Complications

The enlargement of the prostate is harmless in itself. The worsening symptoms and complications that affect the urinary tract and kidneys, such as urinary tract infection and cystitis, are detrimental. Acute urinary retention can occur at any stage.

Here, the already narrow bladder outlet is completely closed by additional swelling. This is an emergency that must be treated immediately by inserting a bladder catheter (urinary diversion tube that is inserted into the urethra) or by urinary diversion by puncturing the bladder through the abdominal wall (suprapubic bladder puncture). A backflow of urine over a longer period of time (due to the disturbed emptying) can lead to a bulging of the ureter or renal pelvis.

Prostate enlargement in old age

The enlargement of the prostate is a typical disease of old age. In deceased persons, an enlarged prostate has been found in about 50% of 60-year-olds and in about 90% of men over 80. An enlarged prostate does not necessarily cause any symptoms, but often leads to benign prostate syndrome (BPS).

This is the simultaneous occurrence of prostate enlargement and problems in the lower urinary tract (LUTS). These are problems with urination and continence. The development of BPH begins around the age of 50 and most commonly occurs between the ages of 60 and 70.

In Germany, about 15% of men over the age of 50 show signs of a disorder in the flow of urine from the bladder. Approximately 40% of men over 50 have bladder problems requiring treatment or urination (LUTS). Increasing age is one of the main risk factors for the development of complaints, along with an elevated PSA level and an enlarged prostate volume.

Factors that are held responsible for the development of BPH are related to age. An important factor is the age-related increase in estrogen levels with a simultaneous decrease in testosterone levels. Testosterone also seems to play an important role: It has been shown that men without testosterone production do not develop prostate enlargement even in old age.

Other factors that influence prostate size are more common in old age and can thus help explain the age-related occurrence of prostate enlargement.These are mainly lack of exercise, hypertension and diabetes mellitus, as well as overweight and cirrhosis of the liver. When treating BPH in old age, special attention must be paid to concomitant diseases and medication. The risk of surgery must be assessed and interactions of medication with previous illnesses and their medication must be considered. For example, phosphodiesterase inhibitors (tadalafil) should not be prescribed for coronary heart disease and phosphodiesterase inhibitors (tadalafil) and alpha-blockers (alfuzosin) for heart failure.