About prostate adenoma detail

---

Author: Stingrays BV, Urologist, andrologist. Experience since 1996.
September, 2018.

---

Men of the disease, particularly prostate disease (prostate), located in the area of ​​attention of both patients and doctors. The term "BPH" jarring modern man, and the disease itself acquires implausible myths, rumors and misconceptions. Let's try to dispel some of these myths and to orient the reader to the correct action upon detection of unpleasant symptoms.

Synonyms: BPH, prostate adenoma, benign prostatic hyperplasia (BPH) - the latter term is used the most in the international medical practice.

BPH - a proliferation of the prostate from the inside, resulting in obstruction urethral deterioration and outflow of urine from the bladder.

As a result of violations of the outflow of urine in the prostatic area at the man there are frequent urge to urinate, difficulty in emptying the bladder, until, until the complete cessation of the flow of urine.

BPH, prostatitis and Oncology

From prostatitis prostate adenoma fundamentally different:

• BPH - neoplastic process, ie, process to produce more connective tissue.
• Prostatitis - the disease with pronounced signs of inflammation, particularly inflammatory changes in tissues is prostate itself.

Often a combination of these detected in the prostate gland diseases - and prostatitis, and prostatic hyperplasia.

BPH has nothing to do with varicocele - these diseases do not cause each other and do not influence one another (as some believe), it is independent urological diseases.

Communication prostatic hyperplasia and cancer, scientists have not figured out until the end, but the research is being conducted around the world, and data are quite contradictory. Yet BPH is conventionally considered a precancerous condition and requires constant vigilance of cancer with annual PSA check.

prevalence

At the age of 55 years, 50% of men are changes characteristic of prostatic hyperplasia, in the age of 80 - 90%.

BPH is the main cause of urinary disorders in men aged 60 years and older.

Symptoms of the disease are usually not life-threatening, but often have a significant impact on its quality.

The causes of prostate adenoma

By hyperplasia risk factors for prostate include:

• age over 50 years,
• level of prostate-specific antigen (PSA) levels greater than 1.5 ng / ml,
• increase in prostate volume of more than 30 cm³, The presence of diabetes.

The main cause of BPH - increased activity of a specific enzyme - 5-alpha-reductase. Under the influence of female hormones - estrogen (their concentration increases with age in men) is an increase in the concentration of 5-alpha-reductase. In turn, under the influence of this factor, testosterone prostate converted into its byproduct - dihydrotestosteroneWhich leads to an increased division of prostate cells, causing its proliferation.

Causes of BPH up to 40 years

At a young age, men rarely acquire prostatic hyperplasia, but such cases happen.

It's connected with

• genetic predisposition,
• low primary sex hormone - testosterone,
• obesity
• diabetes.

symptoms of adenomas

Manifestations of BPH are dependent not only on the size of the prostate, but also on the location of the nodes in the prostate. The most severe urinary tract obstruction occurs when localizing the nodes in middle lobe prostate, near the top of the passage of the urethra.

Symptoms of BPH can be connected with impaired bladder filling:

• frequent, sometimes unproductive, urge to urinate;
• frequent nighttime urination (several times during the night);
• unexpected urinary leakage (incontinence in a variety of everyday situations - when coughing, laughing, and others).

In addition, hyperplasia of the prostate gland has a number of symptoms that reflect the problems emptying Bladder:

• difficulty beginning to urinate;
• weak (flaccid) urine stream;
• feeling of incomplete emptying of the bladder;
• the need to strain your lower abdomen at the beginning of urination;
• spraying a jet of urine;
• urine output drops at the end of urination;
• an interrupt urine jets;
• interesting symptom - delay urination in combination with urinary incontinence (the so-called paradoxical ischuria), Speaks of the nature of the disease is running.

Also, when prostate adenoma distinguish symptoms that occur after a person has urinated (postmiktsionnye):

• feeling of incomplete emptying of the bladder;
• undermining the characteristic of urine after urination is finished.

Of the non-obvious, but common symptoms should highlight the following:

• discomfort, pain in the rectum, especially when large amounts of adenoma when she presses on the rectum - many patients complain about it;
• may be pain during bowel movements, and constipation.

Pain during prostate hyperplasia

In addition to the above symptoms, a man can feel pains of different nature and intensity of the perineum, rectum, lower abdomen.

Pain in the lumbar region for BPH is not characterized, but may appear pulling sensations in the later stages of the disease, with kidney damage.

