Benign prostatic hyperplasia

Benign prostatic hyperplasia is non-cancerous enlargement of the prostate gland.

It is the most common urological condition in men. According to the European Urology Association, it affects 50% of men aged 50, and 80% of those aged 80.

The growth of the prostate obstructs the urethra causing urinary symptoms that can disturb sleep, lead to incontinence and decrease patients’ quality of life.

Monitoring of prostate health is essential from the age of 50, through an annual check-up with the urologist, who will monitor growth of the prostate and can propose treatment if necessary.

HC Marbella offers specialist treatments for benign prostatic hyperplasia. Our team of urologists offer expert evaluation and personalised treatment to alleviate symptoms and restore patients’ well-being.

What is benign prostatic hyperplasia?

¿Qué es la hiperplasia benigna de próstata?

The prostate is a gland responsible for producing part of the seminal fluid. It is located at the base of the bladder and surrounds the first part of the urethra, the tube through which urine flows out of the bladder.

In BPH the prostate gland is continuously growing. This enlargement is largely due to the local action of the hormone dihydrotestosterone. As the gland grows, it can block the urethra, restricting the flow of urine and causing urinary problems.

What risk factors predispose men to developing it?

Age is the main risk factor.

First degree family history (father or brother).

Hormonal factors through dihydrotestosterone.

Physical exercise reduces the risk of BPH, as well as the symptoms and the need for surgical treatment.

Nutrition. Although studies are inconclusive, a high total calorie intake, excess protein, red meat, fat, dairy, cereals and poultry may increase the risk

Obesity is associated with an enlarged prostate.

What are the symptoms?

The symptoms it produces are related to urination and are associated with depression and sleep disturbances. Sometimes they significantly limit the patient’s daily activities and quality of life.

1. Filling symptoms

Urgency: Sudden need to pass urine.
Nocturia: Need to get up several times to urinate at night.
Polachisuria: Abnormal increase in the amount of times urine is passed, without associated increase in quantity.
Incontinence: Involuntary passing of urine.

2. Voiding symptoms

Weak stream
Intermittent urination: Involuntary stopping and restarting of urinary flow.
Voiding delay: Difficulty starting to pass urine.
Voiding effort: The patient must make an effort to initiate or maintain urinary flow.

3. Postmictional symptoms

Sensation of incomplete bladder emptying.

Post-mictional dribble. Loss of a few drops of urine after the main flow has finished.

How is it diagnosed?

Clinical History

The specialist will ask about the patient’s health, previous conditions and symptoms. Patients may also be asked to take an IPSS (International Prostatic Symptom Score) questionnaire to verify how symptoms affect their quality of life.

Physical examination

The specialist will examine the abdomen and genitals, and perform a rectal examination to assess the size of the prostate and the prostate surface and its consistency.

Blood tests

Creatinine and glomerular filtration are analysed to assess renal function and to rule out renal failure as a complication.

PSA, the prostate tissue marker, is checked as it can predict the risk of progression and complications such as acute urinary retention and the need for surgery.

Urinalysis

Urinalysis allows us to rule out urine infection or the presence of blood in the urine (haematuria) as the symptoms can be similar.

Bladder Diary.

This is useful in patients with nocturia and to establish dietary-hygiene recommendations. It must be completed for at least 3 days. It records the time and volume of each urination and additional information such as fluid intake, use of absorbent pads, activities performed …

Uroflowmetry

This is a non-invasive urodynamic test that assesses peak urinary flow. A flow greater than 15 ml/s is considered normal.

Post-void residual

This measures the amount of urine left in the bladder after urinating and is assessed after uroflowmetry using an abdominal ultrasound. A residual amount of over 20-30% of the volume passed is abnormal. In addition, it can identify patients for whom medical treatment has not been effective and who are therefore candidates for surgery.

How is it treated?

HC Marbella’s urology service offers personalised solutions, the team is highly experienced in the treatment of Benign Prostatic Hyperplasia.

The treatment to be given is decided together with the patient, depending on the severity of the symptoms. Most patients who remain untreated have worsening symptoms, with a deterioration in quality of life over time.

Treatment is started when symptoms become irritating or when the risk of progression is high (for example, a prostate with a volume greater than 40 ml).

There are three steps to controlling this condition: lifestyle changes, medical treatment and surgical treatment.

