Prostate hypertrophy

Benign nodular hypertrophy of the prostate is a disease that typically develops beyond 50 years of age. The frequency aesce with age. Disorders related to bladder emptying appear more frequently between 60 and 70 years, when prostate hypertrophy reaches an incidence of 65%. Among the diseases affecting the prostate, benign prostatic hypertrophy or prostate adenoma is the most widespread. This is especially true after 50-60 years. As the years go on, in fact, the central part of the prostate tends to become bigger until it is even 2-3 times longer than normal measures. With age, the rate of estrogen increases and being the muscular part of the prostate with a large number of estrogen receptors, the gland becomes hypertrophied.

Classification

The following stages can be differentiated:
• first stage (or irritative stage): reduction of urinary flow, nocturia, pollakiuria, delay in the beginning of urination;
• second stage (or stage of the urinary residue): same disorders of the first stage and appearance of an ever-increasing urinary residue, recurrent urinary tract infections, formation of bladder stones, imperious urination with incontinence;
• third stage (or stage of decompensation): extravasation urination (paradoxical iscuria), stasis kidney, decompensated renal failure up to uremia.

Pathogenesis

The etiology has not yet been fully clarified. Probably they come to act simultaneously various factors, among which the alterations of the prostate play the main role:
• 5-a-reductase activity has increased;
• dihydrotestosterone is formed in greater quantities and the relationship between androgens and estrogens is altered.
These changes act synergistically on the prostatic tissue causing its proliferation.

Pathological anatomy

The denomination of benign prostatic hyperplasia or hypertrophy has been extended, being applied to any increase in the caliber of the gland without taking into account the histopathological forms. It is a neoformation of tissue that comes in the form of masserelle or perimeter nodules, which develops like a benign tumor. Histologically, different types of tissue are observed in variable protocols.

Fibromyoma

. They probably originate from the proliferation of smooth muscle and connective tissue surrounding the exit ducts of the short urethral and submucosal glands. In fibroids, the elastic parts that exist in the stroma of the normal prostate are absent.

Epithelioma

They probably originate from epithelial nodules, which secondarily include neighboring glandular ducts. Almost always they are hypertrophic cylindrical cells that are found with ordered arrangement around numerous papillae. These are morphologically similar to the basal cells of the prostate gland, but possess very little secretory activity.

Location

Hypertrophy is generally present at the level of the glandular tissue of the lateral middle lobe and, only in rare cases, anterior. Hypertrophy almost never originates in the posterior lobe. With the progressive increase in the size of the nodules The glandular tissue of the lateral and posterior lobe is compressed to form a thin layer of tissue located between the hyperplastic nodules in growth and the capsule. This layer forms, inside the real capsule, a wall called a surgical prostatic capsule.
The prostatic adenoma can take macroscopically different configurations that prevent emptying of the bladder:
• a small nodular fibrous adenoma, which causes stiffness of the bladder neck; the prostate in these cases is atrophic, the bladder neck is rigid and contracted, wrapped "in a bag of tobacco". At other times this structural alteration involves the lower part of the bladder, near the urine outflow;
• Symmetrical neoplastic nodules often develop, although they sometimes predominate on one side. The most frequent form involves the lateral lobes (branched lobe) and the adenomas are found mainly in the lateral and middle lobes (trilobular hypertrophy).
ipertrofia prostatica

Signs

The symptoms of the prostate patient are the need to urinate more often than normal, nocturia (need to urinate at night), urinary urgency (urgent need to urinate, sometimes with involuntary loss of a few drops of pee), "intermittent" urination (a more times), feeling of not having completely emptied the bladder, difficulty in starting the urination (despite the presence of a strong stimulus), post-vain drip (after having urinated, the patient notices the release of some drops of urine). In the most serious cases the complete inability to urinate (urinary retention) can also arise, so much so that the discharge to the catheter for emptying is necessary.

Diagnosis

The first control of the prostate uses rectal examination, the examination of the prostate performed through the anal orifice recommended every year starting from 50. One of the main diagnostic tools, then, is the transrectal ultrasound, which allows to detect the size of the prostate and its possible pressure on urethra and bladder. Another test that can be prescribed by the doctor is the flow meter: it measures the speed and the strength of the urinary jet, from which we can deduce a significant obstruction to the urinary flow. A dosage of Psa (a specific prostatic antigen) is often performed, to exclude the coexistence of a prostate carcinoma, and a urine test.

Treatment

In case of mild hypertrophy, the doctor prescribes the following medications:

- inhibitors of the 5 alpha reductase
- alpha-lithic.

The first group of drugs (eg, finasteride and dutasteride) block the transformation of testosterone into its active form of dihydrotestosterone, which stimulates prostate growth. The alpha-lytics, instead, belong to the class of drugs able to relax the muscles of the bladder neck, of the prostatic urethra and of the prostate itself, thus facilitating the passage of urine into the urethra. Both groups of drugs, however, can have side effects. In particular, 5 alpha reductase inhibitors may reduce the erective capacity of the penis, while alpha-lytics can reduce blood pressure causing lipothymia, and, rarely, generate retrograde ejaculation.

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