Prostatic hyperplasia is the most frequently diagnosed urological disease in male patients. One in two men in the 50 to 60 age group is affected.
Increased growth of tissue cells in the prostate gland leads to an enlargement of the organ. The prostate normally weighs only 25 grams and is about the size of a chestnut. Due to cell growth, the prostate gland can then reach a weight of up to 150 grams.
However, the proliferating cells are non-invasive, i.e. they do not grow into neighboring tissue. It is therefore a benign tumor.
The prostate is located under the bladder directly in front of the rectum. Enlargement of the prostate therefore causes corresponding symptoms.
Benign prostatic hyperplasia cannot be prevented. However, a healthy lifestyle and regular physical activity can reduce the personal risk of developing the disease. Maintaining a normal weight and avoiding nicotine are important pillars of a healthy lifestyle.
In the literature, the term prostate adenoma is often used as a synonym for BPH. However, this is not medically correct: in benign prostatic hyperplasia, the number of glandular, muscle and connective tissue cells increases. In an adenoma, however, there is only an increased number of glandular cells.
Enlargement of the prostate mainly manifests itself with the following symptoms:
- weak urinary stream or even urinary retention
- interrupted urinary stream
- delayed urination
- straining to urinate
- frequent urge to urinate, but only small amounts of urine
- urge to urinate at night
- dribbling at night
- residual urine
- Pain when urinating (in individual cases)
- male impotence
If you suffer from one or more of these symptoms, you should see a urologist soon.
If you are unable to urinate at all, go to a hospital emergency room as soon as possible. This can lead to urinary retention up to the kidneys, which causes uremia. In uremia , toxins pass from the urine into the bloodstream, putting your life at risk.
An enlarged prostate presses on the urethra, among other things, making urination difficult © bilderzwerg | AdobeStock
The diagnosis begins with a digital rectal examination by a urologist, who inserts a finger into the patient's rectum and feels the prostate gland. If the prostate is enlarged due to prostatic hyperplasia, it has a smooth, elastic surface.
The doctor then checks the function of the sphincter muscle and reflexes to rule out other diseases such as Parkinson's disease.
To rule out a possible urethral infection, he has a urine sample from the patient examined in the laboratory. A tiny tissue sample from the prostate provides information as to whether the cells are actually benign or whether they indicate prostate cancer. The tissue sample is taken from the rectum.
The ultrasound image makes possible complications such as diverticula (protrusions of the organ wall) and bladder stones visible. Transrectal ultrasound (TRUS) is used for this purpose. It is inserted into the patient's rectum. The conventional ultrasound of the lower abdomen shows the size of the prostate and the amount of residual urine.
Uroflowmetry is used to measure the strength of the urine flow. In healthy patients, this is around 20 milliliters per second. However, if the value is less than 10 milliliters, this is an indication of a narrowed urethra. During uroflowmetry, the patient urinates into a funnel fitted with special sensors.
In certain cases,cystoscopy is also used to clarify the suspected diagnosis of benign prostatic hyperplasia.
Prostate glands produce a secretion that protects the sperm cells and stimulates increased activity. The fluid is released into the urethra. The glands in the prostate are surrounded by smooth muscle cells and connective tissue cells.
In the case of prostatic hyperplasia, the number of muscle and connective tissue cells as well as glandular cells increases significantly. According to current medical knowledge, this occurs because the ageing cells die off late. As a result, the outer layer of the prostate becomes thinner. In addition, the organ is no longer able to produce sufficient secretions.
Medical research has not yet been able to fully clarify what causes the cells to live longer than normal. However, dihydrotestosterone (DHT) appears to play a key role. This is the more potent variant of the male sex hormone testosterone in the body.
The female sex hormone oestrogen, which is also found in the male body, could also promote prostate hyperplasia. It is present in higher concentrations in men after the menopause than in younger men, whereas the DHT level in the blood is lower. This increase in oestrogen in turn increases the risk of developing prostatic hyperplasia.
