Enlarged Prostate

Benign prostate hyperplasia is the most frequent form of non-malignant cell proliferation in men. In a newborn the prostate is barely the size of a pea and its mass varies between 3 to 5 grams. Its volume and mass do not change until puberty, when it is stimulated to growth by androgens. In an adult man at the age of 20 the prostate weighs approximately 20 grams. This lasts until the 4th-5th decade of life, then the prostate starts enlarging in the majority of men. The development, growth and succeeding benign prostate hyperplasia are dependent on the conversion of testosterone, male sexual hormone, to dihydrotestosterone inside the prostate. Exceptions are men castrated before puberty (eunuchs) and men with a congenital disorder of testosterone conversion. Both these cases are extremely rare in the population.

Prostate hyperplasia (enlargement of the prostate, benign prostate hyperplasia, BHP) is a non-malignant enlargement caused by proliferation of prostate tissue cells. The first signs of hyperplasia are apparent under the microscope (histologic examination) already in some 30-year-old men. In the following stage, the enlargement of the prostate is also visible macroscopically. This phenomenon can lead to fundamental changes in the continuous flow of urine from the bladder. The fact that the benign growth occurs at the site of interstitial tissue (stroma) located mostly around the urethra, the urethra is compressed. The bladder thus has to generate higher pressure to let urine leave completely during urination.

Another factor is enlargement of the prostate towards the bladder. In the downward direction the prostate is supported by the tight muscle floor, but in the upward direction it compresses the base of the bladder and lifts it up. This leads to changes in the nervous regulation.

In some men benign prostate hyperplasia can cause serious problems, including infections of the urinary tract, sudden incapacity to urine (acute urinary retention) as well as necessity for surgical intervention. The symptoms that point to an obstruction (obstacle) in the urine flow from the bladder are signs of a potentially more serious disorder, which can lead – if not treated properly – to damage to the urinary bladder or kidneys. In rare cases, this can result in acute (urgent) operation.

With a little exaggeration we can say that prostate problems will be encountered by any man. Until forty years of age only 10% suffer from benign prostate hyperplasia, after fifty the disease is found in 1/3 of all men, after reaching sixty years of age it is approximately one half, between 60-70 already 3/4 of men and after eighty as many as 90% of men.

The disease is long lasting, the troubles usually go aggravating, at the beginning an acute therapeutic intervention is therefore often unnecessary. As in all other long-lasting diseases, proper treatment should be started on time. If you observe problems with urination, don't hesitate to visit a urologist. The sooner you start the therapy, the higher is the chance of recovery. Although BHP does not necessarily threaten the patient's life, in many cases it requires treatment with medicaments or surgery.

The origin of the troubles, however, can be recognized only by the urologist.

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