DEFINITION

It is the increase of the size of the prostate gland produced by a relative increase of the estrógeó (feminine hormones) on the testosterone (masculine hormone) that appears with the age in the men.

CAUSES

The cells of the prostate possess recipients with sensitive to the testosterone and to the estrogen, when the balance changes for the age this imbalance stimulates the production of factors of cellular growth causing the progressive increase of size of the gland that can be a variable depending on other factors.

Other predisposing factors to the increase of the size of the prostate are the existence, in persons older than 70 years, than obesity, hypertension, intolerance to the carbohydrates for resistance to the insulin and alterations in the fats of the blood. In these cases the prostate volume is four times a Superior and more rapid than in persons of the same age without these added factors.

SYMPTOMS

To the being the prostate growth a slow process the symptoms appear progressively, it is called prostatismo and they appear sequentially between them the principal ones are:

• make difficult to urinate
• urinal jet of little force
• need to urinate often
• need to urinate in the night
• need to be too tight to manage to empty the bladder
• the act of urinating is realized in two times with labored jet
• sensation that the bladder does not empty completely
• make difficult to initiate the micturition
• urine dripping on having finished
• imperious sensation of urinating

Sometimes it can go so far as to produce more serious symptoms as there are the absolute inability to urinate (urinal retention), urinal infections, the blood presence in the urine or the alteration of the function of the kidneys.
The prognosis is unpredictable and variable since it can remain stable or with sharper pictures in sprouts or increase progressively or sometimes to make debut with a sharp urinal retention. In most of the cases it is a progressive development.
In some cases they improve only diminishing the liquids ingestion.

DIAGNOSIS

Since in all the cases the symptoms face to the diagnosis, with the clear suspicion it is necessary to realize a rectal tact. By means of this one exploration the doctor can feel the size of the prostate and knowledge if it is increased of size or not and his consistency to discard a tumor.

An urine analysis will allow to know if there is or not a coexistent urinal infection.

An analysis will be realized to value the prostate specific antigen (PSA), substance produced by the prostate that must be inside a few limits, as regards the age and the prostate size, to be considered to be normal. If it is raised other explorations will be realized to verify if a more serious pathology exists or not.

Sometimes methods are used to measure the flow of the urine, and the abdominal ultrasound scan can be useful to measure the size of the prostate and to discard other illnesses in the bladder or the presence of calculations in his interior.

TREATMENT

As treatment medicamentoso they are used:

• The Hormones, like the inhibiting ones of 5 alpha reductasa (Finasteride). It is used in long periods of 6 months so that his efficacy is ideal, being able to achieve a reduction of 30 % of the volume of the prostate in most cases. If the effect is the awaited one it is supported for years.
• The medicines alpha bloqueantes selective, like the alfuzosina, the doxazosina, the tamsulosina and the terazosina. These medicines act relaxing the muscles of the exit of the bladder, of the urethra and of the prostate, improving the difficulty to urinate in more than half of the patients.

The surgery is used in the not controlled cases of retention of urine, repeated infections of urine by the prostate obstruction, in case of blood presence in the urine originated from the prostate adenoma, in case of calculations formation in the bladder or if they appear divertículos vesicales in the realized study.
The surgery of the benign Hypertrophy of prostate is very effective with the symptoms but it has many side effects, for it the decision must be very thought-out.
In a simplified way, it is possible to be said that there are two surgical procedures: the resection transuretral of the prostate and the open prostate adenomectomía.

The resection transuretral prostate is realized spending an instrument across the urethra to cut by means of electric power the prostate, obtaining improvements in 70 to 90 % of the patients.

The prostate adenomectomía is carried out by means of a surgical incision in the abdomen and as it it usually has more complications but the success of the intervention is major than in another skill since it usually does not demand reinterventions.

Other alternative methods exist in development phase. One is the dilation of the urethra that realizes by means of the laying of one prosthesis in the prostate urethra, which dilates with an inflatable system. Another method is the destruction of the prostate textile with needles that express radio frequencies, or for hipertermia and termoterapia, capable of destroying part of the prostate by means of the heat without injuring the textiles about the same one.

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