Prostatic hyperplasia: symptoms, causes and treatment

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  1. Benign prostatic hyperplasia: treatment and prevention
    1. What is prostatic hypertrophy?
  2. How can this be explained? What are the causes?
  3. What are the symptoms of benign prostatic hyperplasia?
    1. The symptoms of benign prostatic hyperplasia include the following:
  4. What evolution, risks, complications?
  5. What about prostate cancer risk?
  6. When should I consult? How is hypertrophy diagnosed?
    1. If the doctor suspects an enlargement or tumor, a digital rectal exam is performed to confirm the diagnosis.
    2. If the DRE supports the diagnosis of an enlarged prostate, a check-up is usually performed.
  7. How is benign prostatic hyperplasia treated?
  8. Phytotherapy: which plants to treat benign prostatic hyperplasia?
    1. Positive results have been obtained with several plant extracts, among which the best known and most used are :
  9. Drug treatments: what are the solutions?
  10. Surgery: what are prostate operations?
    1. Although they are the only definitive treatments for prostate hyperplasia, these three procedures are not without risk.
    2. Prevention of complications: how to protect the prostate?
  11. You may be interested:

Benign prostatic hyperplasia: treatment and prevention

What is prostatic hypertrophy?

By definition, benign prostatic hyperplasia is an excessive increase in the size of the prostate organ. As a reminder, the prostate is a gland that is part of the male reproductive system.

Prostatic hyperplasia symptoms

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It is located below the bladder and surrounds the upper part of the urethra, the tube that goes from the bladder to the penis and allows the flow of urine and semen.

In general terms, the prostate is the size of a walnut and weighs an average of 15 to 20 grams.

With age, the prostate tends to increase in size and is likely to cause significant discomfort.

Health professionals call this phenomenon by various names: prostatic hypertrophy, benign prostatic hypertrophy, prostate adenoma, adenomatous prostatic hypertrophy...

How can this be explained? What are the causes?

The causes of benign prostatic hyperplasia have not yet been clearly defined. However, there are a number of hypotheses raised by researchers.

In particular, several studies have shown that it could be the consequence of a hormonal imbalance.

While further studies should confirm or refute this hypothesis, scientists are unanimous in their opinion that age is the main risk factor for prostatic hypertrophy.

It is estimated that its prevalence increases from 20% in people in their forties to 80% in people in their seventies. In other words, the risk of prostate hypertrophy is a concern for many men.

What are the symptoms of benign prostatic hyperplasia?

As the prostate gains volume, it puts pressure on the bladder and urethra. This can disturb the urinary sphere and cause great discomfort.

It is difficult to empty the bladder, which has repercussions before, during and after urination.

The symptoms of benign prostatic hyperplasia include the following:

  • Pollakiuria during the day and night, i.e. an increase in the frequency of urination, both day and night;
  • an emergency urinary tract, which corresponds to an urgent need to urinate
  • Nicturia, which is a strong need to urinate at night;
  • a late onset of urination;
  • Dysuria, a difficulty in urination;
  • a weak stream of urine;
  • an interruption of urination or a stinging spurt;
  • ...the abdominal thrust urination;
  • the appearance of delayed drops;
  • a feeling of a full bladder after urination.

Depending on the case, benign prostatic hyperplasia may also be associated with other signs.

Pain can occur in the pelvis, lower back and upper thighs. There can also be sexual dysfunction, including ejaculation problems.

What evolution, risks, complications?

Very limiting on a daily basis, prostatic hypertrophy remains benign in most cases.

This means that it does not present a major health risk, provided of course that it is well managed.

Urination problems due to a prostate adenoma can indeed cause several complications:

  • Acute complications such as urinary or urogenital infections, blood in the urine (hematuria), acute urinary retention due to urethral obstruction, or acute obstructive renal failure
  • chronic complications such as bladder stones, chronic bladder retention or chronic obstructive renal failure.

Beyond these risks, benign prostatic hyperplasia can have a significant psychological impact.

Daily discomfort due to urination problems and the negative impact on sexual life can affect morale and behavior. To minimize complications and repercussions, early diagnosis of an enlarged prostate is essential.

What about prostate cancer risk?

The link between hypertrophy and prostate cancer has been the subject of numerous publications.

Contrary to popular belief, an enlarged prostate is not a risk factor for prostate cancer.

However, the symptoms of the two conditions may be similar.

In fact, an enlarged prostate can be mistaken for cancer, and vice versa. The two phenomena can also coexist, which is consistent with the previous paragraph and the importance of early diagnosis.

When should I consult? How is hypertrophy diagnosed?

Difficulty urinating, urgent need to urinate, feeling of a full bladder... are all signs that can alert and require the advice of a health professional.

At the slightest doubt, the consultation allows to establish a clinical diagnosis through a series of questions about urinary disorders.

The objective of this first diagnosis is to rule out or confirm the presence of an enlarged prostate. This diagnosis also considers the risk of prostate cancer.

If the doctor suspects an enlargement or tumor, a digital rectal exam is performed to confirm the diagnosis.

This test examines the prostate through the wall of the intestine.

In the case of an enlarged prostate, it is large, soft, painless, smooth and regular. A hardening or irregularity may suggest the development of a tumor.

In this second case, prostate biopsies are taken. These are tissue samples that confirm or rule out the presence of a tumor.

If the DRE supports the diagnosis of an enlarged prostate, a check-up is usually performed.

