Enlarged prostate: what does the operation King Charles will undergo consist of

King Charles III will undergo surgery for an enlarged prostate. But what is it? What are the symptoms? How is it treated?

What is it

Prostate hypertrophy is a condition that almost all men who reach the age of 80 have to deal with, sooner or later. Only half show disorders related to benign enlargement of the prostate gland and of these approximately 50 percent require targeted, pharmacological or surgical treatment.

What are the typical symptoms?

The enlargement of the prostate associated with aging can make itself felt with different types of disorders – stated Emanuele Montanari, professor of urology at the University of Milan and director of the complex urology operational unit of the Irccs Policlinico Foundation of Milan -. The need to urinate often and urgency to urinate, with the risk of not having time to reach the bathroom, are typical initial complaints. However, if the prostate enlarges further, other disorders related to compression of the urethra may appear, such as difficulty in peeing and urine retention. In the most serious cases, a complete obstruction can occur which requires rapid intervention in the emergency room to place a catheter to allow bladder emptying.

What are the therapies?

There medical therapy is based on the use of symptomatic drugs. The most used, alone or in combination, are alpha-lytics and 5 alpha reductase inhibitors. The former relax the smooth muscles of the prostate. They act very quickly, but when they are suspended the effect disappears. They can cause retrograde ejaculation and reduction in blood pressure. 5 alpha reductase inhibitors have an antiandrogenic action. They are very effective but require 3 to 6 months to take effect, reducing the volume of the prostate and Psa (prostate specific antigen). Furthermore, they reduce the risk of acute urine retention by 70%, and therefore the need for a catheter, as well as the possibility of having to resort to surgery. However, they have side effects that can limit their acceptance by the patient. In fact, they can reduce libido with consequent erection problems and cause an increase in breast volume.

How necessary the intervention is

When is surgery necessary? When disorders related to prostatic hypertrophy do not respond to therapies or the patient no longer wants to take drugs, surgery is resorted to, which eliminates only the central adenomatous part of the prostate. The caudal part remains, therefore the risk of developing prostate cancer is not eliminated. Prostatic hypertrophy is a benign pathology, therefore there is no mandatory indication for surgery. However, there are five circumstances in which the operation cannot be avoided: urine retention resulting in the placement of a catheter; recurrent infections; significant hematuria (blood in the urine); complications such as bladder stones and/or diverticulosis, renal disease. Usually those who don't have continence problems before don't have them after the operation either and the same goes for sexual potency. The orgasm is preserved while ejaculation is lost because the seminal fluid flows back into the bladder explains Montanari.

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