Benign Prostatic Hyperplasia (BPH)

What is the prostate?

The most important diseases of the genitourinary system that concern the male population are prostate diseases — benign hyperplasia (or hypertrophy) and prostate cancer.

The prostate is an organ found only in men. It is a gland that has two basic functions: to assist in the proper functioning of the bladder during urination and to support normal sexual function by secreting various prostate fluids. The prostate is located just below the bladder and surrounds (embraces) the urethra, which is the tube that connects the bladder to the penis and through which urine exits the body. Other important organs of the genitourinary system include the kidneys, ureters, and testicles.

The prostate is roughly the size of a walnut, and from the ages of 40 to 50, it can begin to grow and swell under the influence of testosterone, the primary male hormone. By the age of 50, approximately half of men have an enlarged (hypertrophic) prostate, and by the age of 80, nearly 100% may experience significant enlargement.

Not all men with an enlarged prostate need to visit a doctor — only 4 out of 10 men seek treatment for their symptoms from a specialist (Urologist).

What are the symptoms of prostate hyperplasia?

• • Frequent urination (pollakiuria): Going to urinate many times during the day. The normal man urinates 3–5 times a day; however, if someone drinks a lot of fluids it is natural to go to the toilet more often.
• • Decreased urine stream: A reduction in the radius of urine — characteristically, in advanced prostate hypertrophy, the patient himself reports urinating "almost on his shoes".
• • Nocturia: The need to wake up at night to urinate. In some people this happens many times during the night so that sleep is kept to a minimum, causing fatigue throughout the day.
• • Difficulty starting urination (hesitancy): Difficulty initiating the urine stream is another symptom that the prostate has grown.
• • Urgency and urge incontinence: The need to go immediately to the toilet without being able to postpone this feeling, resulting in urine loss. This creates hygiene problems and problems of a social type (such as limiting outings due to incontinence or intense frequent urination).
• • Chronic urinary retention: More urine left inside after each urination. This is a dangerous condition because urine that stays in the bladder creates urinary tract infections, and even worse, may reflux to the kidneys, disturbing and burdening their function and often leading to renal failure.
• • Intermittent urination: The inability to keep a continuous flow during urination.

Acute urinary retention

In addition to chronic urinary retention, a sudden, abrupt, acute retention of urine may occur in a patient who urinated with problems due to the enlarged prostate but managed to empty his bladder to a satisfactory extent. This can be triggered by heavy alcohol consumption, a large fluid intake in a short time, or delayed and postponed urination for a long time.

The patient then becomes unable to urinate at all despite the urge to do so, resulting in anxiety and further deterioration of the condition with pain. The only solution is to urgently insert a urinary catheter to drain the urine.

How is prostate hyperplasia diagnosed?

The main tests recommended by the Urologist are basically three:

Digital Rectal Examination

An important examination performed by the urologist. It is essential to be done in every man after the age of 50, at least once a year. For many years before the advent of modern technology, this was the only weapon in the arsenal of the Urologist. It aims to assess the volume and size of the prostate, and to reveal any abnormalities in its contour and texture and possible malignancies.

Prostate Ultrasound

Ultrasound accurately determines the size of the gland in a relatively objective manner, and can also show whether there is urinary retention as well as the condition of the kidneys.

Urine Flow Measurement (Uroflowmetry)

A more specific test that helps assess how someone urinates — the force of the urine stream, the volume, how long urination lasts, etc. It is carried out by urinating into a special machine.

Treatment of benign prostatic hyperplasia

Treatment is divided into drug therapy and surgical treatment.

Drug Therapy

Drug therapy is applied to relieve symptoms in the early stages without actually delaying the swelling and growth of the gland. It is not a definitive solution.

Surgical Treatment

Many methods are applied. Open surgery (which today is rarely applied and only to very large prostates in certain structures, mainly those deprived of technological means) is the most classical. The most popular method is transurethral prostatectomy, which is performed without incision from the urethra using a special instrument, with a very short hospitalisation time (2–4 days). It is currently the main treatment.

Prostate Sublimation with Bipolar Diathermy

One of the minimally invasive, painless and bloodless forms of transurethral therapy is prostate sublimation with bipolar diathermy. With this method, patients using anticoagulant drugs can be led to surgery under regional anaesthesia, as it is almost bloodless surgery and at the same time highly safe.

The patient usually needs hospitalisation of only 24 hours, while the catheter remains for less than a day. Unlike laser treatment, it is a clearly more economical method as it uses only saline. It can treat very large prostates in less surgery time and with greater safety, while it does not present the disadvantages of intense dysuria in the first post-operative period that laser treatment can cause.

In conclusion, it is a method addressed to almost all patients with benign prostatic hyperplasia. In summary, prostate hypertrophy is a condition that forces more than half of men to visit the doctor, while its definitive treatment even today remains surgery.

Will surgery affect sexual function?

A frequently asked question by patients is: "After the removal of the prostate will I have sexual activity as before?" Surgery for benign prostatic hypertrophy has no impact on sexual potency and function. It is important to clarify this distinction from radical prostatectomy for prostate cancer, which involves the entire gland and its surrounding structures.