A high proportion of fat cells in the body also increases the oestrogen concentration in the blood. Men who are very overweight therefore generally have a higher risk of developing prostate enlargement.
The space between the glands is also involved in the development of the disease: If it binds growth factors in excess, this promotes the proliferation of the cells or prevents their natural death.
Prostatic hyperplasia usually only has a genetic cause in patients who develop it in earlier decades of life. Doctors assume that only around 9% of benign prostatic hyperplasia in men over 60 is genetic.
If the disease does not yet cause any symptoms, it is sufficient to check it at regular intervals.
Drug treatment
In stage I of the disease or - in milder cases - in stage II, the patient is given medication.
Herbal preparations are among the most commonly taken medications. They are very well tolerated, but can only be used for mild symptoms. These include, for example, preparations with
- Nettle root,
- pumpkin seeds,
- rye,
- African plum or
- saw palmetto.
They prevent the formation of growth factors, 5-alpha-reductase - the enzyme that converts testosterone into DHT - or cause cells to die more quickly. They also block the male sex hormone.
Alpha blockers are synthetically produced drugs that relax the prostate and urethral muscles. This makes it easier to urinate. This group of active ingredients includes tamsulosin, doxazosin and alfuzosin, for example.
Chemical 5-alpha-reductase inhibitors are the active ingredients dutasteride and finasteride.
Patients who are prescribed these drugs often experience potency problems and sexual reluctance. For this reason, PDE inhibitors such as tadalafil have recently been preferred. They have a similar effect to the herbal enzyme blockers.
To reduce the strong urge to urinate, drugs are used that inhibit the activity of the bladder muscle.
All drugs used to treat benign prostate enlargement slow down the progression of the disease. Sometimes the prostate even shrinks.
Prostate embolization
Prostate embolization (PAE) was first performed in 2008 and is therefore still a relatively new method. Nevertheless, it is increasingly becoming an alternative to drug therapy or TURP (see below). It is a minimally invasive procedure that does not require general anesthesia and can be performed on an outpatient basis.
Current studies show that prostate embolization has significantly fewer complications than a surgical procedure such as TURP:
- low risk of infection
- no bleeding and no secondary bleeding via the urinary tract
- No risk of incontinence
The principle of prostate embolization is based on reducing the blood supply to the prostate. Doctors achieve this with the help of a catheter. It is inserted into the prostate artery through a tiny puncture in the pelvic artery. Doctors check the position of the catheter during the procedure using computer tomography (CT). Tiny plastic particles are then inserted into the branching arteries of the prostate via the catheter until the blood supply is cut off.
Due to the reduced blood supply, the enlarged prostate can shrink again in the weeks or months that follow. This restores the patient's quality of life. Doctors are successful in 75-94% of all operations.
However, prostate embolization cannot always be performed. Exclusion criteria are various diseases, including
Surgical treatment
There are various procedures for the removal of benign prostate enlargement. Which one is ultimately used depends on the individual.
Thegold standard is still transurethral resection of the prostate (TURP). The procedure is similar to cystoscopy: the surgeon inserts a narrow tube into the urethra, the free end of which is equipped with a high-resolution camera and light. The energized metal loop removes the excess tissue layer by layer.
The technically improved TURP procedure used today only occasionally leads to undesirable side effects. However, the complication rate increases the larger the prostate is.
The transurethral incision of the prostate (TUIP) can only be considered if the prostate hyperplasia is not yet too severe. Excess tissue is only cut at the transition between the prostate and the neck of the bladder so that the urethra is not constricted.
Another surgical method is transurethral microwave therapy (TUMT): the waves destroy the benign tissue with heat, causing the prostate to shrink.
Lasers are also used to treat benign prostatic hyperplasia. They destroy the prostate tissue or remove it layer by layer. The HoLEP method in particular is as effective as the standard procedure.
Open surgery is only necessary if the prostate is very enlarged. The surgeon cuts open the bladder and removes the prostate gland from there (prostate enucleation).