Benign prostatic hyperplasia (BPH) is a condition characterized by an enlarged prostate.
This growth of the prostate is a process stimulated by the presence of the hormone testosterone and occurs throughout life in males. The older a person is, the longer his or her prostate has to grow.
This means that with age, almost all men will have a large prostate. At 40, 10% of men already have an enlarged prostate; at 50, that number jumps to 50%; after the age of 80, more than 80% of the male population has benign prostatic hyperplasia.
Benign prostatic hyperplasia, as its name says, is a benign growth, which has nothing to do with prostate cancer. BPH is a natural aging process.
As it is a very common problem, it is possible that a patient with prostatic hyperplasia will develop prostate cancer, but the hyperplasia itself is not to blame for the appearance of the tumor.
WHAT IS THE PROSTATE?
The prostate is a walnut-sized gland (3 cm in diameter), weighing approximately 20 grams, present only in males. It is located at the base of the bladder and surrounds the initial part of the urethra, the channel that takes urine from the bladder to the penis.
The prostate is part of the male reproductive system, being responsible for the secretion of an alkaline fluid (with high pH) that protects sperm from the acidic environment of the vagina and increases their mobility, facilitating their arrival in the egg.
As it has an intimate relationship with the urethra (channel that drains urine from the bladder), changes in the size of the prostate can compress it and hinder the passage of urine, leading to prostatism symptoms, which will be explained later.
As the prostate is leaning against the rectum, it can be palpated by digital rectal examination, one of the simplest methods of assessing the gland. A prostate enlarged or irregularly shaped due to the presence of a tumor can be easily identified by this method. We will talk in more detail about digital rectal examination in the diagnostic section.
The prostate can grow and cause symptoms in three situations:
- Benign prostatic hyperplasia.
- Prostate cancer.
- Prostatitis – inflammation of the prostate.
The enlarged prostate itself is not a problem. The problem is in the fact that the prostate is anatomically located next to some structures of the urinary tract, mainly the urethra. The enlarged prostate compresses the urethra and hinders urine output, which can even cause obstruction, hydronephrosis (accumulation of urine in the kidney) and kidney failure.
Symptoms of benign prostatic hyperplasia are related to obstruction of the urethra. The first signs are the loss of strength of the urinary stream and the need to urinate frequently.
The frequent urge to urinate, called pollaciuria, occurs because the bladder cannot empty itself completely. The enlarged prostate compresses the urethra and hinders urine drainage. Most of the time, this obstruction is partial and allows some volume of urine to pass, especially when the bladder is full and the pressure inside it can overcome the resistance caused by the enlarged prostate.
However, when the urine level inside the bladder decreases, the pressure drops and the jet, which is already weak, stops. The end result is a bladder that can no longer empty completely, always with some urine inside. Therefore, the patient feels the urge to urinate frequently, but can only eliminate small volumes.
Failure to completely empty the bladder means that a large volume of urine is always dammed, favoring the growth of bacteria inside. In patients with benign prostatic hyperplasia, there is always a “reservoir” of urine for bacteria to reproduce.
It is not surprising, therefore, that cystitis (a bladder infection), rare in young men, is a relatively common problem in elderly patients.
As the prostate grows, the urethra becomes more compressed, to the point of complete obstruction of the passage of urine.
Urine that is not drained accumulates inside the urinary tract and can reach the kidneys, a condition we call hydronephrosis.
Hydronephrosis is a dilation of the kidneys that are filled with urine that cannot be drained. If the problem is not corrected quickly, the patient may develop severe renal failure requiring urgent hemodialysis.
It is worth noting that even with severe obstruction, the patient can still continue to urinate. Whenever the pressure in the bladder is sufficient to overcome the resistance caused by the prostate, the patient will urinate. The problem is that the amount of urine it eliminates is usually less than the volume produced by the kidneys daily.
The longer the kidneys are clogged and filled with urine, the less chance of recovery after the flow is cleared. After 7 to 10 days of hydronephrosis, irreversible damage to the kidneys begins to appear, a process that is completed after 3 to 4 months of obstruction, at which time the patient will likely remain dependent on hemodialysis, even if he corrects the problem.
Another symptom of prostate growth is erectile dysfunction (impotence), which occurs by compressing the nerves that control erection.
In summary, the main symptoms of benign prostatic hyperplasia are:
- Pain or difficulty passing urine.
- Weak urinary stream.
- Need to urinate small volumes with great frequency.
- Inability to empty the bladder.
- Urinary infection.
