All about prostate adenoma: causes,symptoms, treatment, prognosis

Update: October 2018

This problem becomes every year more and more urgent.
Many men, as well as many women, are interested in this issue.
After all, the incidence is increasing, and diagnosing this disease is like
usually occurs in later stages. And, as you know,
the later the diagnosis is made, the more neglected is the disease, and this
for any diseases, the more difficult the treatment and the worse the prognosis.

Therefore, we consider it necessary to draw your attention to such
an important problem, because the treatment of prostate adenoma (AGS)
possible, and in the early stages it has a much larger
efficiency.

In this article we will look at the reasons for the development of this
diseases, factors contributing to the occurrence of adenoma
prostate, symptoms, diagnostic methods, all methods
treatments from folk to the latest techniques. And also describe the ways
prevention and possible complications, if the person is not on time
pay attention to the symptoms that appear and do not turn to
to the doctor.

A synonym for this disease is benign hyperplasia.
prostate gland (BPH), it is found in the medical
literature and can be used in the text below. Some are confused
this is a disease with inflammation of the prostate (prostatitis), it is a mistake.

Prostatitis and prostate adenoma are different.
diseases and have a different etiology.

APJ is a benign prostate tumor that can
to form either from glandular epithelium or from stroma
prostate gland.

Anatomy of the prostate gland

To better understand why certain symptoms occur when
APJ, tell you a little about the structure of the gland.

The prostate gland (prostate) is located in the pelvis below
bladder in men. It has a spherical shape and covers
urethra. Macroscopic structure – iron
consists of two lobes and an isthmus. Its size is normal 2 * 3 * 4 cm.
The gland consists of glandular tissue, which is assembled into lobules and
connective tissue (stroma). Prostate function is secretory, then
there is a production of fluid that is necessary to maintain
normal functioning of sperm.

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  • 1 – bladder
  • 2 – prostate
  • 3 – prostate duct
  • 4 – rectal ampoule
  • 5 – urethra (urethra)
  • 6 – pubic symphysis

How often does the disease occur

Benign prostatic hyperplasia is very
common disease. Most often it develops in men in
age from 40 to 50 years. Rarely found in younger
patients. According to doctors, about 80% of men sooner or later
are found with this disease. The risk of developing BPH increases
with age.

Causes of adenoma

The cause of the development of BPH is male menopause. After 40 years
men hormonal changes occur in the body. Declining
the level of androgens (“male” hormones) and the level increases
estrogen (“female” hormones). All men are always in the body
there are both androgens and estrogens, but in the period
climax their balance changes.

During this period, estradiol levels increase, it is he
has the ability to stimulate cell growth and reproduction
prostate gland.

Risk factors for developing BPH:

According to long-term observations, a number of factors have been identified, which
increase the risk of developing benign hyperplasia
prostate

  • Age men over 40 years
  • The presence of obesity (adipose tissue – a substrate for making
    estrogen)
  • The presence of this disease in relatives
  • Alcohol Abuse
  • Smoking
  • Hypodynamia
  • High blood pressure
  • Unhealthy diet – the use of a large number of acute,
    greasy food

Factors that do not affect the development of BPH:

There is no valid relationship between frequency
the occurrence of this disease and the following factors:

  • Sexual orientation
  • Sexual activity
  • Transferred inflammatory diseases of the pelvic organs, in
    including venereal diseases

Symptoms of adenoma

In this section, we simply list the possible symptoms.
benign prostatic hyperplasia, they will be discussed below
in details.

  • Frequent urination (see causes of frequent urination in
    men)
  • Frequent nightly urges
  • Sleep disturbance (see how to fall asleep quickly)
  • Symptom “sluggish jet”
  • Intermittent urination
  • Feeling of incomplete bladder emptying
  • The need for strong tension of the abdominal muscles with
    urination
  • Involuntary urination in small portions (see incontinence
    мочи у men).

Classification of BPH

By location:

  • Subvesical form – the tumor spreads in the direction of
    rectum.
  • Intravesical form – the tumor spreads in the direction of
    Bladder.
  • Retrotrigonal shape – the tumor is located under the triangle
    Bladder.

