Surgery is a common treatment for prostate adenoma. While it removes the source of discomfort, it can significantly reduce quality of life and even lead to impotence. The current trend is to use medication.
 |
Prostate adenoma compressing the bladder neck (Photo: SK & ĐS/VNE) |
Prostate adenoma (benign prostatic hyperplasia) is very common among middle-aged men and older, ranking second among urinary diseases (after kidney stones). At the age of 50, about 50% of men are affected; this rate increases to 70% by age 70 and over 90% after age 80. More than half of patients experience urinary disorders severe enough to require treatment.
The prostate is located at the bladder neck, and when enlarged, it compresses the bladder and obstructs urination. Additionally, this gland has an autonomic nervous system that causes spasms when stimulated, and numerous alpha receptors that strongly constrict smooth muscles. When the adenoma is not large enough to obstruct urine flow, the prostate still has a reflex contraction that impedes the urinary tract. Men may experience urinary urgency, retention, increased residual urine, leading to urinary tract infections, bladder stones, bladder muscle hypertrophy, and hydronephrosis…
The impact of the disease forces 58% of men to limit their fluid intake before traveling; 40% avoid attending movies or cultural events; and 62% avoid places without restrooms… Most of them cannot sit in a vehicle for more than 2 hours continuously, restrict outdoor sports activities, and hesitate to drink water before bedtime, resulting in disrupted sleep…
Prostate adenoma has been recognized since ancient times, when treatments were entirely based on herbal remedies. To this day, some medications are still under research, such as tadenan and permixon…
In the 1960s, thanks to advances in surgery, treatment of the disease was primarily surgical. By the end of the last century, laparoscopic surgery became preferred, considered an appropriate method for addressing benign tumors—essentially cutting them out. However, it is clear that nature does not allow for any part of the body to be redundant. While removing the tumor solves one problem, it does not address all issues.
There are other methods like balloon dilation of the urinary tract (currently rarely used), microwave thermotherapy targeting the prostate via the rectum, or laser vaporization, causing necrosis of the tissue compressing the urinary tract, as well as resecting the prostate through the urethra… All these methods can affect quality of life. After prostate adenoma removal, about 70% of men experience anejaculation, resulting in loss of sexual pleasure.
The current trend in treatment is medication, aiming to improve quality of life rather than focusing solely on the size of the tumor. In Italy, the use of medications has increased fivefold. In the United States, the Urological Association recommends using alpha-adrenergic blockers (like Cardura) and smooth muscle relaxants in the prostate and bladder neck to alleviate urinary obstruction and improve maximum urine flow rate.
Dr. Bùi Nguyên Kiểm, Health & Life