Active surveillance

When symptoms are mild and do not impair the patient’s quality of life, the urologist may recommend a period of active surveillance. Tests are performed periodically to check that the disease is not progressing.

Lifestyle Changes

When symptoms are at an initial stage, the urologist may recommend lifestyle changes to help you control your symptoms and prevent them from deteriorating.

Drug treatment

This is indicated when symptoms are moderate or severe and affect the patient’s quality of life. Depending on each patient, the specialist may prescribe:

Alpha blockers(terazosin, doxazosin, alfuzosin, tamsulosin, silodosin), these drugs relax the muscles of the prostate and bladder outlet,

5-alpha reductase inhibitors(finasteride and dutasteride) help inhibit the effects of male hormones that cause prostate enlargement.

Muscarinic receptor antagonists (oxybutynin, solifenacin, tolterodine, trospium).

Phosphodiesterase-5 inhibitors. These improve symptoms. They are usually indicated for those patients who have associated erectile dysfunction.

Beta-3 adrenergic receptor antagonists . (mirabegron).

Phytotherapy (use of medicinal plants).

¿When is surgery indicated?

When symptoms deteriorate despite pharmacological treatment or when treatment is not tolerated.

When high-risk complications appear such as renal failure, haematuria, frequent urine infections, urinary retention, bladder stones…

If the patient prefers definitive treatment.

What types of surgery are available for benign prostatic hyperplasia?

Open or laparoscopic prostatectomy

This is indicated when the prostate is very large or there is any associated condition (stones, diverticula…) which can be treated during the same operation.

Transurethral resection of the prostate (TURP))

This is performed by inserting a cystoscope through the urethra until it reaches the prostate, removing everything except for the outside of the prostate.

Symptoms are quickly relieved after the operation and the flow of urine increases significantly.

This technique is usually limited to prostates of up to 80 cc in volume.

Resección transuretral de la próstata (RTUP)

Incisión transuretral de la próstata (ITUP)

Transurethral incision of the prostate (TUIP)

Small cuts are made to facilitate the passage of urine, using a cystoscope inserted into the urethra.

It is indicated in small prostates (30 cc) or in at-risk patients who cannot undergo more invasive surgery

High-power laser enucleation of the prostate

This is the reference technique for treatment of benign prostatic hyperplasia and has proven its long-term effectiveness.

The excess prostate tissue (hyperplastic area) is separated using a high-power laser, leaving the capsule intact.

The removed remains are deposited in the bladder and extracted with a morcellator, a device that slices and aspirates the tissue, allowing samples to be obtained for pathological analysis.

It enables removal of the entire adenoma, regardless of the size of the prostate.

It is a minimally invasive technique, bleeding is minimal and recovery is quick.

Learn more

Enucleación prostática con láser de Holmio

Fotovaporización prostática con láser (FVP)

Photoselective vaporisation of the prostate (PVP)

This is performed using a laser that produces vaporisation of the prostate tissue, releasing the obstruction. This technique does not allow any tissue to be obtained for pathological analysis

Rezum

This is performed by injecting water vapour into the prostate tissue causing the blockage. It is performed via the urethra. This technique does not allow tissue to be obtained for pathological analysis.

Complications

BPH is not a malignant process and does not increase the risk of prostate cancer.

BPH is not a malignant process and does not increase the risk of prostate cancer.

Urinary retention.
Repeated urinary tract infections.
Repeated bleeding (haematuria).
Formation of bladder stones.
Renal failure.

The appearance of any of these complications is an absolute indication for surgical treatment.

Lifestyle changes. Advice for patients.

Decrease fluid intake late in the evening or when leaving home, but always keep in mind that total fluid intake should not be reduced to less than 1500 ml a day.

Avoid caffeine and alcohol as they have a diuretic and irritant effect.

Optimise your usual medication (for example, do not take diuretics late in the day).

Use distraction and relaxation techniques.

Avoid constipation.

Wait to empty your urethra completely to prevent post-urination dribble.

Retrain your bladder, wait for the desire to pass urine to increase, lengthening the time between passing urine and thus increase your bladder’s capacity.

Stay at your correct weight and participate in physical exercise.

Unidad Láser

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¿Quieres más información?

Consultants

Dr. Arrazola, Tomás
Especialista en Farmacia Hospitalaria
Especializado en terapia contra el cáncer, certificado por la Sociedad Americana de Farmacéuticos de Hospital