Adenoma of the prostate: symptoms, treatment, consequences

Prostate adenoma - a benign enlargement of the prostate gland in men older than 50 years, which causes a narrowing of the bladder outlet and urinary disorders.

The narrowing of the lumen of the urethra occurs gradually, increases the time required to emptying the bladder pressure is reduced urinary stream occur stagnant changes in the bladder and kidneys.

With the progression of the disease observed growing difficulty urinating until AUR.

Causes of

What it is? The exact causes of prostate adenoma is still not established. It is known that there is a direct correlation with age. The closer the "male menopause", the higher the risk of benign prostatic hyperplasia. Apparently, a large value has neuroendocrine regulation of prostate activity - reduction of testosterone, the principal male hormone and increasing concentrations of estradiol. This hormone is able to stimulate increased reproduction of prostate cells.

Factors contributing to the development of prostate adenoma:

1. Hypertension;
2. Physical inactivity and associated weight - fat tissue produces estrogen;
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3. Genetic predisposition - adenoma cases of the disease in relatives;
4. Improper diet - inclusion in the diet of fatty, fried food with hot spices.

The study found that BPH occurs in 25% of men aged 40-50 years, 50% - 50-60 years old, 65% - 60-70 years old, 80% - 70-80 years old, more than 90% - over the age of 80 years. However, the symptoms of the disease and, consequently, diagnosis of BPH vary greatly. The reason for this is the different intensity of symptoms in different men. Symptoms problematic urination concerned about 40% of men with the disease, but only 20% of those applying for medical assistance.

developmental stage

According to the development of this process, there are three stages of the development of benign prostatic hyperplasia:

Compensated.	The picture of a gradual difficulty urinating. Urine flow becomes sluggish, with some delay urination. The patient noted frequent urge (especially at night). However, the bladder empties completely.
Subcompensated.	As the compression of the urethra above symptoms worsen. The urinary bladder loses its capacity of complete emptying and residual urine exceeds 100 ml. Gradually, a feeling of incomplete emptying of the bladder. Bladder wall thickening significantly.
Decompensated.	Stagnation of urine leads to irreversible changes in both the urinary tract and kidneys. Kidney damage leads to the development of renal failure, which is characterized by thirst, urine odor in the breath, poor appetite and others. The bladder is gradually increasing in size and loses the ability of urine expulsion.

The most serious complications of prostatic adenoma are infectious: pyelonephritis (acute and chronic), urethritis, prostatitis, adenoma, vesicles, epididymitis.

The symptoms of benign prostatic hyperplasia

Under the influence of prostate tissue growth occurs body increase, which in turn compresses (narrows) the urethra. The disease is characterized by the following symptoms:

1. Weakening of the urine stream - is shown in the initial stage of the disease, until other symptoms frequently go unnoticed.
2. Urinary incontinence - symptoms, which tend to occur in long-term development of adenomas.
3. Sudden, trudnosderzhivaemye (mandatory) urination - in the presence of this symptom men usually go to the doctor.
4. Difficulty and frequent urination - especially at night urination is speeded up. This is due to the peculiarities of the nervous regulation of the functioning of the bladder. Men can absolutely not feel any discomfort during the day but at night get up to the toilet 3-4 times, and difficult to empty the bladder. A feeling of incomplete emptying of the bladder is often unnoticed because of frequent urination in the morning. Men with this problem complain that, in spite of normal urination during the day, in the morning they have to do it 3-4 times per hour.

All of the above signs of the disease manifest themselves immediately, but gradually their number increases with the passage of time. For a long time BPH able to manifest itself in some subtle one symptom. This state a man can find the reason in the form of age, stress or other factors, but when complications begin and will appear more unpleasant symptoms, he turns to the doctor.

Diagnostics

Symptoms of the disease in question may indicate other pathologies of the prostate, so a doctor for further diagnosis is required to conduct a full examination of the patient. The list of diagnostic procedures for suspected adenoma include:

• ultrasound of the prostate, including transrectal method (through the rectum);
• urological examination - inspection and digital rectal examination of the prostate gland;
• urodynamic study type - reveal the extent of the violation and the nature of urinating changes by measuring the flow of urine.

Required as part of the diagnosis carried out the procedure for determining the level of prostate-specific antigen in the blood. This makes it possible to identify at an early stage of prostate cancer.

Treatment for prostate adenoma

During the treatment of patients with BPH are advised to avoid supercooling prolonged sitting, receiving spicy food, alcohol, and significant amounts of liquid, especially at night.

