What is the prostate?

The prostate is a structure of the male reproductive system located below the bladder. It surrounds the urethra, the duct that carries urine from the bladder to the outside.

The prostate produces 20% of the ejaculate fluid. Its components help liquefy semen to support sperm progression; its zinc-rich secretion has an antimicrobial effect, and its high citrate concentration supports sperm viability. The prostate's musculature contributes to ejaculation.

What are the most common prostate diseases?

  1. Benign prostatic growth (benign prostatic hyperplasia, BPH)
  2. Prostate cancer
  3. Acute and chronic prostatitis

Benign Prostatic Hyperplasia (BPH)

What increases the risk?

  • Aging, after 50 years old.
  • Metabolic syndrome: increased waist circumference, obesity, high triglycerides, low "good" cholesterol, elevated glucose, and high blood pressure.
  • Family history.
  • Sedentary lifestyle (lack of physical exercise).

Lower urinary tract symptoms (LUTS)

Lower urinary tract symptoms occur in patients with BPH, but other associated problems must not be overlooked: bladder aging and weakness, overactive bladder, neurogenic bladder, infections, bladder tumors, ureteral or bladder stones, and urethral stricture.

Important: these symptoms can also appear in the early stage of prostate cancer, so your physician must perform the studies needed to differentiate and identify the cause.

How is the diagnosis made?

Clinical history and physical exam (including digital rectal exam)

The digital rectal exam is very important because:

  • It evaluates the consistency and contour of the prostate and detects nodules or areas suspicious for a tumor.
  • The most aggressive malignant tumors may not raise prostate-specific antigen (PSA); the blood test alone is not enough.
  • It can detect changes suggesting a rectal or colon tumor (the third most frequent cancer worldwide).
  • It can identify anorectal problems (fissures, thrombosed hemorrhoids, fistulas, abscesses) that may confound the diagnosis.

Other evaluation tools

  • International Prostate Symptom Score (IPSS): a scale that grades symptoms from mild to severe and helps define next steps.
  • Voiding diary: shows how the patient manages fluids and which factors contribute to daytime and nighttime urinary frequency.
  • Laboratory: urinalysis and urine culture (infections); blood chemistry (kidney function); prostate-specific antigen. The PSA test does not replace the rectal exam — they are complementary.
  • Imaging: abdominal ultrasound of kidneys, bladder, and prostate; depending on the case, urography, CT, or MRI.
  • Uroflowmetry and urodynamic studies: assess bladder strength, degree of obstruction, and whether bladder emptying is complete.

Treatment

Watchful waiting and lifestyle measures

  • Lifestyle modification: management of metabolic syndrome and weight normalization; regular physical activity.
  • Adjustment of fluid intake and other beverages (alcohol, coffee).
  • Review of current medications and how they are prescribed.
  • Attention to comorbidities: sleep apnea, cardiovascular problems, diabetes, chronic kidney disease.
  • Management of anxiety and stress.

Medication

  • Alpha-adrenergic blockers (open the bladder outlet): Tamsulosin, Alfuzosin, Terazosin, Doxazosin, Silodosin.
  • 5-alpha reductase inhibitors (reduce prostate volume): Finasteride, Dutasteride.
  • PDE5 inhibitors (useful for urinary symptoms plus erectile dysfunction): Tadalafil, Vardenafil, Sildenafil.
  • Phytotherapy (Saw palmetto, Serenoa repens): effectiveness insufficiently proven in controlled studies.

Your urologist may combine these medications depending on each case.

Surgical treatment

There are multiple techniques; the choice depends on prostate size, the patient's condition, and the urologist's judgment:

1. Transurethral resection of the prostate (monopolar and bipolar TURP). Removal of the obstructing tissue through the urethra, with no incisions. Good obstruction relief in 92% of cases.

2. Laser vaporesection (Holmium, Thulium, GreenLight). Tissue removal by vaporization, with less need for blood transfusion.

3. Open enucleation surgery. Indicated for large prostates (over 80-100 ml). Complete removal of the adenoma with excellent, durable results.

4. Laser enucleation (HoLEP) or bipolar enucleation. Removes the adenoma in prostates of any volume, with less bleeding, shorter catheter time, and shorter hospital stay.

5. Minimally invasive simple prostatectomy (laparoscopic or robot-assisted). An alternative to open surgery for complete adenoma enucleation, with less bleeding and shorter hospital stay.

6. Bipolar transurethral resection with our team's modified Mauermayer technique. Applies the principles of enucleation to remove tissue with less bleeding, more completely and in less time, without requiring morcellation.

7. Robotic Aquablation (AquaBeam). Tissue ablation with a robot-guided high-velocity waterjet under real-time ultrasound, generating no heat. Improvement is maintained at 5-year follow-up.

8. Prostatic artery embolization (PAE). An option without general anesthesia for selected patients; preserves ejaculation to a greater degree than transurethral resection.

9. Water vapor ablation (Rezum). Can be performed in the office under sedation; helps preserve erectile function and ejaculation.

10. Prostatic urethral lift (UroLift / PUL). Implants that hold the prostatic lobes apart without cutting tissue; a 10-15 minute procedure with no catheter needed afterwards.

11. Temporary implantable nitinol device (iTIND). Placed for 5 days to open the urethra; ambulatory, preserves ejaculation and erection.

12. Intraprostatic injections. Under investigation; current evidence does not support routine use.

Each technique has specific indications, advantages, and risks (bleeding, urethral stricture, transient incontinence, ejaculation changes, among others) that your urologist will explain in detail for your particular case.

When should you see a urologist?

If you notice a weaker or thinner urinary stream, straining to urinate, a feeling of incomplete emptying, increased urinary frequency, or the need to urinate at night, seek evaluation. Preventing and treating your problem today means a healthier future for you.

At our Urology Clinic in Guadalajara we have the experience and technology for the comprehensive diagnosis and treatment of prostate diseases. Schedule your appointment at 33-3630-3316.

This article is for information and education; it does not replace professional medical consultation. See your urologist for a personalized diagnosis and treatment.