Prostate Hyperplasia

Anatomy of the prostate gland

The prostate is a small chestnut-shaped gland, measuring 3×4 centimeters and weighing 10-20 grams. It is located just below the bladder and above the end of the intestine, the rectum. Above the prostate are the seminal vesicles, organs that also belong to the male reproductive system.

Externally, the prostate is surrounded by a fibromuscular sheath that expands internally and creates follicles. This is the supporting layer of the prostate. Inside, there are the adenoids, from where the prostatic fluid is produced that is stored in the gland and expelled during ejaculation through muscle contractions of the prostate towards the urethra. At that moment, the bladder neck closes, so that the sperm does not escape to the bladder. The ejaculatory ducts pass through the prostate, to end up in the spermatic cord, an opening of the urethra where they ejaculate.

The prostate surrounds the final part of the urethra, which is called the prostatic urethra, and extends from the spermatic cord to the bladder neck. Depending on its composition, the prostate is divided into zones:

–The transition zone surrounds the urethra near the bladder and is the one that overgrows in benign prostatic hypertrophy.

–The central zone extends behind and below the transitional zone and encloses the ejaculatory ducts.

– The peripheral zone extends distally from the previous ones to the bowel, where about 80% of prostate cancers originate.

– Finally, the fibromuscular zone lies anterior to and above the urethra.

In prostatic hypertrophy, the growth of the transition zone presses on the others and practically occupies most of the gland, and in some cases it also penetrates into the cyst, and then we speak of the growth of the middle lobe. It is to this close anatomical relationship of the prostate-urethra-bladder that the urination problems associated with prostate diseases are due.

Benign prostatic hypertrophy

Benign prostatic hypertrophy is the enlargement of the gland observed after 40 years. The enlargement of the prostate often compresses the wall of the urethra circularly, but also the bladder upwards, causing disturbances in urination called lower urinary tract symptoms. It should be emphasized that it is not related to prostate cancer, which unfortunately does not show early symptoms.

It is an extremely common condition, since 4 in 10 men have symptoms in their 5th decade of life, 7 in 10 in their 6th decade, 8 in 10 in their 7th decade, to reach 90% in their 90s. The condition is more often observed in men who are obese, lead a sedentary life, suffer from metabolic syndrome, have erectile problems and a burdened hereditary history. On the contrary, men with hypogonadism, i.e. a lack of testosterone, will rarely develop the disease, since the development of the prostate depends on the male hormone.

What are the symptoms of the condition?

The symptoms of urinary disorders, i.e. symptoms from the lower urinary system, are divided into those related to the storage of urine in the bladder and those related to the elimination of urine from the bladder, i.e. urination.

The symptoms related to the storage of urine in the bladder are the following:

-Urinary frequency, when for small amounts the regular need to urinate is caused.

-Nocturia, when we wake up at night to urinate.

-Urgent urination, when we cannot postpone urination.

-Urge incontinence, when we no longer have time to go to the toilet.

The symptoms associated with the elimination of urine are the following:

-Decreased flow of urine, when the radius of the urine decreases.

-Difficulty starting to urinate.

-Intermittent urination.

-Loss of drops of urine after the end of urination.

-Feeling of incomplete emptying, i.e. the feeling that the bladder has not emptied completely.

-Complete inability to urinate, the so-called urinary retention.

Treatments

Today there are many treatment options, able to solve the problem of every man. Your urologist will recommend the most suitable ones for you and help you decide which one to follow. But let’s get to know them:

Active monitoring

This is recommended for patients with mild symptoms, for men who do not notice effects in their daily life. This treatment option includes regular visits to the urologist and possibly changes in the patient’s lifestyle, e.g. controlling liquids and limiting them before going to bed at night, urinating before going to bed, avoiding coffee and alcohol that have a diuretic and irritating effect, treating possible constipation, checking the drugs the patient is using for other conditions and possibly worsening the symptoms.

Medication

To understand the medicinal treatment of the condition, we should know the 3 factors that determine the patient’s symptoms:

• The first factor is the innervation of the prostate and bladder. The prostate, as well as the neck of the bladder, i.e. the part of the bladder that joins the urethra, have muscle fibers that can contract and relax through nerves. The nerves responsible for contraction are called adrenergic. At the endings of these nerves, a substance, norepinephrine, is secreted, which causes contraction of both the bladder neck and the prostate when it binds to special receptors, the adrenergic receptors.
• The second factor that determines symptoms is the size of the prostate. The larger the gland, the more difficult it is to urinate. The enlargement of the gland occurs only in the presence of a hormone called dihydrotestosterone (DHT). This is produced by the well-known male hormone, testosterone.
• The third factor has to do with bladder function. Many times, the bladder shows disorders of its innervation, as a result of which it contracts involuntarily in volumes of urine smaller than normal, i.e. below 400ml. Then, we are talking about an overactive bladder. This, of course, hyperactivity is expected in prostate hyperplasia, in the attempt of the bladder to empty itself. However, when it coexists at pathological levels, then frequency, nocturia and urinary urgency worsen significantly, even in patients with mild obstruction.

Surgical treatments

Surgery for the disease is usually done under epidural or spinal anesthesia, and improvement in symptoms is evident immediately after surgery. It must be emphasized that the improvement in symptoms offered by surgical procedures is much greater than that achieved by medication. As with any surgery, the risks for the patient depend on the patient’s preoperative condition and health problems. Prostate surgeries are divided into open, i.e. with an incision, and endoscopic, i.e. through a special endoscope inserted into the urethra.

The types of interventions are as follows:

-Transurethral prostatectomy

It is to date the most common surgical treatment for prostates up to 80 grams, although it is limited internationally, due to the development of less invasive methods, such as laser prostatectomy.

-Open prostatectomy

Open prostatectomy is done when the prostate has grown so large – usually more than 80 grams – that it does not allow a transurethral prostatectomy to be performed safely.

-Transurethral prostatectomy using laser

It is a technique that has gained ground in the last 10 years and is replacing transurethral and open prostatectomy internationally. After the laser surgery is completed, a catheter is placed through the urethra for 24 hours, and the patient is discharged the day after surgery.

Conclusion

As it can be seen, the symptoms of urination due to an increase in the size of the prostate can, today, be treated easily and effectively. Living with the problem is not a solution and a visit to the urologist can save us from a daily worry and suffering. The sooner this is done, the lower the chances of the need for surgical treatment.