Symptoms of enlarged prostate: diagnosis, urinary disorders

L'benign prostatic hypertrophy (BPH)is a non-cancerous enlargement of the prostate gland that occurs mainly with age. It can compress the urethra, causing urinary symptoms such as difficulty urinating or frequent urination, especially at night.

What is the prostate organ?

Symptoms male prostate: prostate hypertrophy

The main symptoms of an enlarged prostate are due to compression of the urethra by the adenoma. In fact, affected men experience a reduction of the urethra hinders bladder emptying. There are also sexual complications, symptoms that appear due to this compression of the urethra.

The most common urinary symptoms thebenign prostatic hyperplasia include a variety of micturition disorders, often resulting from compression of the urethra at the bladder outletunderneath. The most common symptoms are :

Frequency and urgency of urination day and night, with frequent awakenings.
Pain when urinating and feeling of incomplete emptying.
Interruption and weakness of the urinary stream requiring effort to urinate.
Pollakiuria recurrent urge to urinate after 30 to 60 minutes.
Acute urinary retention unpleasant sensation of a full bladder with no possibility of urinating.

In case of presence of blood in urine orurinary tract infections repeated clinical examination by a urologist is essential to assess the situation and rule out the risk of prostate cancer.

Origin of urinary problems due to prostate adenoma

When the prostate, located under the bladder, develops, it exerts pressure on the urethra, the channel through which urine is evacuated from the bladder. This compression causes the urethra to narrow, slowing or partially blocking the flow of urine. As a result, the individual may experience difficulty in urinating, frequent urges to urinate, and a sensation of incomplete bladder emptying. Urinary output may be reduced or, in more severe cases, the patient may be unable to urinate at all.

Benign prostatic hyperplasia is the cause of these obstructive urinary symptoms. These symptoms can become bothersome and affect quality of life if left untreated.

Sexual problems: a weak ejaculatory stream

L'benign prostatic hyperplasia (BPH) can lead to a number of sexual disorders, mainly due to compression of the prostatic urethra and the effects of treatment. Symptoms include:

1. Erectile dysfunction Difficulty maintaining an erection, often due to pain or discomfort associated with urinary symptoms.
2. Retrograde ejaculation The sperm is redirected to the bladder, resulting in a weak ejaculation.
3. Decreased libido : Permanent discomfort and frequent nocturnal awakenings affect sex life and desire.

Some BPH treatments, such as drugs or surgery, can also aggravate these sexual problems.

Prostate adenoma: what diagnosis and clinical examination?

Although symptoms are often associated with prostate adenomait is essential to confirm the diagnosis in order to choose the right medical treatment the most appropriate. Our center adapts the process according to factors such as the size of theprostatic hypertrophy and frequency of urinary disorders.

First of all, our specialists evaluate the hypertrophy with a ultrasound to examine the prostate gland and urinary tract. Next, a flowmetering is carried out to assess urinary discomfort, and a PSA assay is performed to exclude any possible tumor potential. If a risk of cancer is suspected, a MRI is prescribed for in-depth analysis.

When the surgeon confirms that the adenoma is responsible for the symptoms, a angioscanner is carried out in preparation for the operation surgical. This procedure makes it possible to plan the partial removal of theprostate adenoma preserving as far as possible the prostate tissue surroundings.

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.

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.

PSA Prostate: cancer marker?

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 cancer? Diagnosis

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.

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.