Prostate hypertrophy: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 23, 2023

Prostate hypertrophy (often referred to as benign prostatic hypertrophy or BPH) is a condition caused by an increase in prostate volume

The prostate is a gland located below the bladder and in front of the rectum that is part of the male genital apparatus

The purpose of this organ is to produce and act as a store for the seminal fluid that will be released during ejaculation.

The functions of the prostatic fluid are many, including the ability to mitigate the acidity of urine and promote the survival of spermatozoa.

The symptoms of prostatic hypertrophy are different

The benign form of hypertrophy affects many men over 50, particularly in the 60-80 age group.

In Italy, about 6 million men over 65 suffer from this pathology.

Another fact is very important: more than 70% of those who suffer from this disease ignore its symptoms and resort to ‘do-it-yourself’ treatment without consulting a doctor.

Let’s take a look at what causes prostatic hypertrophy, its symptoms and treatment.

Development of prostatic hypertrophy

To understand what prostatic hypertrophy is, it is important to have an overview of the anatomy of the male genital apparatus.

An increase in the size of the prostate gland can lead to complex consequences: in fact, as it increases in volume, it increasingly reduces the space of the prostatic urethra that originates at the urethral orifice and ends at the penile urethra.

This closure of the orifice leads to difficulty urinating, one of the most common symptoms of prostatic hypertrophy, as the bladder is subjected to an increased workload.

This strain makes expelling urine more complex and can lead to a weakening of the muscle fibres of the bladder. In addition, this weakening can also lead to the development of bladder hernias.

The symptoms of prostatic hypertrophy can be different

The differentiation between the different symptoms is characterised by the severity of the enlargement and the extent to which it impedes the flow of urine and, consequently, strains the bladder.

Symptoms of prostatic hypertrophy thus include

Difficulty urinating: this is the most common and widespread symptom among sufferers of this disease. But the opposite is also common: when suffering from increased prostate volume, the patient may feel the need to go to urinate several times during the day and night. Certain elements may increase this need, such as a long walk or the sound of running water.
Irregular leakage of urine: the stream is weak and often intermittent. In more advanced cases, it may be necessary to strain for the urine to come out by contracting the abdominal muscles and waiting a few seconds.
The inability to urinate may also be accompanied by incontinence: when the patient feels the need to urinate, he or she may not reach the toilet in time.

In more severe cases, which often correspond to patients who neglect the first signs of the disease, there may also be more complex and severe symptoms, such as bladder stones, the presence of blood in the urine, dilation of the upper urinary tract and kidney failure.

Generally, the three main symptoms are the need to urinate frequently during the day and night, difficulty in maintaining a good urine stream and urinary urgency.

If the patient experiences these symptoms, he or she most likely suffers from this condition.

Causes of prostatic hypertrophy

One of the most frequently asked questions is “what are the causes of prostatic hypertrophy?”.

The answer, as yet, is not definitive.

In fact, there are numerous studies trying to investigate the origin of this disease and why there is this increase in the volume of the prostate gland.

At present, however, the causes of this disease have not yet been confirmed.

Several studies seem to conclude that the cause of prostatic hypertrophy is hormonal changes.

Indeed, during andropause, as during menopause for women, there are several hormonal changes that men can undergo.

These hormonal changes that occur late in life and certain haemodynamic factors could lead to an increase in prostate volume.

These hormones of testosterone or dihydrotestosterone could have an effect on prostate cells, causing the gland to increase in size.

Other studies have shown, however, that there may be a hereditary factor in those who suffer from prostatic hypertrophy.

Increasingly, patients who contract this disease at a younger age, under 60, have other cases of prostatic hypertrophy in their family.

In this case, therefore, a cause related to ageing and andropause is ruled out and a genetic cause is preferred.

Diagnosis

The first step in obtaining a diagnosis of prostatic hypertrophy is to visit your general practitioner.

During an initial examination, the doctor can draw up a detailed anamnesis not only of the patient’s symptoms, but also of any medication intake, other family illnesses and related diseases.

After this first visit, the doctor may request a specialist examination and, above all, specific tests.

The most common test to diagnose prostatic hypertrophy is the rectal exploration.

This test provides a reliable first assessment of the state of health of the prostate, and it is also an easy and non-invasive test.

Already at this stage it is possible to check whether the prostate is hardened or painful.

If there is a diagnostic suspicion and symptoms of prostatic hypertrophy, the urologist may request further tests.

These will serve to make a differential diagnosis between a BPH and a malignant neoplasm that may hide further pitfalls and lead to much more serious consequences.

To make a correct diagnosis, the doctor may require

PSA analysis, prostate-specific antigen, which aims to assess any increase in this biochemical indicator. Moderate increases are suggestive of BPH while more significant alterations should lead one to suspect a malignant process.
Urine tests to detect the presence of white blood cells, which could be a sign of a prostate infection,
Ultrasound, which allows the health of the kidneys, bladder and prostate to be studied (this test is usually carried out with a full bladder).
After these three tests, it is possible to make a diagnosis of prostatic hypertrophy with reasonable certainty and to rule out other diseases related to the prostate gland.

Therapies

There are various therapies for the treatment of prostatic hypertrophy, both pharmacological and phytotherapeutic.

Especially in less severe cases, many physicians favour pharmacological remedies, such as 5 alpha reductase inhibitors and alpha-lithotics.

Inhibitors are concerned with reducing the action of testosterone at the prostate level by blocking the stimulation of volume increase by dihydrotestosterone.

Alpha-lithics, on the other hand, are relaxants, which improve the passage of urine by relaxing the bladder neck, prostate and urethra.

Sometimes drug treatments can be discontinued due to side effects reported by the patient, e.g. difficulty having erections, excessive lowering of blood pressure and, in rare cases, retrograde ejaculation (towards the bladder).

Among the less traditional methods as a remedy for prostatic hypertrophy is also phytotherapy.

Today, there are several medicinal plants and supplements that aim to alleviate the symptoms of this disease, especially for very mild cases.

These include the use of rye, nettle, pumpkin seeds, African pigeon and serenoa repens.

These natural raw materials are increasingly being included in supplements for their anti-inflammatory effect.

Another way to treat prostatic hypertrophy, of choice in more severe cases, is surgery

There are two types of operations that can resolve this pathology:

Endoscopic. This technique is the most advanced and today more than 90% of patients who decide to have surgery opt for it. This operation is also called TURP (Trans Urethral Resection of Prostate) and does not require any kind of incision or cut. To perform this operation, the surgeon uses the resector, an instrument that can be introduced into the urethral canal and through which the operation can be performed. Inside this instrument is an optic that can provide guidance to the doctor, who can locate the prostate lobes that create obstruction, resect them and extract them. Despite the lack of an incision, this type of surgery requires about 3 days of post-operative course, with the placement of a catheter to allow the internal wound to heal.
Traditional surgery. It involves an incision and is therefore chosen less and less by those who have to undergo the operation. In spite of this, however, in more serious cases with high volume increases, it is still advisable to perform the classic surgery.

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