What does Prof. Alessandro Natali?

These are the uro-andrological clinical fields in which Prof. A. Natali practices his profession both from the medical and surgical point of view


Benign Prostatic Hypertrophy

What is Benign Prostatic Hypertrophy ?

Benign Prostatic Hypertrophy (BPH) is a disease characterized by an enlarged prostate with symptoms of the lower urinary tract (LUTS = Lower Urinary Tract Symptoms), which interfere with the quality of life of male subjects.

The number of health services related to prostatic diseases is very high, in fact the BPH is the second pathology for diagnoses made in men every year in Italy (with 8,173,432 visits), behind only arterial hypertension and in front of other diseases frequent such as ischemic heart disease, dyslipidemia and diabetes mellitus. The number of visits has more than doubled since 1990 (3,550,000) to 2003 (8,000,000).

Other indexes of the strong economic impact of the BPH in Italy can be seen from the data of the Ministry of Health on the expenditure for drugs reimbursed by the NHS (327.8 million euros spent on drugs for BPH) and on the number of hospitalizations for this disease (14,854 admissions for BPH, for a total of 74,834 admission days).

Considering that the prevalence of BPH increases with increasing age, with the progressive aging of the population, a particularly significant phenomenon in Italy, the economic impact of this pathology will be increasingly important.

What does it mean an enlarged prostate?

The prostate is a small gland located in the man just below the bladder, which surrounds the urethra, which is the conduit that carries urine outside, starting from the bladder.

The prostate together with the seminal vesicles produces 90% of the liquid that comes out at the time of ejaculation, the remaining 10% comes from the testicles and from the so-called accessory glands.

The physiological enlargement of this gland (BPH) linked to age, involves a sort of compression of the urethra, with a decrease in its caliber. This situation determines a whole series of urinary disorders of the lower urinary tract, called, as we mentioned earlier, LUTS, which are:

  • Increase in day and night urinary frequency
  • Reduced urine flow of intensity
  • Dribbling after urinating
  • Sudden and strong urgency to urinate
  • Sensation of incomplete bladder emptying after urinating
  • Burning urination

How is BPH diagnosed?

An accurate medical history of the patient must be collected, a complete andrological examination must be performed which includes, an evaluation of the external genitalia and a digitorectal prostate exam.

Laboratory tests are prescribed including the determination in the blood of the prostate specific antigen (PSA), which is a substance produced by the prostate that can tend to increase during a tumor process, but also an inflammatory and physiological enlargement of this gland.

In addition, specific tests are required such as transrectal prostatic ultrasound and uroflowmetry, all non-invasive tests, to determine how much this prostate is enlarged. In particular cases, for example in the course of full-blown diabetes, a complete urodynamic examination may be required to see how the bladder works (relaxation and contraction). With this examination a small catheter is placed in the bladder to measure its internal pressures. 

How is BPH treated?

Not all enlarged prostates for BPH create problems or disorders. In these cases periodic checks are carried out with PSA execution, digitorectal examination and a transrectal prostatic ultrasound scan.

In the case of symptomatic BPH instead, there are medical therapies based on oral drugs that aim to try to slow down the physiological enlargement of the prostate and to reduce urinary symptoms. When medical therapies are no longer effective in containing disorders related to BPH or there is a risk of major complications such as urinary tract infections and acute urinary retention, surgery can be performed. In these cases there is no single type of surgery.

But depending on the patient's condition and the prostate features. We will be able to perform the classic open cut surgery to remove the gland in its entirety, transvescical adenomectomy (TVA), or a transurethral endoscopic resection (TURP) or new techniques using the lasers at various wavelengths.

The type of intervention must be decided with the reference urologist. A constant consequence of any type of surgery for BPH is the retrograde ejaculation which is the phenomenon by which at the moment of orgasm the sperm is no longer seen to come out, but this goes into the bladder.


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