Benign prostatic hyperplasia

What is meant by Benign Prostatic Hyperplasia?: Causes and Risk Factors, Treatment

Benign prostatic hyperplasia is a disease characterized by an enlargement ( hyperplasia or  hypertrophy ) of the prostate – more specifically of the prostate epithelial and stromal cells – which leads to the formation of nodules in the periurethral region of the prostate.

When these nodules are large enough, they compress the urethral canal, causing a partial obstruction of the same, thus interfering with the normal urinary flow . This alteration is very frequent, especially in men from the age of 40. In fact, with advancing age, the gland tends to spontaneously change its volume, due to hormonal variations and the action of numerous growth factors. In other words, benign prostatic hyperplasia accompanies the normal aging process.

Causes And Risk Factors

What Causes Prostate Hyperplasia?

Benign prostatic hypertrophy accompanies the normal aging process .Unfortunately, the underlying causes are not yet known exactly, but it is now established that changes in the hormonal structure ( andropause ) are involved.

In fact, with advancing age, the gland tends spontaneously to change its consistency and volume in response to the imbalance between the androgen and estrogen hormones , in favor of the latter, and to the action of numerous growth factors.

In addition to age, the following can also predispose to prostatic hypertrophy:

  • Familiarity;
  • Other concomitant pathologies, such as obesity, cardiovascular disease and diabetes ;
  • Physical inactivity.

Symptoms And Complications

Benign Prostatic Hyperplasia Symptoms

Rather indicative symptoms of benign prostatic hyperplasia are the urgency and frequency of the diurnal and nocturnal urge to urinate , burning during and after urination perceived in the penis , weakness of the urinary stream and the sense of incomplete bladder emptying.

In the long run, benign prostatic hyperplasia can cause anatomical obstruction of the urethra and create problems with correct urinary outflow, so much so that the subject must increase the pressure necessary to empty the bladder .


Bph: How Is It Diagnosed?

There are different types of diagnosis, but the most commonly used is the rectal examination of the prostate (palpation of the prostate via the rectum) , which in most cases allows us to perceive a possible increase in the volume of the prostate. In some cases, this examination is not enough; in this case, a rectal ultrasonography can be performed , to better distinguish the size of the prostate. Alternatively or in combination, tests that measure serum prostate specific antigen concentration may be done to rule out prostate malignancy.



The remedies for benign prostatic hyperplasia are mainly two: the pharmacological one and the surgical one.

As far as drugs are concerned, there are two main therapeutic categories, which are alpha-blockers and 5-alpha-reductase inhibitors. Alpha -blockers reduce muscle tone in the prostate and bladder neck. Essentially, they relax the prostate by making it easier for urine to pass through the urethra. 5-alpha-reductase inhibitors
, such as finasteride and dutasteride , inhibit prostate volume growth by suppressing androgen stimulation. Basically, they work by blocking the transformation of testosterone into its active form, dihydrotestosterone(DHT), which participates in the enlargement of the prostate .
The major problems with the use of drugs for the treatment of benign prostatic hypertrophy are related to the possible side effects. Among these are erectile dysfunction , retrograde ejaculation , and gynecomastia for 5-alpha-reductase inhibitors, while hypotension , migraine , dizziness , headache , and asthenia are common among alpha blocker users . Another common problem is that the effectiveness of these drugs tends to decrease with long-term use.


When drug therapy is ineffective, surgery is used .
The most commonly used technique is transurethral endoscopic resection or TURP , a reduction of the prostate performed by endoscopy, i.e. without engravings. Alternative techniques aim to destroy part of the glandular tissue without damaging what will remain in place. For this purpose, depending on the method used, laser beams, radio waves, microwaves or chemical substances are concentrated directly inside the prostate. The suitability or otherwise of these alternative techniques is mainly influenced by the extent of prostatic hyperplasia; generally, the greater the degree of hyperplasia, the more invasive the surgery will be. For example, if the size of the prostate is excessive, it is necessary to proceed with an open operation, called adenonectomy. This surgery involves the removal of the entire prostate adenoma through a skin incision,

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