Prostate Center Paris

Enlarged prostate symptoms : Frequent urination

Dysuria, ejaculation problems

Enlarged prostate symptoms

The main symptoms of an enlarged prostate are urinary, and are due to compression of the urethra by the adenoma. In fact, the reduced urethral caliber impedes bladder emptying. There are also sexual complications due to the prostate.

The most common symptoms of prostate enlargement are :

  • a frequent need to urinate,day and night.

  • Some pain when urinating.

  • the feeling of not having completely emptied the bladder after urinating, and the urge to urinate again, less than two hours after having finished urinating (pollakiuria).

  • the urgent need to urinate.

  • interruption of the urine stream (a start of the stream, then a stop, followed by a restart).

  • a decrease in the strength or size of the urine stream.

  • the need to force the bladder to urinate.

  • frequent waking at night to urinate (up to five times a night).

  • a sudden inability to urinate, or acute retention of urine, with the unpleasant sensation of a full bladder.

  • Some bladder weakness.

Sexual problems: a weak ejaculatory stream

Firstly, as the prostate enlarges, it presses on the tube that evacuates urine, squeezing the bladder. This manifests itself in frequent urges to urinate, even at night, with a difficult, weak or even intermittent flow of urine. It seems that the bladder is not emptying completely.

Sometimes, urination can be painful, and urine may contain blood. Finally, on a sexual level, discomfort may be experienced, as hypertrophy leads to less vigorous ejaculation.

Prostate embolization : Learn more

Enlarged prostate : how is it diagnosed?

Although symptoms can be linked to prostate adenoma, it's best to confirm the diagnosis before choosing the right treatment. 

Our center adapts the process to each individual case, taking into account factors such as the size of the adenoma and the frequency of urinary disorders.

 

  1. First and foremost, our specialists evaluate hypertrophy by ultrasound.
  2. Then, in a second step, our specialists evaluate the discomfort using flowmetry.
  3. To rule out any risk of prostate cancer, our specialists check PSA levels and perform an MRI scan if necessary.
  4. Once the surgeon has confirmed that the disease is responsible for the symptoms, our radiology specialists perform an angioscan to prepare for the operation.

Urine flowmetry

This examination has no direct anatomical interest, but enables us to assess the dynamic functioning of the urinary system. It allows us to quantify patients' functional discomfort (and therefore subvesical obstruction), which is subjective and often poorly experienced.

The result is a curve expressing urine flow rate as a function of time. Maximum urine flow (Qmax) measures the maximum quantity of urine eliminated in 1 second. Optimum urinary flow is obtained with micturitions of over 150 mL. The normal Qmax value is above 15 mL/s.

The method is simple: a device electronically measures the quantity of urine emitted by the patient into a graduated glass while he is urinating with a full bladder.

The following measurements are taken:

  • Maximum urine flow (Qmax) in mL/s,
  • Average urine flow in mL/s,
  • Micturition volume in mL,
  •   Ordinary micturition time, i.e. when the patient urinates on the occasion of a moderately recent need, without having retained this need for too long.

Prostate CT angiography: Arterial mapping

Mapping the vasculature that irrigates the prostate is essential to identify any abnormalities and anticipate the need for interventional radiology. The angioscan will trace the arterial map surrounding the prostate and locate the arteries that irrigate the prostate.

Inferior vesical artery generally gives :

 - One or more vesico-prostatic branches that penetrate the base of the prostate, near the bladder neck, to descend along the prostatic urethra to the seminal colliculus. They vascularize the bladder neck, urethra, ejaculatory ducts and adjacent supra-collicular prostate. This group of arteries expands considerably in benign prostatic hypertrophy to irrigate the entire neoformation.

- prostatic branches, which run along the lateral and posterior surfaces before entering the gland. They vascularize most of the prostate (peripheral portion and infra-collicular part).

- the internal pudendal artery, which participates in the vascularization of the fibromuscular zone.

- the artery of the vas deferens and the middle rectal artery participate secondarily in its vascularization.

For patients with severe atherosclerosis and/or vessel tortuosity. Preoperative imaging with angioscan to assess pelvic vascularization is recommended in severely arteriosclerotic patients.

Non-surgical embolization of the prostatic artery.

Prostate ultrasound

Ultrasound examination of the urinary tract is optional in the initial work-up. However, it is recommended for preoperative BPH. It can be used to detect abnormalities of the renal parenchyma, gallbladder and upper tract. It can also be used to assess the prostate volumethe presence of a median lobe and vesical protrusion of the prostate. The endorectal approach is invasive and should not be used routinely.

PSA Prostate

PSA (prostate-specific antigen) levels increase progressively with age. A total serum PSA level of less than 2.5 ng/ml before age 50, < 3.5 ng/ml between ages 50 and 60, < 4.5 ng/ml between ages 60 and 70 and < 6.5 ng/ml between ages 70 and 80 is considered normal.

It increases temporarily in certain situations, such as after ejaculation, digital rectal exam, strenuous exercise, urinary tract infection, acute prostatitis or benign prostatic hypertrophy. This level is statistically linked to the presence of prostate cancer, with a threshold of 4 ng/ml generally considered abnormal. 

In people aged 60 to 70, early detection has a sensitivity of 70% and a specificity of 88%.

If screened, around 30% of people with a PSA level above 4 ng/ml have prostate cancer, while a level below 4 ng/ml rules out cancer in around 90%.

Prostate MRI

Many patients benefit from prostatic MRI prior to embolization. There are as yet no specific recommendations on this subject. this imaging modality offers several advantages:

-It provides a reliable assessment of prostate volume,

-It allows us to assess the size, morphological characteristics and vascularization of the adenoma, which could represent a real asset in the future.

-It can be used to investigate certain complications of BPH in the bladder: diverticulum, calculus, etc.

-It can be used to screen for prostate cancer, which is useful to do because the interpretation of PSA after embolization is problematic.

MRI imaging is proving to be a promising technique for the visualization of prostate cancer. Thanks to its excellent tissue contrast, it enables precise visualization of the gland and tissue structure.

Recent studies show that MRI is the best imaging method for prostate cancer diagnosis in terms of detection and localization (particularly in patients with persistent negative biopsies but high PSA levels). It is also a reference for pre-treatment assessments, as well as for post-treatment evaluation and follow-up.