It is the most frequent pathology of the prostate gland. This is a benign growth of the gland that affects 40% of men over the age of 60 years and 80% of those over the age of 80%. In many cases makes it makes urination difficult and produces symptoms that significantly alter the patient’s quality of life. Early diagnosis and treatment can prevent in many cases the appearance of complications such as urine retention, kidney failure, bladder stones, etc.
Recently appeared new technologies have improved the possibilities of treatment of this pathology. We offer the following diagnostic and therapeutic techniques:
- Abdomino-pelvic urological ultrasound
- Uroflowmetry, urodynamic studies for ambulatory patients
- High-resolution transrectal ultrasound prostate biopsy, under sedation
- Flexible endoscopy under sedation
- Individualised pharmacological treatment
- Conventional and minimally-invasive surgical treatment
- Transurethral resection of the prostate with bipolar technology (minimum hospital stay)
- KTP “Green Light” laser photo-vaporisation of prostate for patients of same-day surgery
- Transurethral resection of the prostate and conventional open surgery
- Endoscopic enucleation with holmiun laser
What is the prostate?
What is benign prostatic hyperplasia?
Benign Prostatic Hyperplasia, or BPH, refers to the growth of a noncancerous (benign) tumour of the prostate. The normal prostate grows rapidly starting from puberty and suffers histologic changes (at the cellular level) from the age of 40 onwards. It is a very common disease in older men, affecting 60% of men over the age of 60, and up to 80% of men over the age of 80 years. Currently, Benign Prostatic Hyperplasia (BPH) cannot be prevented. It is important to stress that the BPH is not cancer, nor will it develop into cancer in the future.
Although BPH may not cause any symptoms, some men eventually develop low obstructive urinary problems. Among these symptoms, the sensation of not emptying the bladder completely or having to urinate frequently, the presence of a weak stream or the fact of waking up during the night to empty the bladder. These symptoms can interfere with your quality of life.
About one-third of men with BPH eventually have symptoms that interfere with their activities or any other related problems that require treatment. As we get older, these symptoms may become increasingly annoying. Symptoms usually are independent of the size of the prostate, and some patients with small prostates can have severe symptoms.
What is the cause of urinary symptoms of BPH?
Urinary symptoms are not always caused by the prostate and may well be the manifestation of problems in another organs such as the bladder or urethra. Although the exact cause of the discomfort is not always found, symptoms may be secondary to a combination of prostate growth as well as an increase in muscle tone of the bladder neck and prostate. As it grows, the prostate compresses the urethra (the tube that passes through the prostate and is responsible for draining urine from the bladder). This gradual compression of the urethra may cause difficulty in urination. In the initial stages of BPH, the bladder muscle (detrusor) can force the urine through the urethra. However, if the growth of the prostate continues, the bladder muscle becomes stronger, thicker and more sensitive.
The result is a feeling of urinary urgency. Getting up during the night to urinate is an indirect symptom of prostate growth. Some patients may find themselves in the situation of not being able to urinate (a condition called urinary retention). If this occurs, you should see a doctor immediately and is likely to require you to place a probe to the bladder to urinate. Over time, if the prostate causes a blockage may be very important, bladder problems or kidney infections, urinary tract infections, bleeding or the formation of kidney stones.
When should you see an urologist?
What are the symptoms of BPH?
During the visit, we will perform:
- Clinical history
- Physical examination: digital rectal examination to assess the characteristics of the prostate
- Ask you to fill out a questionnaire relating to the symptoms that causes BPH (called International Prostate Symptom Score, IPSS)
- Perform an ultrasound of your bladder to determine whether there is urine left after emptying the bladder (called Residual Urine Volume)
Moreover, it may be necessary to perform some laboratory tests such as urine tests, urine cultures, blood biochemistry (determination of the prostate-specific antigen or PSA) to rule out the possibility of Prostate Cancer. There is another series of studies that may be required to prove that the symptoms are caused only by BPH, and not by problems at another level, as well as to determine whether the BPH has not affected other organs such as the bladder or kidneys:
- Uroflowmetry: serves to measure the volume of urine in a period of time
- Urodynamics: serves to identify the pressures inside your bladder during urination
- Other: urine cytology, x-rays, ultrasound, cystoscopy, etc
When should BPH be treated?
In most cases, an enlarged prostate alone is not an indication for treatment. Making a decision to receive a treatment or not depends only on how inconvenient the symptoms are for you. If your symptoms are mild or even moderate, and do not affect your daily activity, it is possible that they do not require treatment at this time. If your symptoms are severe, compromise your quality of life, or have already affected your urinary tract, it is important to discuss the different therapeutic options with us.
How are the therapeutic options assessed?
There are different types of treatment for BPH. Each of them can improve symptoms in a greater or lesser extent. The following factors should be taken into account before deciding different therapeutic options:
- The severity of your symptoms
- The probability that the offered treatment will provide a marked improvement of symptoms
- The duration of the effects of the treatment
- The disadvantages, risks and inconveniences of the treatment
For example, a surgical treatment can improve your symptoms to a greater extent and for a longer time than a medical treatment, however, surgery conveys a higher risk of complications.
What are the therapeutic options?
The options are as follows:
- Monitor (without treatment)
- Medical treatment
- Surgical (procedures to remove part of the prostate)