessary, surgery.

If the patient has mild to moderate symptoms, prostatic hyperplasia can be treated with medication.

“These drugs will promote this relaxation of prostate compression under the urethra, causing the prostate to not compress the urethra so much and thus facilitate the passage of urine”, explains Dr Vishal Patel. In this way, the patient returns to have a better urinary flow and adequate emptying of the bladder.

However, if the patient presents an advanced condition of hyperplasia, or if the drug treatment fails, surgery is the most indicated treatment for the problem. The most serious conditions, according to Leão, occur when there is urinary retention and the bladder is very injured due to efforts to be able to empty the bladder.

Other more serious symptoms that require surgery are:

• Urinary incontinence
• Recurring blood in the urine
• Inability to completely empty the bladder (urinary retention)
• Recurrent urinary tract infections
• Renal insufficiency
• Bladder stones.

Medicines

Alpha 1 blockers are a type of medication used to treat high blood pressure. These medications relax the muscles in the prostate and bladder neck, which makes it easier to urinate. Most people treated with alpha 1 blocker drugs notice improvement in their symptoms.

Alpha 1 blockers decrease levels of hormones produced by the prostate and the size of the prostate gland, increase the rate of urine flow and decrease symptoms. It may take the patient three to six months to notice a big improvement in their symptoms. Potential side effects related to the use of finasteride and dutasteride include decreased sexual desire and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which can eventually accompany an enlarged prostate.

Surgery

With surgical treatment, three factors must be taken into account, according to urologist in Mumbai:

• patient’s age
• health status
• prostate size
• Illnesses that the patient has associated with

Thus, it is possible to analyze the best surgery to be indicated to the patient. According to Leo, there are three:

• Open surgery: a cut is made below the navel, where the bladder is opened and the central part of the prostate is removed.
• Robotic surgery: it is a technique without cuts, minimally invasive and less aggressive, performed by a robotic system
• TURP: surgery in which the prostate is scraped off, a resection usually performed with an electric scalpel
• Greenlight: it is a laser surgery, less aggressive and with faster recovery, indicated to treat high-risk patients.

Choosing a specific surgical procedure is usually based on the severity of symptoms and the size and shape of the prostate gland. Consult a urologist to find out which surgery is the best alternative for you, if it is really necessary.

Most men who undergo prostate surgery have improvements in urine flow rates and symptoms.

Is there a cure?

Yes, an enlarged prostate can be cured through drug treatment or surgery. When necessary, treatment is usually successful. Recovery time depends on the type of treatment used.

Prevention

There is no way to prevent the enlarged prostate problem, since it is a condition linked to genetic issues and is not linked to the external habits of each patient. However, as highlighted by urologist Dr Vishal Patel, it is possible to prevent the complications of the disease by maintaining regular consultations with the urologist.

Living together (Prognosis)

Making some lifestyle changes can often help manage symptoms of an enlarged prostate and prevent it from getting worse, such as:

• Limit drinks at night: not drinking anything for an hour or two before bedtime helps to avoid waking up during the night to go to the bathroom
• Don’t drink too much caffeine or alcohol: these can increase urine output, irritate the bladder and make symptoms worse.
• If you take diuretics, talk to your doctor: your doctor may prescribe a lower dose, or limit your intake to just the morning. This can help alleviate urinary symptoms. Do not stop taking diuretics without first talking to your doctor.
• Limit decongestants or antihistamines: These drugs put pressure on muscles around the urethra, which control the flow of urine, making it harder to urinate
• Go to the bathroom when you feel like it : try to urinate when you feel the need to. Waiting too long to urinate can strain your bladder muscle and cause damage.
• Always go to the bathroom, even if you don’t feel like it: try to urinate at regular times to “train” your bladder. This can be done every four to six hours during the day and can be especially helpful if you have frequent urination.
• Stay active: Inactivity causes you to retain urine. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
• Stay Warm: Colder temperatures can cause urine retention and increase your urge to urinate.

possible complications

If left untreated, an enlarged prostate can lead to more serious health problems, such as:

• Urinary infection
• Bladder stone formation
• Worse sleep quality
• Bladder stone formation
• reduced kidney function
• acute urinary retention
• Permanent damage to the bladder and kidneys.

Leão mentions a possible picture of acute renal failure due to prostate growth. “As he does not have complete emptying, this urine ends up becoming infected in the bladder and even compromising the kidneys, and what will happen is to evolve with an acute renal failure”.