Drogosis Achillefs Urological Surgeon Athens Greece

BENIGN PROSTATIC HYPERPLASIA

Benign Prostatic Hyperplasia (BPH) is a common condition in males aged 60 and above.

Benign Prostatic Hyperplasiasource: en.wikipedia.org

The prostate gradually increases in size and squeezes or partially blocks the urethra, which is the tube that carries urine out of the bladder, resulting in urinary obstruction.

The condition is caused by hormonal changes occurring due to aging.

Benign Prostatic Hyperplasia (BPH) affects voiding and entails negative effects on the patient’s quality of life as a result of the symptoms it causes.

It constitutes the most common disease in the field of Urology.

The function of the prostate

The prostate is a gland which produces a fluid (prostatic fluid) which is found in the semen (sperm).

Benign Prostatic Hyperplasia

source: www.medscape.com

It contains smooth muscular fibers which advance the sperm during ejaculation.

It is located under the bladder and surrounds the urethra.

Symptoms

Benign Prostatic Hyperplasia can cause:

  • Reduced stream when passing urine
  • Intermittent urination (urinary flow starts and stops many times)
  • Frequent urination (need to urinate frequently during the day)
  • Nocturia (need to urinate frequently during the night)
  • Urgency that may cause undesired loss of urine, i.e. incontinence.
  • Feeling of incomplete bladder emptying
  • Post-void dribbling and loss of urine

Diagnosis

The following are required:

  • Medical history
  • Clinical examination, incl. digital rectal exam (DRE), i.e. finger exam
  • Blood tests, including PSA
  • Urinalysis
  • Uroflowmetry
  • Urinary tract ultrasound
  • Post-void residual measurement

Treatment

Benign prostate hyperplasia requires treatment if causing symptoms which affect patient quality of life.

Careful monitoring

If the symptoms are mild, no medication or surgery is required.

Instead, careful monitoring is needed.

Symptoms may improve with patient education and lifestyle changes, i.e.:

  • Less fluid intake at night, before going to bed, to reduce nocturia
  • Reduced consumption of tea, coffee and alcohol
  • Full bladder emptying in sitting position

Medication for the treatment of the symptoms due to benign prostate hyperplasia

There are five classes of drugs:

  • Herbal drugs
  • Alpha-blockers
  • 5-alpha reductase inhibitors
  • Muscarinic receptor antagonists
  • Phosphodiesterase-5 inhibitors

Surgical management is required in the following cases:

  • Failure of medication
  • Recurrent urinary tract infections
  • Post-void residual volume exceeding 100 mL
  • Bladder lithiasis
  • Kidney failure due to benign prostate hyperplasia
  • Uncontrollable hematuria originating in the prostate
  • Acute urinary retention

Types of surgical procedures

  • Transurethral prostatectomy (TURIS technique)

Transurethral prostatectomy (TURIS technique)source: patients.uroweb.org

It constitutes the treatment option in patients with benign prostate hyperplasia.

The goal of the surgery is to remove the prostate adenoma causing the symptoms.

The surgery is performed via the urethra; no abdominal incision is required.

This type of surgery is known as Minimally Invasive Surgery (MIS).

  • Transvesical prostatectomy (Open prostatectomy)

Transvesical prostatectomy

source: patients.uroweb.org

The prostate adenoma is dissected through an incision in the lower part of the abdomen.

It is performed in patients with prostate volume over 80cm³.