In the case of joining of infection in the prostate, bladder, can increase the body temperature.

developmental stage

Conventionally, there are three displays at step prostate adenoma. The main criteria is prostate volume and the presence of " residual urine"- that amount which remains in the bladder after micturition complete (as determined by ultrasound).

Symptoms are grouped by the International Index of symptoms of prostate disorders (IPSS) Provided in the points:

• minor symptoms - 0-7 points;
• Moderate - 8-19 points;
• expressed - 20-35 points

In stage I - prostate volume of 30-40 cm³, Residual urine is negligible, up to 40 ml.

In stage II - prostate volume reaches 40-60 cm³, The residual urine can be up to 100 ml.

In stage III - a very large volume of the prostate, 60-80 cm³ or more, residual urine volume reaches more than one liter. At this stage it develops paradoxical ischuriaWhen, after a very weak external sphincter, urine leaks from arbitrarily overstretched bladder.

It should be understood that it is not always stage prostate adenoma depends on the size of the prostate, a large value has an arrangement of the prostate, with respect to the urethral area, and the time neglect process.

Examinations and tests

Screening (primary) prostate examination includes:

• Seen urologist;
• digital rectal examination;
• general urine analysis;
• a blood test for PSA;
• TRUS;
• additional methods as needed.

Urologist

If you suspect a prostate adenoma and the identification of similar symptoms, screening should start with a visit to a urologist, who primarily conduct a digital rectal examination prostate.

Blood PSA

Required in the first stage is carried out examination of PSA (prostate-specific antigen) in the blood to exclude oncological processes.

• It should be alerted if the index is greater than 1.5 ng / ml.

Donating blood PSA should TRUS to perform because of the probable prostate micro-analysis may be misleading. The variant of giving blood a week after TRUS, when everything will be restored.

OAM

At this stage propose to pass a general analysis of urine sediment microscopy (OAM) That will allow to reveal inflammation, get other important information.

TRUS

The next diagnostic step there is a mandatory implementation of research transrectal prostate ultrasound - TRUS. Here define the shape, size, texture of the prostate, the amount of residual urine.

TRUS is held with filled bladder after urination is assessed residual urine volume. ECHO main signs of disease is the presence of

• adenomatous nodes of the prostate,
• hyperplastic areas (altered) tissues,
• increase in size of the prostate.

Sometimes imprisoned on TRUS can read these terms:

• and diffuse hyperplasia of the prostate;
• prostatic hyperplasia with inhomogeneous structure.

Nothing dangerous about it. It is understood that the areas free from hyperplasia to change, there are signs of concomitant prostatitis (inflammation), which requires additional therapy.

additional methods

A certain value in the diagnosis of BPH has micturition score using uroflourometrii (measurement of urinary flow rate).

If you suspect that a process Cancer of the prostate and bladder, narrowing of the urethra and bladder neck bladder, urolithiasis, conduct in-depth examination, using such diagnostic measures, such as:

• Biopsy (sighting taking) of a portion of the prostate.
  • performed in cases of suspected cancer, PSA at above 4 ng / ml.
  • the biopsy is performed by specialists urologists oncologists.
  • TRUS, through the anus, under local anesthesia, take a sample of the suspicious regions of the prostate, of at least 12 points, followed by examination of the tissue under microscope.
• Cystoscopy (presence of blood in urine) - direct inspection bladder special device - cystoscope;
• Cystography - examination of the bladder with contrast on x-ray);
• Magnetic resonance imaging (a kind of computer-layered study of tissues);
• Multislice computed tomography with contrast.

Important! It should be noted that the accompanying hemorrhoids(Increase anus and inflammation of hemorrhoids) worsens the possibility of examination of patients with BPH and require priority treatment, and if the examination can not be postponed, the parallel.

forms of BPH

Nodular prostate adenoma

• It says that the change in prostate tissue are represented as nodes.

diffuse form

• It implies that the process is evenly distributed throughout the prostate.

Focal prostatic hyperplasia

• may mean that the process is localized at a particular site,

Hyperplasia of the transition zones of the prostate

• It demonstrates a shift in emphasis in the transition sections of different shares to the site of the upper part of the urethra.

With what could be mistaken for BPH

In order to properly establish the diagnosis of benign prostatic hyperplasia, eliminate a number of similar symptoms of the disease:

• narrowing of the urethra (stricture);
• inflammation of the prostate and the urethra (prostatitis, urethritis);
• bladder stones;
• fibrosis and sclerosis (hardening) gland;
• Bladder neck sclerosis (Marion disease);
• violation of the nervous regulation of the bladder.

