Prostate hyperplasia: new drugs intensify treatment
Increasing life expectancy has created a new challenge for medicine: paying attention to the diseases of aging, which have become more frequent in our care due to the growth of the elderly population. Among the dysfunctions of aging, changes in urination are among the most disturbing to the male elderly, both in the difficulties to adequately empty the bladder and in the involuntary loss of urine - known as urinary incontinence.
Specifically in men, The main cause of urination related symptoms is enlargement of the prostate, caused by a process called benign prostatic hyperplasia (BPH). The prostate is an accessory gland of the male reproductive tract, which is located at the base of the bladder and is traversed by the urethra. In BPH, enlargement of the gland can obstruct the urethra, thus causing urinary symptoms.
Statistically, the percentage of men with BPH is much higher than the percentage of men with voiding symptoms. This means that not all BPH makes urination difficult, and that only a fraction of men, around 40%, will need to do some treatment to relieve the urinary symptoms caused by BPH. However, 40% of a population that has been growing continuously represents a very high number and therefore it is necessary to offer forms of treatment to these patients in addition to surgery, a method that for decades was the only way to treat these patients. These facts led to several researches being carried out in this field, in an attempt to understand the disease itself, as well as to seek effective drug treatments. At first we discovered that obstruction of the urethra caused by BPH has two main causes:
Today the recommended treatment is the association of both medications, and there are already presentations on the market with the aggregation of them in the same capsule. 1- A mechanical cause:
the? Bottleneck? of the urethra caused by the enlarged prostate; 2 - A dynamic cause:
The muscle fibers that surround the urethra and make up the structure of the prostate do not relax during urination, keeping the urethra closed. new medications appeared. In order to allow the urethral / prostate musculature to relax during urination, several solutions have been developed, including so-called a1 blockers. These blockers act quite quickly and, depending on the case, may improve the symptoms within a few days after starting treatment. However, they are medications that do not interfere with the progression of the disease, and the prostate continues to grow, and over time patients become clogged and require some surgical intervention on the prostate. Bottom line, medicine has discovered that benign prostatic hyperplasia is stimulated in part by testosterone, and that this testosterone action depends on an enzyme called 5a reductase. This has led to the development of drugs that block the action of this enzyme, thus reducing the process of continuous growth of the prostate.
These two drugs are currently the most effective in treating BPD. The profile of patients who benefit from these treatments is well defined: they are men with micturition symptoms, prostate size over 30g, and prostate specific antigen (PSA) level above 1.5. recommended treatment is the association of both medications, and there are already presentations on the market with the aggregation of them in the same capsule. However, even with all these advances, surgery is still an option that has to be remembered, especially in patients who do not respond well to drug treatment or who present a risk of more severe complications. However, it is worth mentioning that in the field of surgery there have also been many advances, such as the possibility of using the laser for and elimination of the enlarged portion of the prostate in selected cases, as well as in the anesthetic support techniques during the operation, as well as in the structure available for the postoperative care. But the current recommendation is that the man does not wait for the signs and symptoms to appear. Regarding the prostate, specifically, special attention should be given to the early diagnosis of prostate cancer, especially in patients at higher risk, such as those of African descent or with a history of this disease in the family history. Any suspicion or doubt, talk to your urologist.
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