The patient's prostate.

notes Dr. Claudio Italiano, internist


I am reminded of the case of a patient who comes to our attention for shortness of breath is treated with steroids, theophylline and then, having inserted a urinary catheter, the patient has significant stagnation of urine in the bladder, about 900 cc!

So also begins to urinate and pulmonary congestion seems to be solved by magic, despite adequate respiratory therapy. Anamnestic investigation to discover that the patient has long presented an obstacle to urination and peripheral edema. We were faced with a patient "prostate", ie with prostatic hypertrophy.

The prostate gland is the male accessory sexual organ larger in the young adult that weighs 20 grams. The biological function of the prostate is still poorly known, but we know that the prostate requires the presence of testicular functioning for its development and conservation. The prostate is localized in the pelvis in connection with the right rear, so that the exploration of it is accomplished by rectal palpation and so the maneuver of "squeezing" with which you come out of the male urethra prostatic fluid, ie that exists on the glans meatus for the examination of semen culture and prostate (prostatitis). Also the top is related to the bladder and urethra in its proximal segment crosses. The prostate cells produce a slightly acid liquid, which contains citric acid, poliamone (spermine and spermidine), acid phosphatase, protease serum, ie PSA prostate specific antigen which is an important marker in prostate cancer and dysplasia, yet calcium, zinc and sodium. Dihydrotestosterone is present in prostatic fluid and prostate cells. The problems associated with diseases of the prostate are increasing in modern swirl. The benign prostatic hyperplasia (BPH) or prostate adenocarcinomas and infections are increasing, with 40,000 deaths per year in the U.S. and 800,000 hospitalizations. The problems associated with the prostate are between 4 ° and 8 ° decade.

.... Benign prostatic hyperplasia (BPH).

Impact: 200,000 in U.S. run TURP procedures per year, auditors for endoscopic prostate for the unblocking of the urethra. It is the elderly who come to urologist difficulty in urination, ie MITTO ipovalido; the classic elderly patient who often gets up at night, urine with difficulty, the urine dripping with MITTO weak!

Etiopathogenesis.

The presence of sex hormones is a high risk factor for the development of prostatic hypertrophy, as Asians, for constitutional factors are affected to a lesser degree of that problem. Still speaking of correlation between obesity, smoking, alcohol consumption, hepatic dysfunction and vasectomy and BPH. Conversely in those castrated before puberty do not exhibit the BPH and so in subjects with deficiency of 5-alpha-reductase and block hormone does not develop. The prostate responds to androgen stimulation for the duration of life. There is an inheritance with regard to BPH or other prostate disease.



Clinic.

Irritative symptoms are present in the prostate: dysuria, nocturia, urgent urination, incontinence and urinary frequency and urgency, that the subject can not control the bladder, so to say, 'locks automatically "as a kind of elastic ball with a burst of urine and we are obviously talking of subjects with benign prostatic hyperplasia and wall vesicles.

On examination the doctor, transrectal palpation, the prostate can appreciate pushing forward and down, which appears increased prostate volume, increased consistency, fibrous, which still retains a smooth and elastic. Urinocolturale The survey will serve to exclude a concomitant urinary tract infection and, likewise, the cultural examination of pressing the prostatic fluid. Is still indicated Control of renal group, ie urea and creatinine than that of serum PSA. It then proceeds with the ultrasound of the urogenital tract and bladder and transrectal ultrasound investigation.

Treatment.

For the purposes of patient care is usually split the prostate in 4 groups:

Patient under study
Patient medical treatment
Patient treatment combined with techniques that microinvasive
Patient underwent resection of the prostate.
. The medical uses of herbal medicine (Palmetto), therapy alfaadrenergici antagonists (eg prazosin, which is administered in the evening, terazosin, doxazosin, tamsulosin, or with drugs 5alfareduttasi inhibitors (finasteride). The techniques are invasive TURP, which is incision of the prostate by transureterale or open prostatectomy because transpubica; side effects are retrograde ejaculation. After removal of the catheter, patients may have mild urinary problems that can persist for 3 mesi.Inoltr is possible that residual degree of urinary incontinence in 2% of subjects.



Other techniques use less destructive use of needle ablation, laser techniques, techniques of hyperthermia. Sometimes it is sufficient to deal with current problems such as infections of the prostate, situations very frequent species with promiscuous sexual behavior and because of unprotected sex, especially homosexual.......

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