It consists of measuring the concentrations of two specific markers: prostate-specific antigen (PSA) and creatinine.

On the other hand, the evaluation is based on a cyto-bacteriological urine test (UBCT), the measurement of urine flow and the renal-vesico-prostatic ultrasound.

The tests and examinations carried out in the assessment allow to confirm the presence of benign prostatic hyperplasia, to evaluate the level of urinary disorders and, consequently, to take appropriate medical measures.

How is benign prostatic hyperplasia treated?

There are several treatments for benign prostatic hyperplasia.

The choice depends on the results mentioned above, the opinion of the medical profession and the opinion of the patients.

In fact, the treatment can be adjusted if the patient tolerates the symptoms of prostatic hypertrophy more or less well. There are three main levels of treatment:

  • First line phytotherapy, that is, the use of plants to naturally alleviate the symptoms of benign prostate hyperplasia;
  • drug treatments if symptoms are too difficult to tolerate;
  • surgery if complications arise.

Phytotherapy: which plants to treat benign prostatic hyperplasia?

Phytotherapy has been used for many years to relieve the symptoms of prostatic hypertrophy.

Today, it is still recommended as a first-line treatment and many scientific studies have confirmed its effectiveness.

Positive results have been obtained with several plant extracts, among which the best known and most used are :

  • Saw palmetto berries, whose efficacy in relieving the symptoms of benign prostatic hyperplasia is recognized by the European Medicines Agency (EMA);
  • the bark of the African plum (Pygeum africanum), whose benefits are also recognized by the EMA;
  • nettle root (Urtica dioica), whose use is recommended by the German Commission E and by ESCOP (European Scientific Cooperative on Phytotherapy).

These plant extracts have one thing in common: they all contain phytosterols, especially beta-sitosterols.

It is these compounds that are responsible for the benefits to the prostate.

Thanks to advances in extraction methods, it is now possible to capitalize on beta-sitosterol concentrates in the form of dietary supplements.

Drug treatments: what are the solutions?

If the situation requires it, a health professional may decide to start drug treatment. He or she may prescribe:

alpha-blockers, substances that act within 48 hours to facilitate urination by reducing muscle tone in the bladder, urethra and prostate, but which have contraindications (elderly, people on antihypertensive treatment, etc.) and side effects (orthostatic hypotension, ejaculation problems, headaches, dizziness, nausea, etc.);

The 5-alpha-reductase inhibitors, substances that are considered when alpha-blockers have not given satisfactory results, but that have a slow action, benefit only after 6 months of treatment, have side effects (decreased libido, erectile dysfunction...) and could increase the risk of breast cancer in men;

phosphodiesterase type 5 inhibitors (IPDE5) , vasodilator drugs originally prescribed only for the treatment of erectile dysfunction, but now being considered for the treatment of benign prostatic hyperplasia.

Surgery: what are prostate operations?

The treatment of benign prostatic hyperplasia through surgery is carried out in only a few cases: when drug treatments are not sufficient, when the symptoms are too difficult to bear, when there is a risk of complications or when complications arise.

Three main types of interventions are currently being studied:

  • the cervical-prostatic incision (ICP), an operative technique proposed when the weight of the prostate does not exceed 30 grams, performed by endoscopy, which consists of making a small incision at the level of the prostate adenoma and the bladder neck (meeting point between the bladder and the urethra);
  • Transurethral resection of the prostate (TURP), a surgical procedure that is usually performed when the prostate weighs between 30 and 80 grams and consists of removing part of the prostate to facilitate the passage of urine;
  • Upper Adenomectomy (UA), an operation performed when the prostate exceeds 80 g and consists of the partial removal of the prostate (removal of the prostate adenoma, the central part of the prostate).

Although they are the only definitive treatments for prostate hyperplasia, these three procedures are not without risk.

Several complications can occur: blood in the urine (hematuria), acute urinary retention, urinary tract infection, retrograde ejaculation, stenosis (narrowing) of the bladder neck or urethra.

In some cases, especially if the patient is at risk of surgery, other surgical procedures may be preferred.

For example, stenting, laser surgery or the use of radiofrequency may be considered.

Prostatic hypertrophy: what medical follow-up?

Once the diagnosis of prostatic hypertrophy is confirmed, a special medical follow-up is established.

It is based on several tests that are performed each year: the measurement of urinary flow, the IPSS (International Prostate Symptom Score) and the measurement of post-micrology residue.

The results make it possible to monitor the enlargement of the prostate, evaluate the evolution of the symptoms and anticipate the development of possible complications.

Prevention of complications: how to protect the prostate?

Numerous studies have been conducted on the prevention of benign prostatic hyperplasia.

Researchers have shown that several plant extracts, including some of the extracts mentioned above, as well as some flower pollens, may help prevent prostate disorders.

To capitalize on these important discoveries, formulas combining various natural active ingredients have been developed in recent years.

Conceived for the well-being of the prostate, the ProstaNatural Formula food supplement combines, for example, extracts of saw palmetto (Serenoa repens), nettle root (Urtica dioica), African plum (Pygeum africanum) and flower pollen.

To avoid complications, a series of hygienic and dietary measures can also be recommended. Health professionals tend to advise men over the age of 40 to :

  • Decrease water intake after 6 p.m. to avoid waking up at night to urinate;
  • Limit consumption of certain foods and beverages such as caffeinated beverages, alcohol, and salty and/or spicy foods;
  • Avoid holding urine and going to the bathroom when you feel the need;
  • exercise on a regular basis.

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