Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Specialties Seremas Urology

Urology

SEREMAS takes special care of men’s and women’s uro-genital tract disorders.

Urinary infections, Lithiasis, urinary incontinence and other urological diseases are diagnosed and treated in our Center, but especially those urologic diseases typical of aging male are studied in SEREMAS.

This is why the prostate is a gland which generates high interest in SEREMAS, because of the implicancies of its changes as long as the man grows older.

Prostate enlargement

The prostate is a male reproductive gland which produces the liquid transporting spermatozoa during ejaculation. The gland surrounds the urethra, the tube through which, urine gets out of the body.

Prostate enlargement means that the gland has grown bigger and this happens to almost all men when they age. As long as the gland grows, it can press the urethra and cause urinary and vesicular problems.

Prostate enlargement is usually called benign prostatic hypertrophy or hyperplasia (BPH). This is not a cancer and it does not increase the risk of prostatic cancer.

Alternative names
BPH, benign prostatic hypertrophy (hyperplasia), enlarged prostate.

Causes, incidence and risk factors
The exact cause of prostate enlargement is unknown. It is believed that factors linked to aging and testis themselves can play a role in the gland enlargement. Men whose testis are removed at an early age (for instance, as a result of a testicular cancer) do not develop BHP.

In a similar way, if testicles are removed after the man has developed BHP, prostate starts to get reduced.

Some facts about prostate enlargement are:
• The probability of developing prostate enlargement increases with age.
• BHP is so common that it has been said: “Every man will have prostate enlargement provided that they live long enough”.
• A slight degree of prostate enlargement is present in many men older than 40 years old and in more than 90% of men older than 80.
• Risk factors have not been found beyond that of having testicles which function normally.

Symptoms
Less than half of men with BHP have symptoms of the disease. Among them, the following can be mentioned:
• Difficulty in starting to urinate.
• Weak urine flow.
• Post-micturition dropping.
• Strong and sudden urinary urge.
• Incomplete emptiness of the bladder.
• Need to urinate twice or more times per night.
• Urine retention (total incapacity to urinate).
• Incontinence.
• Painful micturition or bloodish urine (this can indicate infection).
• Effort to urinate

Signs and tests
After having the patient’s complete medical records, the physician will carry out a digital rectal test in order to palpate the prostatic gland. However, the following tests can be performed:

• Urinary flow tests.
• Residual urine test after emptying the bladder in order to check how much urine remains in it after micturition.
• Flow of pressure tests in order to measure pressure in the bladder while urinating.
• A “PIV” (X-rays tests) to confirm the presence of BHP or to look for obstruction.
• Urine test to verify the presence of blood or infection.
• Uro-culture to look for traces of infection.
• Evacuation cystourethrogram.
• Blood test of prostatic specific antigen (PSA) to detect prostatic cancer.
• Cystoscopy.

Additionally, the patient may be asked to complete a form in order to evaluate seriousness of symptoms and their impact on daily life. The results of that evaluation can be compared with previous registers in order to determine if the infection is getting worse.

Complications
Men who have suffered from BHP for a long time and present gradual increase in symptoms may develop:

• Sudden incapacity to urinate.
• Urinary infections.
• Urinary calculus.
• Renal lesion.
• Blood in urine.

Even after surgical treatment, it is possible that after some time, BHP reappears.

There may be difficulty in micturition if there is some problem in the structures forming the male urinary apparatus. In men, the urethra is the inferior urinary via duct transporting urine from the bladder out of the body through the penis. The prostate does not participate directly in the process of micturition, but since it surrounds the urethra in the place where it comes out from the bladder, problems of the prostate frequently affect the urethra and can contribute to male urinary dysfunction.

Possible prostate problems are prostatitis or prostate inflammation, prostate cancer and benign prostatic hyperplasia (BHP). Male urinary apparatus dysfunction may be caused by other several problems, such as bladder infection and urethral stenosis.

If the man suffers from male urinary disorder, the symptoms he shows, such as difficulty in starting to urinate, need to urinate frequently or pain, can be caused by different underlying illnesses. For this reason, it is important to consult your doctor in order to identify the cause and start the proper treatment.