BPH Treatment

The essence of the treatment of prostatic hyperplasia is on the one hand to eliminate the symptoms that reduce the quality of life of men (frequent, shortness of urination, pain in the lower abdomen and perineum, etc.), on the other hand - to keep prostate growth and slow down process hyperplasia in the early stages of the disease.

In the later stages of the disease we are talking about a partial resectionOr complete removal of the prostate itself, which threatens to complete overlap of urine flow from the bladder.

behavioral therapy

In mild cases with minor symptoms of BPH treatment is to carry out behavioral therapy, which includes:

• Dynamic monitoring every six months:
  • regular visits to the urologist
  • carrying out TRUS in the dynamics,
  • PSA blood sampling
  • renting urinalysis.
• The decrease in fluid intake, especially before going to bed.
• The restriction or elimination of drugs with a diuretic action.
• Exception food and drinks with a diuretic effect:
  • fruit - including melon, watermelon,
  • milk products,
  • alcohol, especially beer,
  • Tea coffee.
• Execution of special medical physical training, Kegel exercises to train the muscles of the urogenital diaphragm.

The most simple and effective exercises:

• Kegel exercises: squeezing-unclamping anal sphincter - if possible as often as possible;
• Volitional interrupt urination, resuming it after a pause is constantly increasing - at every opportunity;
• Squat "crouch" - up to 50 times a day;
• Walking "on the buttocks" in the room, both forward and in reverse is not less than 20 passes per day.

drug therapy

Drug therapy for prostate adenoma is designed to solve several important problems:

• elimination of difficulty urinating,
• reduction in the frequency of urination,
• reducing the size of the prostate and curb its growth.

Develops treatment urologist who weigh the "pros" and "cons" in the appointment of any particular drug, otherwise medications can only do harm, aggravate the condition.

First step

"First-line therapy" in the treatment of BPH are alpha-blockers, eliminating the obstruction of the lower urinary tract, improving urination and voiding. Admission them can last for life or until the cause of the obstruction.

This group includes 5 preparations which have approximately the same effect:

• tamsuzolin at a dose of 0.4 mg / day - the most popular drug in Russia, the drug does not require adjustment of the dosage.
• alfazozin - 10 mg / day - has a safe profile.
• silodosin - a dose of 8 mg / day - have a greater selectivity in terms of removing unpleasant symptoms.
• terazosin - gradually increase the dose - from 1 to 10 mg, may lower blood pressure, so it is better to take at night.
• doxazosin - the dose chosen individually from 1 to 8 mg, significantly lowers blood pressure.

Second phase

The next stage of drug therapy of BPH is prescriptions groups inhibitors of 5-alpha reductase, sole of medication that can actually decrease prostatic size (an average of 30%). These are the two main drugs:

• Finasteride - 5 mg per day, the course of 12 months;
• dutasteride - 0.5 mg per day, the course of 6 months.

When the reception state of these drugs can significantly improve: reduced signs of compression of the urethra, the risk of surgery, and acute urinary retention.

Some foreign experts recommend the appointment reductase inhibitors as soon as possible for early prevent the growth of hyperplasia and elimination of adverse events, but the issue is under study.

Moreover, inhibitors of 5-alpha-reductase has a very unpleasant side effect - sexual dysfunction, So the use of the drug is limited to young patients.

Important! When therapy with finasteride and dutasteride, be sure to monitor PSA levels.

combination therapy

To improve the treatment of BPH results using the tactics of the combination therapy, which affects the different pathological stages of pathogenesis of the disease.

Sufficiently effective combination of blockers and inhibitors of 5-alpha-reductase. This optimal therapy for patients at high risk of further development of BPH.

Well proven and other combination: inhibitors of muscarinic receptors in conjunction with the same blockers. This therapy significantly improves the quality of life in patients with concomitant urinary incontinence.

at prostatic hyperplasia combined with prostatitis, To the media about the adenoma, add anti-inflammatory drugs and antibiotics, taking into account the existing microflora.

Preparations for the normalization of urination

With frequent, painful urination, including at night, the question of the appointment of a muscarinic receptor blockers represented by such means as:

• solifenacin,
• tolterodine.

Important! You need to know that the purpose of antimuscarinic drugs is limited for large size of the prostate and a significant amount of residual urine, since their use can cause the opposite effect and cause acute delay urine.

desmopressin

At night painful urination, more than 5 times during the night, a man almost deprived of sleep. In this case, the use of analog promising antidiuretic hormone - desmopressin drug that reduces excretion of urine.