Showing a walk in the fresh air, physical exercises with an emphasis on exercises for the muscles and organs of the pelvic floor and hips. The sexual life of such patients should continue to be rhythmic.

medication

Drugs used for the treatment of adenomas do not lead to its extinction. They should be used for a long time, regularly, or adenoma will begin to progress. Usually prescribers of the following groups:

1) medicaments, relaxing smooth muscle tone in the neck of the bladder and prostate, which leads to a weakening of the pressure on the urethra and facilitate the flow of urine outside. This α-blockers long (prolonged) and short-acting:

• doxazosin,
• prazosin,
• terazosin,
• alfuzosin,
• tamsulosin and others.

2) Drugs that inhibit the conversion of testosterone to the active form, thereby reducing prostate volume (blockers 5-α-reductase)

• dutasteride,
• Finasteride.

3) Phytopreparations. Currently, herbal medicines due to low efficiency and lack of proven clinical benefit in many developed European countries and the United States for the treatment of adenomas are not used. However, in some countries herbal remedies are assigned, which include lipidosterolovye extracts, e.g., Serenoa repens, Pygeum africanum, and others. They are believed to possess anti-inflammatory action, reduce swelling, block the conversion of testosterone to the active form is stopped, and growth adenoma.

4) Combined means. Currently, the "gold standard" is the co-administration of drugs of the first two groups within 3-4 years. This allows almost immediately to improve urination and after a few years by a quarter to reduce the volume of the prostate gland.

Parallel treatment performed comorbidities - cystitis, prostatitis, pyelonephritis, urethritis.

Surgery

There are many different operations that are used in prostate cancer.

1. Transurethral resection of the way - with the help of special tools through the urethra the surgeon enters the urethra and a small tool removes those parts of the prostate, which is squeezed urethra. Usually after this intervention urethral function is restored, however, you may need to install a catheter for temporary diversion.
2. The open prostatectomy - the removal of the prostate lobes, abdominal surgery performed under general anesthesia. It is used for large mass of the prostate (more than 60 g.) And the amount of residual urine is not less than 150 ml. Possible to carry out the intervention in 2 stages. The first stage of the prostate removed, the fistula is formed to the anterior abdominal wall, through which extends a urine drainage bag. The second stage of recovering the normal flow of urine.
3. Transurethral laser vaporization - as the name implies, the operation is carried out using a laser. Through the urethra catheter when the laser exposure on the tumor occurs evaporation of water from its cells, leading to their death. The prostate is reduced in size. Application of the method is only advisable for small tumors.
4. Transurethral microwave therapy - through the urethra catheter, through which the microwaves are supplied. Breast tissue heats up and coagulates. The method applies only for small adenomas. Postoperatively, there is local edema and catheter installed to drain urine.
5. Fouksirovanny high intensity ultrasound (FUVI) - with a probe is inserted a microscopic video camera and an emitter of ultrasonic waves. Ultrasound impacts thermally and destroys tissue. A significant complication is the impotence that develops in 1-7% of cases.
6. Transurethral needle ablation - through a cystoscope, the doctor inserts a needle into the prostate tissue. Through them serving radio frequency waves. It heats and destroys the tumor tissue. The method does not apply to the large size of the tumor. Possible complications are the same as that for transurethral microwave therapy - violation urinary outflow due to swelling of tissues.
7. Stenting - installation of stents, which do not allow the urethra to narrow. The discomfort of such intervention is that stents must be changed frequently (every six to eight weeks) to prevent infection and inflammation. Sometimes stents are mounted on a small period of time before surgery. Stenting is rarely used, only if the patient can not tolerate surgery.
8. Balloon dilatation - via a cystoscope is inserted into the urethra a balloon, through which extend the lumen of the urethra. This method is used in cases where conservative treatment is ineffective, and surgery is contraindicated. Balloon dilatation allows only reduce the symptoms, but does not affect tumor growth.
9. Embolization of arteries of the prostate gland. The newest method, which is owned by endovascular surgery. Through the femoral artery with a catheter reach prostate arteries. In their lumen serves small spheres of medical grade plastic with a diameter of 0.1-0.4 mm. Current blood they are carried in small arterioles and clog them. prostatic tissue do not receive power and die, thereby achieving a significant reduction in its.
10. Cryodestruction - via a cystoscope is inserted freezing head, through which liquid nitrogen is fed. Prostate tissue frozen under the influence of low temperatures and collapse. To prevent damage to the urethra low temperatures using heating element in its area.

To after treatment carried with BPH be pushed back, preventive measures should be followed - timely undergo routine check-ups, not to drink plenty of fluids, especially at night, do not drink alcohol excessively, and spicy fatty foods.

Total

BPH treatment should be individualized! You can not start to take a particular drug "because it helps his neighbor to testify Ivan Ivanovich, who seems to have the same sore!" Acting on such tactics, you can skip some much more severe pathology, for example, prostate cancer, which is largely similar to the symptoms of BPH.

The ideal way to treat a particular patient should identify skilled urologist possessing basic methods of combating the disease (and medication and surgical).