The enlargement of the gland is a natural phenomenon that affects practically all men with advancing age. Although benign, the disorder causes bothersome symptoms that should not be underestimated and that can also be resolved thanks to new treatments.
When the first symptoms appear, men generally ignore them, even for years, but the situation does not improve e the disturbances are becoming more and more annoying. Worsening of the urinary stream, sensation of incomplete emptying of the bladder, difficulty in starting urination, urgency, frequency, nocturnal pollakiuria (high frequency of small amounts of urine), up to urinary retention, renal failure and recurrent urinary infections. Are the possible symptoms ofBPH, which with advancing age comes to interest practically all men. And if there are many therapies already available today (there are different types of drugs, surgery and lasers), these are solutions that involve more or less annoying side effects and it is precisely to offer patients a better quality of life that new effective solutions are being studied.
First symptoms around the age of 50
The appearance of the problems due to hypertrophy, moreover, is an almost inevitable fact, completely natural, because the size of the gland tends to increase in all males from about 40 years of age, with the first urinary discomfort appearing around 50 and symptoms which, around 60, affect over 70% of men. The enlarged prostate, with the presence of a benign adenoma, is diagnosed in over 6 million Italians every year – underlines Giuseppe Carrieri, director of the Department of Urology at the University of Foggia and general secretary of the Italian Society of Urology (Siu) -. It can cause compression of the urethra (the channel through which urine is expelled) and over time cause problems ranging from difficulty urinating to a complete obstruction of the urethra.
Prevention
In a preventive key, some risk factors can be modified both for the development of hypertrophy and its symptoms. Lead a healthy lifestyle and keep certain conditions under control (body weight, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes) are a first step for the well-being of the gland. To reduce symptoms, then, European guidelines recommend avoid or moderate the consumption of coffee, which has a diuretic and irritating effect on the prostate; modulating fluid intake, reducing it when going to the bathroom often could create discomfort. And strongly recommended the integration of fiber in the diet, to avoid constipation, an often underestimated enemy. To solve the problem effectively, then, the first step that a man with these symptoms must take is to be examined by a urologist, which suggests possible solutions based on the symptoms and size of the prostate gland.
New minimally invasive treatments
For small adenomas, new minimally invasive therapies can be used, such as temporary prostatic stents, water vapor or innovative lasers, solutions with objective advantages for the patient: They can be performed on an outpatient basis or in day hospital, they improve symptoms avoiding the unpleasant side effect of retrograde ejaculation, caused by both drugs and most endoscopic surgery – he explains Francesco Porpiglia, Professor of Urology at the University of Turin and head of the SIU scientific office -. There are many effective medicines today, but men do not always follow the treatment with precision, even in consideration of the long periods of treatment. Standard surgery is performed almost exclusively using endoscopic procedures and, just like the lasers already available, it allows to carry out an enucleation of the gland, that is the removal of its central hypertrophic part.
Surgery
Retrograde ejaculation, the most unwelcome effect of surgery, is circumvented by minimally invasive techniques such as temporary intraprostatic stents which, through elastic forces, cut into the tissue and resolve prostatic obstruction (i-TIND) – adds Porpiglia -. Or with permanent devices that, as if they were small tie rods anchored to the outside of the prostate, compress the adenoma and dilate the urethra, thus improving the flow of urine (Urolift). To reduce the size of small to medium sized adenomas it is now also possible to use high temperature water vapor, injected into the prostate through a special endoscopic handpiece (Rezum). Or the energy of a laser released inside the gland through optical fibers introduced percutaneously, which leads the adenoma tissue to necrotize, thus causing a reduction in the prostate volume with consequent unblocking (SoracteLite). All these techniques have shown, even in a recently published analysis, results similar to standard care in terms of efficacy and improvement of the quality of life. The new minimally invasive solutions are available in various Italian centers through the National Health System: they have, in fact, already passed the validation tests in terms of safety and efficacy and have been authorized by the regulatory committees, concludes Carrieri.
A few tests are enough to evaluate the obstruction
According to the estimates presented at the recent congress of the Italian Society of Urology, he suffers from benign hypertrophy 50% of males between 51 and 60 years old, 70% of 61-70 year olds, even 90% in eighty year olds. The process of enlargement of the gland begins well before the development of urinary disorders, which increase due to the growth of the portion that compresses the urethra, and to have a diagnosis, a visit to the specialist who prescribes the first level examinations is enough: ultrasound, blood and urine tests (to check for signs of infection or microscopic blood in the urine), flowmetry (simple and non-invasive procedure that measures the flow of urine during urination, giving information on the possible presence and severity of the obstruction caused by the prostate on the urethra). Only if necessary, other insights are then used. Once the diagnosis of Ipb is reached, it can be established the most appropriate therapy for the individual case, evaluating how much the symptoms affect the person’s life – explains Carrieri -. a decision that must be taken both on the basis of the type and severity of the present disorders, and also on the needs of the patient.
December 12, 2021 (change December 12, 2021 | 19:05)
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