The prostate is a walnut-shaped gland that is part of the male reproductive organs, which also include the penis, scrotum, and testicles. The prostate is susceptible to a variety of diseases, including enlarged prostate, prostatitis and prostate cancer.
The prostate secretes a portion of semen, which is a mixture of sperm and prostate secretions. It is located in the front of the rectum, below the bladder. It surrounds the urethra at the neck of the bladder.
Also through the prostate, urine and semen flow through the urethra, which carries urine from the bladder out of the body. It also transports semen through the penis during ejaculation.
Symptoms of an enlarged prostate
- Urinary retention and difficulty urinating
- A few drops of urine after urination (incontinence).
- Needing to go to the toilet frequently
- Increases the time the patient waits for urine to pass
- Urinary tract infection and burning when urinating
- Urethral obstruction, bladder and kidney stones
- Exiting blood with urine
- Effort and internal pressure during urination: Difficulty emptying the bladder completely due to low and intermittent urination
- Reduced efficiency of the kidneys, which may lead to kidney failure
Diagnosis of benign prostatic hyperplasia
Initially, symptoms of an enlarged prostate may be noticed by the patient themselves, or a doctor may notice an enlarged prostate during a routine examination. When an enlarged prostate is suspected, it is best to see a urologist. He is an expert in urology and male reproductive system. There are few tests that help doctors diagnose problems and determine if surgery is necessary. These tests vary from patient to patient. Some of the checks to do include:
DRE – digital rectal exam (finger)
This examination is usually the first examination done by a specialist. In this test, the doctor inserts a finger into the anus and tries to examine the part of the prostate near the rectum. This test provides doctors with preliminary information about the size and condition of the prostate.
PSA (Prostate Specific Antigen – PSA) blood test
To rule out the presence of cancer as a cause of urinary tract symptoms. Your doctor may recommend a blood test for PSA (prostate-specific antigen for prostate cancer). A protein produced by prostate cells that is usually found in high levels in men with prostate cancer.
The US Food and Drug Administration (FDA) has approved a PSA test at the same time as a digital rectal exam to help detect prostate cancer in men age 50 and older, and for follow-up of prostate cancer after treatment in men who have developed it.
However, how to interpret and analyze PSA levels is not entirely clear. How well can this test differentiate malignant (cancerous) tumors from benign prostate tumors? What is the best way to respond if elevated levels of PSA are detected?
Medication for an enlarged prostate
1- Alpha blockers
Alpha blockers are based on disrupting a special type of nerve receptor found in the muscle cells that make up the walls of the prostate and bladder. Blocking these receptors reduces the rate at which muscles are stimulated. This relaxes the prostate and bladder muscles, which helps relieve symptoms. At the same time, alpha-blockers do not completely change the size of the prostate, but only reduce the occurrence of what would be described as muscle spasms around the bladder. This medicine is considered the best in the treatment of mild and moderate cases of prostatic hypertrophy, which started treatment within two days. Examples of this medicine are: CARDURA. However, care must be taken when using this type of medication, as it was originally used to treat high blood pressure, so it can sometimes cause side effects such as dizziness, headache, nausea, as well as relaxation of the muscles surrounding the bladder. . May cause retrograde ejaculation of semen.
2. 2-5 alpha reductase inhibitors
These drugs act on the putative BPH mechanism, which is based on an enzyme that converts testosterone into a more active hormone complex that causes the prostate to enlarge. These drugs counteract this effect by decreasing the enzymes needed to convert hormones, and they actually succeed in reducing the size of an enlarged prostate, which in some cases may enrich it. With regard to resorting to surgery, but this does not happen until after a treatment period of 3-6 months, and the improvement of symptoms begins after the third month of the usual treatment, an example of this drug: Finasteride. However, this medication should be used with caution without consulting a doctor because it alters hormone levels in the body for therapeutic purposes, but taking the wrong dose may cause problems with sexual performance and quality of sperm production, and these side effects will disappear when the medication is stopped.
3 – Cialis drugs
The drug, known to help improve sexual performance and treat impotence, has been found to improve some cases of BPH, but this is still being studied to fully understand its mechanism. However, it should be noted that Cialis and similar sex stimulants should not be taken with alpha-blockers. It should also not be used with nitrates to dilate the arteries of the heart.
Surgical treatment of enlarged prostate
Open surgical treatment is used in cases that do not respond to medical treatment, which makes surgery necessary to relieve symptoms and avoid complications. This includes surgery to:
1. Surgical removal of prostate tissue that is pressing on the urethra
The idea of surgery is to insert a small incision through the urethral opening to reach the position where the prostate is pressed against the urethra, and then begin removing the enlarged prostate tissue by cutting and cauterizing. It is one of the most common types of prostate surgery.
2. Urethral incision of the prostate
The idea of surgery is not to remove the enlarged prostate tissue, but rather the surgeon makes a small incision in the prostate tissue in the blocked area of the urethra, which helps urine pass more easily and relieves symptoms. This procedure is used in cases of moderate hyperplasia, or when public health does not allow this type of procedure. In addition to surgery, patients can go home the same day and have a catheter placed for several days, with relatively slower improvement in symptoms compared to previous surgery.
The idea of surgery is open surgery, in which the inner part of the prostate tissue is removed, and this surgery is used in advanced cases of prostate enlargement and other types of surgery cannot be relied upon as it is used in this case. Late bladder and urethral complications and recovery from this surgery will take a few weeks.
Minimally invasive prostate cancer treatment
Minimally invasive surgery refers to surgery that uses the smallest possible minimally invasive surgical intervention, where many modern techniques are used to reduce the possibility of complications and increase the speed of the patient’s recovery, the most important of which are:
1. Laser treatment of benign prostatic hyperplasia
The idea: to destroy and remove the enlarged tissue in the prostate with a high-energy laser beam. This type of treatment is used in some patients with an enlarged prostate whose general health does not allow for other procedures.
2. High microwave heat in the treatment of benign prostatic hyperplasia
The idea is to rely on a surgical rod inside the urethra to generate high heat from microwaves. This heat directs and destroys the enlarged prostate tissue, causing the prostate to shrink in size. This treatment is used in some moderate and special cases.
3. Cauterization of the enlarged prostate tissue
The idea is to insert a specialized surgical needle through the urethra to the site of the enlarged prostate, which then begins to generate high-energy waves that cause the enlarged prostate tissue to cauterize and bleed rapidly.
4. Prostate stents
The idea is to insert a small metal stent into the urethra where the enlarged prostate tissue is under pressure, so this stent keeps the urethra from being blocked. This adjuvant solution is used in people who refuse to take medication, such as those who refuse. Treating people who have undergone surgery, and the solution is considered one of the least acceptable by the doctor because of its long-term therapeutic effect.
Interventional radiotherapy for benign prostatic hyperplasia
Interventional radiology aims to treat benign prostatic hyperplasia and many other health problems that are usually managed surgically by modern techniques based on medical imaging in order to achieve the same therapeutic effect with the least possible medical intervention, as in the field of BPH, an obstruction process prostate arteries;
Prostate artery obstruction
The idea is to inject a dye into the blood vessels around the prostate area so that it can be imaged using medical imaging techniques, then insert a catheter into the artery that supplies blood to the prostate tissue. Once this large artery is closed, the artery swells. Prostate tissue begins to shrink and shrink.
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