Index
It is the enlargement of the prostate.
Benign Prostatic Hyperplasia (BPH) is the excessive growth of the non-malignant adenomatous periurethral prostate gland. The diagnosis is based mainly on the rectal examination, which may also be necessary for cystoscopy studies, transrectal ultrasonography, and urodynamics.
Symptoms and signs
Symptoms include progressive urinary frequency due to incomplete emptying and rapid bladder filling. Decreasing the size and strength of the current causes hesitation and urinary intermittency. This combination of symptoms is often called Lower Urinary Tract Symptoms (LUTS).
Pain and dysuria are usually not present. The sensations of incomplete emptying, terminal drip, overflow incontinence, or complete urinary retention may occur.
Some patients present sudden, complete urinary retention, with significant abdominal discomfort and distension of the bladder. Any of the following reasons can cause urinary retention:
- Attempts to postpone prolonged urination.
- Immobilization.
- Exposure to cold.
- The use of anesthetics, anticholinergics, sympathomimetics, opioids, or alcohol.
Diagnosis
The diagnosis is easily demonstrated through:
- The digital rectal examination
- The analysis of urine and urine cultures.
- Level of the specific antigen of the prostate.
- Flujometry and ultrasound of the bladder.
Treatment
- Avoid the use of anticholinergics, sympathomimetics, and opioids.
- The use of alpha-adrenergic blockers if there is a concomitant erectile dysfunction.
Urinary retention
The urinary retention requires immediate decompression. Using a standard urinary catheter with a coudé tip can be effective.
If this catheter can not be passed, flexible cystoscopy and followers (guides and dilators that can progressively open the urinary tract, this procedure must be performed by a urologist) may be necessary.
Drug Therapy
Product of partial obstruction that causes annoying symptoms, all anticholinergics, sympathomimetics, and opioids must be suspended, and any infection must be treated with antibiotics.
Alpha-adrenergic blockers (e.g., terazosin, doxazosin, tamsulosin, alfuzosin) may decrease urination in patients with mild or moderate obstructive symptoms.
Surgery
Surgery is performed when patients with Prostatic Hypertrophy do not respond to drug treatment or develop complications such as recurrent urinary tract infections: urinary stones, severe bladder dysfunction, or dilation of the upper tract.
