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Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

What is the prostate?

The prostate is a gland whose main function is to exude the prostatic fluid. The prostatic fluid, spermatozoa and the fluid of the seminal vesicles, creates ejaculation, during the climax of sexual intercourse. Benign prostatic hyperplasia is the increased size of the gland that often compresses the wall of the urethra circularly, but also the bladder upwards, causing disturbances in urination.

Prostatic Hyperplasia

As the prostate increases in size, the bladder suffers, because its responsibility is to storage the urine and to vacate when it is time. So, as the bladder needs to overcome the prostate blockage, the bladder muscle is overfed (hypertrophy), to exert more pressure on the urine.

However, the hypertrophy of the bladder cannot be forever, and as the time passes the bladder thickness decreases and residual volume of urine is observed. Thus, the urine produced in the kidneys cannot go down into the bladder and hydronephrosis occurs. If the obstruction persists and a catheter is not immediately placed, the parenchyma of the kidney is destroyed, and the patient develops renal failure.


There are obstructive and irritating symptoms. Obstructive symptoms are mainly due to the mechanical obstruction caused by the enlargement of the gland and include difficulty in starting urination, prolonged urination, decreased urine flow, intermittent urination, dribbling, incomplete emptying, overflow incontinence and urinary retention.

- Irritating symptoms, which may be due to obstruction but also to bladder dysfunction, include frequency, urgency or even incontinence, nocturia, burning sensation during urination and suprapubic pain.


  • medical history (including IPSS questionnaire).
  • rectal finger examination of the prostate
  • KUB - prostate ultrasound
  • TRUS ultrasound of the prostate
  • uroflow

In some cases they may need:

  • urine analysis and urine culture
  • urea and creatinine, to check kidney function.
  • PSA test for early diagnosis of prostate cancer
  • cystoscopy
  • upper and lower abdomen CT scan
  • urodynamic study

Pharmaceutical Treatment

  • Plant extracts: to deal with the irritating symptoms and they have no side effects.
  • a-blockers: to reduce the tone of the muscle fibers of the prostate and of the neck of the bladder. Their action appears immediately. The main side effect is that they cause hypotension in 10% of patients.
  • Anti-androgen: to reduce the size of the prostate, improve the urine flow and to mitigate the symptoms. Their action appears after a few months. The main side effect is that they affect erectile function at a rate of 7% – 10%.
  • Antimuscarinics: when bladder overactivity is present. Main side effects are dry mouth and constipation.
  • Drugs for both erectile dysfunction and urination symptoms.

Surgical treatment

Surgical treatment is recommended in patients with large residual volume of urine - urinary retention, bladder lithiasis, frequent urinary infections and especially in patients with severe clinical and subjective complaints, which do not subside with medication and affect the quality of life. Improvement in symptoms is evident immediately after surgery.


There are three types of procedures: transurethral prostatectomy (TURis) , open prostatectomy and LaserProstectomy (HoLeP).


The most common complication after prostatectomy is bleeding, so patients who are taking anticoagulants and aspirin should stop taking them several days before the surgery. After the operation, patient may have urgency for a few months, but in most people, retrograde ejaculation is observed, while erection and orgasm are not affected. This happens, because the bladder neck is now open and the sperm travels freely to the bladder.