What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH), sometimes simply called prostatic hypertrophy, is an increase in the volume of the prostate gland with unique characteristics. The prostate, a chestnut-shaped gland, is part of the male genital system and is located below the bladder. The first section of the urethra, the canal that carries urine from the bladder to the outside, runs through it like a tunnel through a mountain. Benign prostatic hyperplasia involves enlargement of a section of the gland around the upper part of the prostatic urethra. This swelling blocks the urethra from opening funnel-shaped during urination, when the bladder empties. In other words, if the prostatic urethra fails to open funnel-shaped under the pressure of bladder contraction, this creates an obstacle that disrupts the flow of urination.

 

What is the medical treatment for benign prostatic hyperplasia?

Alpha-blockers

To improve urinary flow and alleviate the symptoms of benign prostatic hyperplasia, medications called alpha-blockers are often prescribed. By relaxing the muscles of the prostate and bladder, they help to quickly relieve these problems. However, it is important to note that these medications can lead to side effects such as dizziness, increased fatigue, and retrograde ejaculation, which can cause a decrease or absence of sperm during ejaculation in the patient. All these symptoms are related to taking the medication and it is important to note that its side effects are entirely reversible upon cessation of treatment. These medications are recommended for patients with moderate to severe benign prostatic hyperplasia, but only if the prostate size is "average", because for volumes greater than 45 cc, alpha-blockers are less effective.

 

5-Alpha Reductase Inhibitors

To improve your urological health, there is a family of medications known as 5-alpha-reductase inhibitors. By blocking the conversion of testosterone to dihydrotestosterone (DHT), these medications gradually reduce the size of the prostate. By choosing this treatment, patients can avoid surgery and side effects are usually sexual in nature, with a possible decrease in libido. To obtain satisfactory results, it is recommended to use these medications for at least 3 to 4 consecutive months. Thus, for men struggling with significant prostatic hypertrophy, this solution may be the most advantageous.

 

Combination Therapy

Combination therapy involves the simultaneous use of an alpha-blocker and a 5-alpha-reductase inhibitor. According to numerous studies, this approach is more effective than using a single drug to reduce lower urinary tract symptoms and improve the quality of life of patients suffering from urinary symptoms. Unlike taking a single medication, the combined use of these two types of medications helps prevent the worsening of benign prostatic hyperplasia. In addition, men with a large prostate are often good candidates for this form of treatment.

 

When to opt for prostatic hyperplasia surgery?

To improve symptoms related to benign hyperplasia of the prostate, it is possible to resort to surgery targeting the prostate directly. This approach can be minimally invasive and is an ideal option for men suffering from moderate to severe lower urinary tract symptoms.

Individuals considering this procedure may experience:

• Moderate to severe symptoms (LUTS);
• Urinary tract and/or bladder obstruction;
• Lithiasis;
• High post-void residual;
• May not respond to medical treatment;

Why use a minimally invasive procedure for the surgical treatment of benign prostatic hyperplasia?

The goal of minimally invasive procedures is to significantly relieve the patient's symptoms. These treatments, varied and renowned for their reliability and excellent results, are as follows:

• Transurethral resection of the prostate (TURP): Transurethral resection of the prostate (TURP) is the most common procedure to treat benign prostatic hyperplasia. It involves the use of an electric current to cut pieces of prostatic tissue. The instrument is introduced through the urethra and the fragments are moved into the bladder before being removed. After the operation, the patient can leave the hospital after 48 to 72 hours, with a bladder catheter previously placed. This treatment offers remarkable results;
• Photoselective vaporization of the prostate by plasma: This procedure involves the use of an instrument that is inserted through the penis into the urethra. An electrode is then positioned on the surface of the prostate, where it delivers "bipolar" type energy that effectively vaporizes the prostatic tissue. Thanks to this process, a plasma cloud forms on the surface of the prostate, thus allowing the vaporization of tissues while ensuring the automatic closure of blood vessels. After an operation, it is very rare for the patient to experience postoperative bleeding or fluid absorption syndrome. In general, he can leave the hospital without a catheter within 24 to 48 hours of the procedure;
• Enucleation of the prostate with plasma: When plasma is used to perform a prostate enucleation, the surgeon inserts a resector through the penis into the urethra. Thanks to the power of plasma energy, he manages to separate the adenoma from its prostatic capsule. Then, the adenoma is pushed into the bladder where it is fragmented using a dedicated instrument before being removed;

The benefits of this surgery include:

• Minimal or absent bleeding and complications;
• An attractive possibility: avoiding the risks of abdominal incision surgery and its complications before and after the operation;
• Ideal candidates for this surgical procedure are men with significantly hypertrophied prostates who wish to avoid more invasive surgery, as well as those whose health problems prevent them from undergoing major surgery;