The prostatic patient

Benign prostatic hyperplasia

The real clinical case.
I am reminded of the case of that elderly patient who, coming to our attention for dyspnoea, treated with cortisones, theophylline and diuretics, without result, once a bladder catheter was inserted, the patient thoroughly urinated and pulmonary congestion was resolved. , presenting considerable stagnation of urine in the bladder, for about 1200 cc. So when a patient begins to urinate, pulmonary congestion seems to resolve immediately as if by magic, despite adequate respiratory therapy. When we are faced with elderly people, often a careful anamnestic investigation makes us discover that the patient has for some time presented an impediment to urination and declining edema. We were faced with a "prostatic" patient, that is, with prostatic hypertrophy. The prostate is the largest male sexual accessory organ that weighs 20 grams in the young adult. The biological function of the prostate to date is scarcely known, but we know that the prostate requires the presence of the functioning testis for its development and conservation.

The prostate is localized in the pelvis, in relation to the rectum posteriorly, so much so that the exploration of it is accomplished through rectal palpation and so also the "squeezing" maneuver by which prostatic liquid from the male urethra is released, that is, from the meatus that exists on the glans, for the purpose of the cultural examination of the spermatic and prostatic liquid (prostatitis).

Moreover superiorly it is in relationship with the bladder and the urethra in its proximal tract it crosses it. Prostatic cells produce a slightly acidic liquid, which contains citric acid, polyamide (spermine and spermidine), acid phosphatase, serum protease, PSA ie prostate specific antigen that is an important marker in dysplasias and prostatic neoplasms, also calcium, zinc and sodium. Dihydrotestosterone is present in prostate fluid and in prostate cells. The problems associated with prostate diseases are increasing rapidly in modern man. Benign prostatic hyperplasia (BPH) or adenocarcinomas and prostatic infections are increasing, with 40,000 deaths / year in the US and 800,000 hospitalizations. The problems associated with the prostate are between the 4th and 8th decade of life.

Benign prostatic hyperplasia (BPH)

Incidence: in the US 200,000 TURP / year procedures are performed, ie revision for endoscopic prostate for the purpose of the disruption of the urethra. These are elderly subjects who turn to the urologist due to difficulty in urination, ie mitto hypovalide; the classic elderly patient who often gets up at night, urinates with difficulty, dripping with urine, with a dull breath!

Etiopathogenesis

The presence of high sex hormones is one of the risk factors for the development of prostatic hypertrophy, so Asians, due to constitutional factors, are less affected by this problem. We still talk about the correlation between obesity, smoking, alcohol consumption, hepatic dysfunction and vasectomy and IPB. Vice versa in the castrated subjects before puberty the IPB is not found and so in the subjects with 5-alpha reductase deficiency and the hormonal block does not develop. The prostate responds to the androgenic stimulus for the entire duration of life. There is inheritance with regard to IPB or other prostatic diseases.

Clinic

Irritative symptoms are present in the prostate: dysuria, nocturia, imperious urination, pollachiuria and incontinence and urgency, ie the subject can not control the bladder that, as it were, "automatically clicks" like a sort of elastic balloon with sudden leakage of urine ; we are obviously talking about subjects with prostatic hypertrophy and vesicle wall hyperplasia. On physical examination, the doctor, at the transrectal palpation, can appreciate the prostate pushing forward and downward, prostate that will appear increased in volume, of increased, fibrous consistency, which still retains a smooth and elastic surface. The urinalogical survey will serve to exclude a concomitant urinary tract infection and, as well, the culture examination of the squeezing of the prostatic fluid. It is still indicated to carry out the control of the renal group, ie azotemia and creatinine as well as serum PSA. Finally, the ultrasound of the urogenital tract and the bladder and the transrectal ultrasound survey are carried out.

Treatment

For the purposes of treatment, the prostate patient is divided into 4 groups:

Patient under study
Patient in medical treatment
Patient in combined treatment, with microinvasive techniques
Patient undergoing prostatic resection.

Medical therapy uses phytotherapy (palmetto*), therapy with alpha -adrenergic antagonists (eg prazosin which is administered in the evening, terazosin, doxazosin, tamsulosin or with drugs that inhibit 5alfareductase (finasteride) .The invasive techniques are TURP, which consists of prostate incision transureterally or open prostatectomy transpubically, side effects are retrograde ejaculation After the removal of the catheter patients may have mild urinary disorders that may persist for 3 months.In addition, some residuals may urinary incontinence in 2% of subjects, other less destructive techniques use the use of needle ablation, laser techniques, hyperthermia techniques Sometimes it is sufficient to treat contingent problems such as prostate infections, very frequent situations especially with promiscuous sexual mores and because of unprotected sex, especially in the homosexuals.

*The most popular herbal agent is saw palmetto (Serenoa repens), which is derived from the berry of the American dwarf palm tree. Pygeum africanum and beta-sitosterol are also used by many patients with BPH, either alone or in combination with saw palmetto. A significant limiting factor to our understanding of the use and effectiveness of phytotherapy is the lack of standardization of these products. Despite this lack of standardization and the variation in results that may be seen with herbal products, there is growing evidence from well-conducted clinical trials that phytotherapeutic agents may lead to subjective and objective symptom improvement beyond a placebo effect in men with BPH.

Per apprendere altro: >>

Il paziente che non urina

Il cancro della prostata

La prostatite

cfr anche Webalice:

Adenoma prostatico

Diagnosi e cura adenoma prostata

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