Prostate Enlargement

Benign prostatic hyperplasia (BPH), prostate enlargement, benign prostatic syndrome, prostate adenoma, prostate hypertrophy

Definition

There is a benign enlargement of the inner zone (“transitional zone”) of the prostate (prostate gland). Connective tissue and muscle cells (so-called stromal parts) are mainly affected. Affected are mainly men of advanced age.

Here, an incision was made parallel to the forehead (frontal incision): the prostate gland surrounds the urethra. Within the urethra, a mound arches into its interior, the seminal mound. On this mound, a small channel with the preliminary sperm ends from each half of the body. Directly next to the seminal mound, the numerous excretory ducts of the prostate gland lead into the urethra!

Bladder
Urethra
Prostate
Seed mound with the two openings of the spray channels
Prostate excretory ducts

Frequency

It is the most common cause of micturition disorders in men. Approximately 25% of all men between 50 and 60 years of age suffer from problems when urinating, among those over 60 years of age it is already 40%.

Causes

An enlargement of the prostate gland usually means an enlargement in the sense of benign prostatic hyperplasia (BPH). This is a benign (benign) type of excessive growth. Nevertheless, it can lead to discomfort, especially when urinating (urination difficulties).

Benign prostate hyperplasia is common in men aged 50-60 years and older, and the incidence rises sharply with age. The causes of benign enlargement of the prostate have not yet been conclusively clarified. There are several theories on this topic, especially hormones seem to play a decisive role.

Among other things, dihydrotestosterone (DHT) is produced in the prostate. This is an intermediate product (metabolite) of testosterone. Contrary to popular opinion, it is usually not testosterone that is the active hormone but its metabolite DHT.

It is produced by the enzyme 5-alpha-reductase from testosterone. Among other things, DHT causes the prostate gland to grow. It is therefore assumed that an excess of DHT leads to prostate hyperplasia.

This hypothesis is the basis of one of the drug therapy pillars for the treatment of benign prostate hyperplasia. So-called 5alpha-reductase inhibitors are used to reduce the volume of the prostate by limiting the formation of DHT. One member of this group of drugs is finasteride.

Another factor that is believed to contribute to prostate enlargement is a relative increase in the hormone estrogen in the male body. Commonly, estrogen is the female hormone and testosterone is the male. However, this is not quite true.

Women also have testosterone in their blood and men have estrogen. In men, the concentration of testosterone in the blood decreases with increasing age. Although the concentration of estrogens remains the same, the relative ratio of estrogen to testosterone shifts towards estrogen, which presumably leads to the growth or reduced death of prostate tissue.

Further hypotheses discuss the influence of growth factors and excessive growth of embryonic prostate stem cells as a reason for benign prostatic hyperplasia. There are two complexes of symptoms. On the one hand, irritant symptoms of the bladder and bladder outlet (irritative symptoms).

These include more frequent urination (more often during the day than every three hours as well as at night), painful urination, an unsuppressible urge to urinate (so-called imperative urge to urinate), incontinence with a strong urge to urinate (urge incontinence) and a residual urge to urinate (as if the bladder could not be emptied completely). On the other hand, there are symptoms of a voiding disorder (obstructive symptoms). The urinary stream is weakened.

Urination takes longer and is stuttering. The onset is delayed and dribbling occurs. Occasionally, residual urine is also present, indicating that the bladder cannot be emptied completely.

All these symptoms can be assessed by the doctor using a standardized questionnaire. Points are awarded for each symptom present, depending on the frequency of occurrence. This makes it possible to classify patients from mild to severe symptoms.

Pain can occur as a symptom of prostate enlargement. They usually only appear in the later stages of the disease. The anatomical position of the prostate plays a decisive role in this process.

The prostate gland completely surrounds the urethra, so that an enlargement of the prostate causes an increasing narrowing of the urethra.If the diameter of the urethra becomes smaller and smaller, the first problems with urination occur, which can already cause pain. If the enlargement of the prostate has progressed to such an extent that urine can no longer properly drain away and accumulates in the bladder, this can cause severe pain for the affected patient. The pain is caused by a stretching of the bladder muscles and is localized in the lower abdomen. If urination fails to occur at all, i.e. so-called urinary retention occurs, a doctor or hospital should be consulted urgently. In addition, an enlarged prostate can also cause increased urinary tract infections due to the accumulation of urine.