- Bladder calculation.
- Renal failure, in cases of severe obstruction and hydronephrosis.
As many patients with enlarged prostate and hydronephrosis are still able to urinate, it is not uncommon for patients not to seek medical help early, neglecting their urinary symptoms. This behavior ends up making the condition much more severe, often causing the patient to stop at the hospital, later on, with a condition of advanced renal failure. It is important that any elderly person, at the first sign or symptom of prostate growth, be evaluated by a urologist in Delhi.
There is a table of points called the International Prostatic Symptom Score . There are 7 questions and each one receives a score from 0 to 5:
- How many times was the feeling of not completely emptying the bladder?
- How many times did you have to urinate again less than 2 hours after urinating?
- How many times have you noticed that when you urinate, you stopped and started again several times?
- How many times have you observed that it was difficult to contain urine?
- How many times have you noticed that the urinary stream was weak?
- How many times did you have to strain to start urinating?
- How many times, on average, did you have to get up at night to urinate?
0 = None.
1 = Less than 1 time for every 5 urinations.
2 = Less than half the time.
3 = Half the time.
4 = More than half the time.
5 = Almost always.
Graduation of prostate hyperplasia according to the final score:
- Light BPH: 0 to 7.
- Moderate BPH: 8 to 19.
- Severe BPH: 20 or more.
The above score assesses the severity of prostatic symptoms, but does not differentiate between BPH, prostate cancer and prostatitis, which have very similar symptoms.
The differential diagnosis involves digital rectal examination, PSA measurement, transrectal and abdominal ultrasound, and prostate biopsy.
PSA is a marker of prostate disease, collected through blood tests. PSA increases in BPH, in prostatitis and, mainly, in prostate cancer.
- PSA less than 2.5 – Low risk of cancer.
- PSA between 2.5 and 10 – Intermediate risk of cancer.
- PSA greater than 10 – High risk of cancer.
- PSA greater than 20 – Very high risk of cancer and high chance of metastatic disease.
Low PSA patients rarely have cancer. When the PSA value is intermediate, the most likely diagnosis is BPH, but prostate cancer cannot be ruled out. High PSA indicates a high risk of cancer, but it is also possible that it is prostatitis or even just BPH.
PSA greater than 20, practically only appear in cancer or in some cases of prostatitis.
Digital rectal examination
Digital rectal examination can detect an enlarged prostate, as it is leaning against the rectum. This examination of the prostate, when performed by an experienced urologist in Rohini, allows, in many cases, to know whether the prostate enlargement is uniform, that is, caused by BPH, or localized, caused by a tumor.
Digital rectal examination allows the best urologist in Delhi to detect irregularities, nodules, asymmetries and changes in the consistency of the prostate.
Ultrasound of the prostate
The ultrasound performed by the rectal route allows a good visualization of the prostate, allowing to calculate its size and volume, and can also detect suspicious nodules.
Abdominal ultrasound makes it possible to calculate the volume of urine in the bladder and to evaluate its emptying capacity. It is also possible to see the kidneys and diagnose any serious obstructions that are causing hydronephrosis.
If after all these tests, cancer remains a hypothesis, it is necessary to perform a prostate biopsy to close the diagnosis.
Patients who have BPH diagnosed on routine exams and have no complaints or signs of urinary obstruction can be followed up regularly without specific enlarged prostate treatment in Rohini, Delhi.
If there is an enlarged prostate and signs of moderate obstruction of the urinary tract, usually the indicated enlarged prostate treatment in Rohini, Delhi is done with drugs that reduce the size of the prostate.
When the obstruction of the urinary tract is severe or when drug treatment is unsuccessful, that is, if there is no reduction in the size of the prostate, prostate surgery in Delhi becomes an option.
Transurethral resection of the prostate (TURP) is currently the most widely used surgical procedure. In this procedure, the urologist in Delhi removes much of the prostate with a device called a resectoscope, which is introduced through the urethra. With this device, it is possible to insert a blade to dry the prostate and aspirate the removed tissue. Usually the entire interior of the prostate is removed, leaving only the outer part. The prostate surgery in Delhi is performed under general or regional anesthesia and lasts an average of 90 minutes.
If the prostate is not very large, a possible surgery is the transurethral incision of the prostate (ITUP), similar to TURP, but only removing a small part of the prostate tissue, enough to unblock the urethra.
There are other techniques for resection of the prostate, such as laser, microwave, cauterization, etc. The technique depends on the severity of each case and the experience of the urologist.