Adenoma of the prostate
A gland of the male reproductive system is the prostate.
Its function is to manufacture and store seminal fluid, an essential component of semen.
The prostate is about the size of a chestnut and weighs about 20 to 25 grams in adulthood.
It is located under the bladder and surrounds the urethra, the channel through which urine is passed from the bladder to the outside.
The adenoma of the prostate also called “benign prostatic hypertrophy or BPH” is very common and affects the vast majority of men from 50 years old.
The adenoma corresponds to an increase in the volume of the prostate gland which can sometimes interfere with the emptying of the bladder, thus causing urinary problems.
Symptoms
The symptoms of prostate adenoma observed by the patient result from the obstacle created on the urinary tract, either by a urinary obstruction phenomenon or by the bladder irritation that it causes.
It is important to note that there is no direct link between the size of the prostate and the presence or intensity of urinary disorders
The patient may be bothered by:
°Dysuria: Difficulty urinating, the patient having to push to urinate;
°Pollakiuria: Frequent urination of small amounts, first at night, then at night and during the day;
°Weakness of the stream;
°Urgent urges to urinate;
°Sexual dysfunction.
Diagnosis
It is based on precise questioning to evaluate the importance of the symptoms and the discomfort felt.
A digital rectal exam allows us to estimate the volume, to appreciate the consistency of the prostate: big, painless, elastic, flexible, and of regular texture.
A blood test with a PSA measurement, a urine examination (ECBU), and an ultrasound of the urinary tract (kidney, bladder, and prostate) are most often prescribed.
The quality of the urine stream can be assessed by means of a flow meter.
If left untreated, prostate adenoma can become complicated by bleeding, infection, bladder stones, and even acute urinary retention, which means that the patient cannot urinate at all.
This acute retention of urine is a surgical emergency that must lead to the installation of a bladder catheter as soon as possible.
Finally, at a late stage, the prostate adenoma can lead to renal failure by the destruction of the entire urinary system.
Treatment
The management of a prostate adenoma is based on two main objectives: improving the patient’s comfort and quality of life and preventing complications.
An asymptomatic prostate adenoma requires simple annual surveillance with PSA measurement and digital rectal examination.
The decision whether or not to treat a patient with an uncomplicated symptomatic prostate adenoma depends on the extent of lower urinary tract disorders, the functional discomfort experienced by the patient, and the impact on quality of life.
Medication
The medical treatment of prostate adenoma includes 3 therapeutic classes with comparable efficacy despite different mechanisms of action. :
Alphas blockers promote relaxation of the bladder and neck with risks of ejaculation disorders and hypotension.
5-alpha reductase inhibitors should be prescribed preferentially in patients with a prostate of more than 40 grams.
They reduce prostate volume with risks on erection, libido, and a modification of the PSA.
Phytotherapy, a treatment using plants, acts as a pelvic decongestant, without side effects.
All these treatments can be taken separately or in combination.