Symptoms
There are three elements related to BHP: development of symptoms, prostate enlargement and urinary obstruction. The bothering symptoms of micturition alteration related to the enlargement of the prostatic gland, are increasing in micturition frequency, excessive micturition at night, urge, effort to urinate, vacillation, weak or intermittent urine flow and sensation of incomplete emptiness. Enlargement, which can cause symptoms, obstructs the urine flow because the urethra, the duct going from the bladder to the penis, gets through the prostate.

Not every man experiences bothering symptoms when the prostate gets larger. If the man is 50 or older, it becomes important to visit his physician regularly in order to watch the state of his prostate, since BHP is frequent in men older than 50 years old.

Obstruction
Obstruction related to the prostate appears when the diameter of the duct going from the urinary bladder to the penis, decreases. The duct is a kind of tube called urethra that can be partially or totally obstructed when the prostate gets larger due to the BHP. The reason is that the urethra gets through the prostate on its way to the penis end.

Benign Prostate Hyperplasia
“BHP” is the abbreviation for benign prostate hyperplasia. The word “hyperplasia” indicates increase in size due to the rise in the number of cells. “Benign” shows the fact that these cells are not cancerous. Therefore, “benign prostate hyperplasia” simply means the prostate has got larger but not because of cancerous causes. BHP is not a cancerous process and does not cause cancer.

BHP is a normal phase of aging which often appears in men older than 50 years old. Nobody knows exactly the cause of BHP, but it seems to be related to changes in the body hormonal balance produced by aging. After 60 years old, more than half men have BHP. At 80 years old, about 8-10 men show this disorder.

However, the fact of having BHP does not mean the man needs treatment. Many men with BHP have few or no urinary problems. He must visit his doctor regularly so that he can control BHP evolution. If problems with micturition appear, the patient must face them quickly. Fortunately, there is efficient treatment in case he needs it.

Prostate enlargement
Prostate enlargement due to BHP is a non cancerous disorder which can be a natural consequence of aging.

As long as the prostate gets bigger, the duct transporting urine from the bladder to the end of the penis (the urethra) gets narrower partially or completely. This happens because the urethra gets through the prostate on its way to the penis. While some men experience urinary problems when the urethra is partially obstructed, others do not.

It is important to have medical check-up periodically, especially if the man is 60 or older, in order to detect the presence of any problem due to the BHP.

Urinary Incontinence Definition
Urinary incontinence is the involuntary loss of urine (the person is not able to control micturition voluntarily). The person affected by this problem has an urgent and sudden need to urinate without having the capacity to retain urine in the bladder. Little losses of urine might take place when or because of sneezing, effort, laughter, exercise, etc. People affected feel embarrassed, which deteriorates their quality of life because they try to avoid social activities. Even if incontinence is not an illness or pathology itself, it is the result of a number of anatomical and/or functional alterations which can affect men as well as women.

Urinary incontinence is the result of an increase in pressure inside the bladder which surpasses pressure in the urethra. It can be caused by hyperactivity of the detrusor muscle of the bladder which, sometimes, is originated by some kind of neurological alteration; by some inconvenient in the exterior sphincter and pelvis muscles (pelvic ground), relaxation or organic lesion, or by neuronal damage.

Urinary incontinence treatment at early stages: Very good results have been observed by using conservative treatment. This kind of treatments include: nutritional habits, exercise of pelvic muscles so that they can acquire more strength and allow urine control, vesicle education (it allows, through simple exercises, determining the real need to urinate and having control before the leak or urine incontinence), electric stimulation of pelvis muscles in order to produce hypertrophy of them. Among all of the treatments described, vesicle education and re-education is the treatment which presents better results for the problem of urine incontinence. Positive results have been shown in about 85% of the cases treated at early stages.

Pharmacological treatment of urinary incontinence: Even if there are several medicines studied for the treatment of urinary incontinence, their effects are regular and the fact of causing several unpleasant side effects determine that they are not useful in daily practice. Among the most commonly used drugs we can find: oxybutinin, flavoxate, propanteline, methantheline and trospium chloride.

Surgical treatment of urinary incontinence: Surgery presents a valid option for the treatment at advanced stages, especially urinary incontinence because of effort. Techniques of retropubic cervical-urethral suspensions are performed (known as Burch Techniques, Marshall-Marchetti-Krantz and laparoscopic techniques with microincisions) and suburethral slings (Techniques of urethral slings) and traditional surgical techniques. Recently, minimally invasive techniques have been developed, giving the chance to carry out ambulatory surgeries, this means confinement in hospital is not required.

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Buenos Aires City
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