But the medicine is assigned very carefully, urologist, together with the therapist, under the control of the sodium level in the blood.

Preparations for the improvement of erection for prostate adenoma

An interesting question is the use of the drug, like the famous "Viagra" - an inhibitor of phosphodiesterase type 5 (PDE-I-5):

• Tadalafil 5 mg per day, in addition to the improvement of erection, a positive effect on the process of emptying the bladder Bubble - eliminates difficulty urinating and prevents inflammation of the prostate gland.

Important! applicable isklyuchetelno tadalafil (Cialis). In another active ingredient of Viagra (siddenafil), which in this case will not have a therapeutic effect. Levitra (vardenafil) is not used.

"Ethnoscience

Many patients with BPH is used for treatment of Herbal medicines. Some effect of herbal medicines, without doubt, have, however, broad international clinical research on them has not been! Therefore, the use of these agents is auxiliary. In Russia, widely used funds allocated from the African palm: Serenoa repens (Prostamol DNA, Permikson), Pigeum Africanum (Pidzheum), Hypoxisrooperi (Gipoksis).

From domestic traditional medicine as an additional strengthening therapy is most commonly used prostate adenoma:

• bee products (honey, pollen, "Podmore" bees, propolis) - inside;
• A decoction of the bark of young aspen;
• A decoction of willow-herb (Epilobium angustifolia);
• A decoction of the root of red (Altai endemic - Hedysarum forgotten) broth;
• Pumpkin seeds (contain zinc, so necessary for the prostate) to 50 pieces a day inside;
• A decoction of burdock root.

In addition, Russia is actively used funds from animal products - Prostate steers, suppositories and injections.

Drugs such as Vitaprost, Prostatilen, prostakor and Samprost. For these drugs have only Russian studies and a certain effect occurs particularly with concomitant prostatitis, but broad international research programs, again, have been conducted.

A certain value in terms of symptomatic therapy of BPH has girudoterapija (treatment leeches), which reduces the inflammatory edema and improves circulation in the zone gland. However, such therapy is fraught with bleeding and conduct it must be exclusively from qualified professionals.

Important! It should be clearly understood that all of these funds are quite uncertain effect, so the development of the symptoms of BPH, a visit to the urologist is required!

Useless tools and contraindications

Quite strange effect is: shockwave therapy, customized Sytina, saline dressings Urinotherapy, TERMEKS, magnetic, microclysters, "Vitaphone", "Almag" hydrogen sulfide baths, vibrosoundtouch, Chinese Urological patch, radon baths, a variety of supplements, homeopathy, salt treatment by the method of Prof. Okulov, hydrogen peroxide at Neumyvakin, castoreum, indigal, and other adenorfin "Exotic" means.

Important! When prostate adenoma contraindicated All physiotherapy, massage the prostate, otherwise it can lead to the progression of the disease, and even the development of cancer.

Surgery

The operation in the later stagesBPH is the elimination of compression at the level of the prostatic urethra.

Indications for surgery :

• pronounced compression of the urethra;
• inefficiency taking medication;
• painful symptoms adenomas (e.g., strenuous frequent urination);
• complications adenomas (renal failure, urinary stones, blood in the urine, chronic urinary retention).

Indications for emergency hospitalization in urological hospital :

• Acute urinary retention - manifested complete cessation of urine from the urethra, distended abdomen, increase of pain in the bladder;
• The development of acute renal failure, which is clinically manifested by a sharp decrease in urination, increase of swelling, degradation, up to the loss of consciousness, increasing concentrations of potassium, urea, creatinine in the blood;
• Blood in the urine and the likelihood of clogging clots bladder.

Types of surgical interventions

TURP

transurethral resection of the prostate.

Is the "gold standard" surgical treatment of BPH. TOUR - the main type of surgery for prostate adenoma medium size.

Used in prostate volume between 30 and 80 cm³.

It is performed under general anesthesia or spinal anesthesia is very gentle in terms of the method of surgical treatment of complications. Is burning out special device Electrical resectoscope prostate tissue which blocked the lumen of the urethra.

operation, an average of up to 1 hour. Rehabilitation may require 4 to 6 weeks. In the postoperative period may appear discomfort during urination, blood in urine, signs of inflammation, delayed sexual activity.

In the postoperative period, the patient takes the tablet: blockers and anti-inflammatory agents, antibiotki.

open prostatectomy

Removal of the prostate gland. Operation is performed through the bladder, but the variant operation through the perineum.

It was first performed more than 100 years, but is still used in patients with large prostate larger than 80 cm³.

