Let's recognize and treat prostate diseases early (Part two)

DIAGNOSIS OF BENIGN PROSTATIC HYPERPLASIA

The basic examination to search for a prostate pathology begins with a rectal exploration. In this way, the doctor touches the prostate and thus can initially orient towards a differential diagnosis between BPH, Prostate Carcinoma, or Prostatitis.

In the case of BPH, the prostate is flat, hard, and slightly painful.

Then there are other auxiliary examinations to obtain more accurate diagnostic data, among which:

• Suprapubic or transrectal vesical ultrasound;
• Endovenous urography;
• Cystography;
• Dosage of Specific Prostate Antigen (PSA);
• Flowmetry.
• Urinalysis as well as kidney function analysis.

Prostate ultrasound is a non-invasive examination, based on the use of ultrasound waves and is simple. It does not require any special preparation, except the bladder must be full. Through it, the size of the prostate, the eventual presence of the median lobe as well as the post-micturition residual urine are evaluated.

The evaluation of PSA aims to probably exclude a malignant pathology of the prostate. In suspicious cases, a prostate biopsy is required.

At the age of 50, every man should go to the family doctor to assess his prostate even in the absence of clinical signs. In cases where there are family historical data for prostate pathology, direction to the doctor should be made at the age of 40. When the above-mentioned clinical signs appear, the patient should go to the treating doctor or to the urologist even at younger ages.

TREATMENT

Possible treatments depend on the severity of the disease, the size of the adenoma, the age and condition of the patient as well as the experience of the treating doctor (urologist). If a patient presents mild signs, the specialist doctor may advise the patient for annual checks to monitor the prostate gland as well as advise what to do.

Upon the identification of significant symptoms with irritative or obstructive signs, treatment should begin.

Until a few years ago, the doctor had available only medications with questionable efficacy. This was the reason that the only therapeutic possibility was surgical intervention. Currently, the introduction of medications that work well in BPH has opened the possibilities of conservative treatment and surgical interventions have been reduced for forms not treated in due time or for other problems of prostate pathologies.

In cases of irritative disorders, alpha-blocker medications are usually used, which help relax the muscles of the vesicles and thus improve urination activity.

In cases of predominance of obstructive disorders, the medication finasteride is usually used, which is a medication that blocks the effect of Prostate Dihydrotestosterone and thus improves the dimensions of the prostate and discomfort.

Treatment should continue for a long time as well as periodic control every year at the specialist doctor.

The aim of timely medicinal treatment is:

• for the patient to urinate better;
• to not create problems in the bladder or kidneys;
• to improve the quality of life.

In desperate cases or delayed or ineffective medical treatment, surgical intervention remains the only alternative.

Surgical intervention techniques have evolved over time, becoming less aggressive and with fewer complications. A few years ago, among the common surgical treatment techniques was the open method, which involved the total removal of the prostate.

Modern times have made it possible to use a series of less invasive techniques among which the main ones are:

• TURP (Trans-Urethral Resection of the Prostate);
• HOLEP (Holmium Laser Enucleation of the Prostate);
• TUIP (Trans-Urethral Incision of the Prostate);
• TULIP (Trans-Urethral Laser Incision of the Prostate);
• Thermal therapies which are three (TUMT; TUNA; ILC).

Resectoscope used in the TURP technique.

Of all these techniques, the most applicable is the TURP technique which is an endoscopic intervention performed between the urethra by means of an instrument called Resectoscope which cuts the prostatic tissue.
Catheterization after the intervention is kept for about 5 days.

If such an intervention is not possible, it should be intervened with the standard procedure of open surgery of prostatectomy.

ADVICE

• Not to drink liquids at least 2 hours before going to sleep (to improve the signs of nocturia).
• To limit or not use alcoholic beverages and coffee (to not irritate the bladder which causes discomfort).
• To do relaxing and breathing exercises to improve the quality of urination.
• Not to use uncontrolled folk medications without consulting with the doctor.

PREVENTIVE MEASURES FOR PROSTATIC HYPERTROPHY

Various studies suggest a diet rich in proteins, use of vegetables, reduction of animal fats and red meat, but these are measures that can only reduce the occurrence of this pathology.

Men, if they feel even the slightest signs and even if they are still in good condition, should not hesitate to go to the specialist doctor, who should help them to feel better as well as to answer all possible doubts that patients may have about their health.