WHAT TO DO WHEN THE PROSTATE IS ENLARGED. TODAY WE ARE GOING TO TALK ABOUT THE PROSTATE BUT FOCUSED ON WHEN THIS PROSTATE IS SO LARGE THAT NATURAL AND DRUG-BASED TREATMENTS DO NOT WORK. WHAT HAPPENS IN BENIGN PROSTATE HYPERPLASIA?: Excessive growth Adenomas in the periurethral prostate Bladder outlet obstruction Weak urine stream Incomplete emptying Infections DIAGNOSIS: Digital rectal exam See symptoms Ultrasounds CAUSES OF GROWTH: High DHT Poor estrogen-testosterone balance WHAT HAPPENS IN THE MOST SEVERE CASES?: Fibroadenomatous nodules that narrow the urethra Increased pressure in the bladder Hyperplasia of the detrusor muscle of the bladder Diverticula in the bladder SYMPTOMS: Pollakiuria Urgency when urinating Nocturia Difficulty in starting urination Intermittence Dribbling Incomplete emptying Urinary retention and abdominal discomfort CAUSES OF WORSENING: Postponing urination Immobilization Cold Alcohol, sympathomimetics, anticholinergics, opiates DIAGNOSIS: 1. RECTAL EXAMINATION: Increased size No pain Rubbery consistency No central groove It is misleading with small prostates because sometimes there may be an obstruction. 2. URINE CULTURE 3. PSA, PROSTATE-SPECIFIC ANTIGEN 4. PROSTATE AND BLADDER ULTRASOUND 5. BIOPSIES WHEN CANCER IS SUSPECTED 6. CYTOSCOPY PSA: 1.5 ng/ml or 1.5 mcg/l prostate volume of 30 ml Above 4, make other diagnoses Above 2.5, make other diagnoses if prostate cancer is suspected TREATMENTS: 1. AVOID SYMPATHOMIMETIC AND ANTICHOLINERGIC OPIATES 2. ALPHA-ADRENERGIC BLOCKERS (tansulosin, terazosin, doxazosin, alfuzosin, silodosin) 3. 5-ALPHA REDUCTASE INHIBITORS Finasteride and dutasteride Natural: pygeum africanum and serenoa repens (wild palmetto) 4. TADALAFIL: increases erection and decreases hyperplasia 5. DETRUSOR MUSCLE RELAXANTS 6. DECOMPRESSION PROBATIONING 7. SURGICAL SURGERIES. When there is no other remedy due to multiple secondary problems of bladders, infections and urinary stones. 1. TRANSURETHRAL RESECTION OF THE PROSTATE 5 to 10% side effects (incontinence, erectile dysfunction and retrograde ejaculation) Side effects are becoming fewer and fewer due to advances in surgical instruments After ten years, the operation must be repeated 2. MICROWAVE THERMOTHERAPY 3. ELECTROVAPORIZATION 4. LASER 5. HIGH INTENSITY ULTRASOUND 6. HOT WATER INJECTION UNDER PRESSURE CONCLUSIONS Control your diet Natural treatments Do not expose yourself to the cold No alcohol Be careful with certain drugs because they are harmful In cases where the prostate is very enlarged, surgery must be performed to avoid serious side effects DON'T MISS OUT!!!!!