The prostate is a secondary sex gland. It surrounds the urethra at the exit of the bladder. The symphysis is located behind the pubis, in front of the rectum, above the urogenital diaphragm. There is a strong structure called Denonvillier’s fascia between it and the rectum.
Zonal structure is expressed as peripheral zone (70%), central zone (25%), transitional zone (periurethral) (5%) and anterior fibromuscular stroma.
It is a glandular organ and glands are lined with columnar epithelium. They end with 30-40 ducts that open on both sides of the verumontanum. They empty their secretion into the prostatic urethra.
Their size remains unchanged from birth to adolescence. With puberty, it begins to mature under the influence of androgens and its volume doubles. It starts to grow again in all men after the age of 45-50. This growth is in the transitional zone located distal to the prostatic urethra.
The secretion of the prostate gland is made by the epithelium in the glands. It constitutes 20% of semen. The substances it contains interact with the substances in the vesicle seminalis fluid and ensure that the semen released into the vagina first coagulates and adheres to the cervix after 20-30 minutes and dissolves after 20-30 minutes. As the semen dissolves, sperms can move. The glycoprotein called PSA (Prostate Specific Antigen), which is used in the diagnosis of prostate cancer, also plays a role in the liquefaction of semen.
Prostate secretion plays a role in sperm motility by neutralizing vaginal acidity with its alkaline pH. Vaginal bacteria can be destroyed with the antibiotic effective substance called seminal plasmin found in its secretion. This effect contributes to fertilization.
A large amount of calcium in the prostate secretion enters the sperm, whose permeability increases after ejaculation, and increases the movement of the tail. In addition, with increasing intracellular calcium, the structure of the sperm head changes and lytic enzymes are released, making it easier for the sperm to pass through the zona pellucida. In other words, without prostatic secretion, sperm cannot reach the ovum and fertilization cannot occur.
The prostate gland, which plays an important role in the continuation of the human race, can be the cause of serious diseases for aging men.
The prostate gland grows with age. It is thought that hormones that change with age play a role in this growth. BPH is not seen in people who are castrated after puberty. The androgen-estrogen ratio, which changes with the decrease in androgens with age and the increase in the conversion of androgens to estrogens in the peripheral tissue, is the etiological factor that has been most emphasized in recent years. Although many other possible etiological factors were investigated, no meaningful conclusion was reached. Benign enlargement of the prostate causes obstruction through changes in the bladder outlet and prostatic urethra.
20% of men over the age of 50 have symptoms related to the lower urinary tract. This rate increases to 35% in the 7th decade and above. Considering that the world population has become 20 years older in the twentieth century, it is seen not only as a health problem but also as a serious economic problem. Annual expenditure for Benign Prostatic Hypertrophy in the USA reaches 4 billion dollars. Medical treatment of patients who can be considered young for Benign Prostatic Hypertrophy is more expensive than surgical treatment.
Symptoms of obstruction such as hesitant urination, decreased urinary flow strength, feeling of not being able to fully empty the bladder, urinating again soon after urinating, urinating with difficulty, dribbling after urination, as well as frequent urination, urinating more than twice a night, rushing to urinate, urgency. It also causes irritative symptoms such as urinary incontinence. Irritative symptoms are due to the changes caused by the obstruction in the bladder.
During digital rectal examination, the size and consistency of the prostate and whether there is any induration on its surface are evaluated. There is no relationship between prostate size and severity of symptoms. A small prostate can narrow the bladder outlet compared to a much larger prostate.
The bladder, which initially increases its pressure by thickening its wall, is able to empty itself. Over time, increasing amounts of residual urine remain in the bladder. This causes the patient’s complaints to increase significantly. In prolonged periods, the upper urinary system is affected, resulting in bilateral hydronephrosis and renal failure.
To evaluate the patients, a full urinalysis, serum creatinine, TPSA level, pelvic ultrasonography, uroflowmetry and measurement of the amount of urine remaining after micturition are performed. They are evaluated with the symptom score and quality of life score created by the American Urological Association. Those with low symptom scores can be monitored with a careful observation protocol.