Open adenoektomiya recommended as the standard treatment of adenomas of the European Association of Urology.

prostate removal is performed under general anesthesia or spinal anesthesia. This type of surgery more traumatic, but the effect is more stable, there is no recurrence. Operation Time - 1.5 hours, longer than with TURP recovery period - up to 3 months.

During the operation in the stomach insert a catheter to drain urine, which is removed after 2 weeks. hospital stay time - 2-3 weeks.

Laparoscopy

Increasingly popular are sparing techniques prostate surgery large size - laparoscopic removal of the prostate by means of special tools and a few small holes in the stomach. Such operations will shorten the operation and the possibility of complications.

One of the variants of laparoscopic surgery - robot-assisted radical prostatectomy (RARP) with the help of a robot "Da Vinci." RARP active "supersedes" open prostatectomy for the treatment of BPH large around the world.

If RARP, compared with a conventional prostatectomy, the amount of blood loss was significantly reduced, there are advantages in the evaluation of the recovery of continence and erectile function.

Alternative methods of treatment of prostate adenoma :

All these methods have a certain value and can make a worthy alternative to prostate surgery.

• stenting prostatic urethra temporary and permanent devices - stents;
• Hyperthermia effects on prostate temperature from 40 to 100 degrees;
• Laser technology:
  • vaporization (evaporation) of the prostate "green" laser beam,
  • laser resection of the prostate,
  • laser photocoagulation,
  • Holmium enucleation HoLAP - variant evaporation of the affected prostate two different laser radiation, developed by New Zealand urologists;
• Exposure to high intensity focused ultrasound;
• Various embodiments of the ablation (destruction of radio frequencies) prostate (transurethral needle ablation).

Despite its good performance, alternative treatments for BPH enough expensive, are not included in the health insurance system OMS and clinics that perform these techniques in Russia Little.

The prognosis of prostate adenoma

The prognosis for the health and life with timely medication, if necessary, surgical treatment - favorable.

Untimely appeal to the urologist, advanced cases of prostate adenoma can lead to disability with poor prognosis of bladder evacuation.

What happens if you do not treat BPH

In the case of ignoring the symptoms of BPH or if self-medication, which is generally 99% of the incorrectly, to benign prostatic hyperplasia, in addition to the worsening of the disease, can be added the following processes:

• sleep disorders, mental disorders;
• erectile dysfunction (erectile dysfunction and potency);
• "Neurogenic bladder" - uncontrolled frequent urination;
• acute urinary retention - the most serious complication, when a sharp increase in the prostate gland completely blocks the lumen of the urinary tract. it state of emergency. At untimely medical assistance (emergency discharge of urine by catheterization of the bladder through the abdominal wall - cystostomy) develops uremic coma;
• pyelonephritis (Inflammation of the kidneys as a result of climbing in the upper sections of urinary tract infections);
• prostatitis (Inflammation of the prostate);
• urethritis (Inflammation of the urethra);
• urolithiasis disease (Formation of kidney stones and urinary bladder);
• hematuria (Presence of blood in the urine) occurs when edstatelnoy gland adenoma sufficiently rare, cases of damage adenomatous nodes prostate significant muscle layers. Basically, it is a characteristic symptom of cancer of the prostate and kidney stones;
• to some extent, the adenoma may cause infertility, because It decreases the secretion of the prostate, which is a medium for the existence of sperm.

Prevention. What can that not be in BPH

Among the methods of prevention of prostate adenoma are the following:

Limitation, but better - a complete rejection of the use of alcohol (stimulates blood flow to the small pelvis, exacerbates swelling of the prostate gland).

Restricting reception spicy food (edema contributes prostatic urethra).

Limitation of meat in side vegetable and seafood.

Compliance with dimensions in sexual activity.

Should, if possible, to avoid local and general hypothermia - it leads to a spasm of the muscles concerned, it leads to the development of inflammatory processes in the pelvic area.

Avoid a sedentary lifestyle, drive, you need to move more, walk, constantly engaged special exercise therapy - Kegel exercises: squeezing-unclamping of the anal sphincter, if possible, as much as possible more often.

Steam bath and sauna with moderate temperatures, with prostate adenoma can attend, it helps to reduce swelling and improve urinary flow.

It is not forbidden to sunbathe, to have sex.

Undesirable cycling and horse have been significantly injured seat directly, prostate tissue.

---

sources

• Urology. Clinical guidelines ed. SOUTH. Alyaev, PV Glybochko, DY Pushkar. - Moscow, MedForum, 2017.