It distinguishes different stages (degrees) of adenoma development:

Stage 1 – compensated

Among the symptoms, patients note frequent urination,
especially at night. Frequency can be up to 10 times per day and (or)
up to 7 once a night. The urges are felt very strongly, but
there is a delay in urination, a stream of urine flows from a small
speed, despite the efforts of men. Can sometimes be observed
involuntary flow of urine.

Bladder emptying occurs due to compensatory
possibilities of the bladder muscle wall. This stage may be
long, up to 9-10 years. But often more intense
progression. After exhaustion of compensatory opportunities,
comes the next stage.

Stage 2 – Subcompensated

At this stage, inflammation of the bladder occurs, which
вызывает появление болезненности при urination. Saved
frequent urination, involuntary becomes more frequent
urine excretion. There is a feeling of incomplete urinary emptying.
a bubble. A stream of urine becomes not only lethargic, but intermittent. AT
urine may appear an admixture of blood. When stress, use
alcohol or hypothermia possible complete absence
urination. AT этом случае появляются боли в области мочевого
bladder radiating to the lumbar region or above the pubic
bone.

Due to the fact that the patient has to strain hard when
urination, может возникнуть выпадение прямой кишки или грыжа.
The walls of the bladder are strongly stretched and there are saccular
formations in which up to a liter of residual urine can accumulate.
If modern methods of treatment of adenoma are not used, then
comes stage 3 of the disease.

Stage 3 – decompensated

At this stage it is necessary to use a urinal, as
continuous leakage from the crowded bladder
urine drop by drop. Common symptoms appear – weakness, nausea,
loss of appetite, thirst, weight loss, may appear
constipation. The accumulation of nitrogenous bases in the blood smells
urine from mouth.

The volume of residual urine can reach two liters, occurs
overstretching of the bladder walls, reducing contractile
the ability of its walls. ATозникает нарушение работы почек. With
stagnation of urine may develop inflammation of the urinary tract that
will manifest as fever. Patient with this stage
urgently need treatment for prostate adenoma, not only
drugs, but also surgical treatment.

Complications of benign prostatic hyperplasia
glands

Often patients are afraid to consult a doctor with such a delicate
problem, or worry that it will be necessary to remove adenoma
предстательной glands, тем самым только повышают риск возникновения
complications that can be life threatening.

Acute urinary retention

With сильном сдавлении мочеиспускательного канала увеличенной
предстательной железой acute urinary retention develops. Launchers
hypothermia, acute respiratory
infection, delayed emptying of the bladder, stress or
drinking alcohol.

The clinical picture of acute urinary retention – the impossibility
urination when the bladder is full. With этом возникают
severe pain in the suprapubic region, radiating to the lower back and
penis.

If the patient is not provided in time
medical assistance then acute urinary retention may be complicated
the development of renal dysfunction, hydronephrosis and coma.

With возникновении признаков острой задержки мочи необходимо
go to the hospital urgently!

ATоспаление мочевыводящих путей

With застое мочи или неполном опустошении мочевого пузыря
It creates very favorable conditions for the reproduction of bacteria. it
can cause urethritis, cystitis and
pyelonephritis.

Urolithiasis disease

With застое мочи и высоком уровне концентрации солей в моче
it is possible to form microliths, and then urinary stones
the bubble. They, in turn, can lead to blockage
urethra that will cause acute
urine retention.

Diagnosis of BPH

Collecting complaints and history and examination of the patient. Finger study
Rectum allows you to determine the size, consistency
предстательной glands, болезненность при пальпации или ее
the absence of.

Every man over the age of 40 should check the level annually.
prostate specific antigen, even if its nothing
worried. This analysis can help diagnose not only BPH,
но и рака prostate gland.

Laboratory research methods:

  • Blood chemistry
  • General urine analysis
  • Determination of prostate specific antigen (PSA, PSA)
    in blood.

Determining the level of PSA in adenoma is not only the most important
diagnostic method, but also a method of controlling the course of the disease.

The rates of prostate specific antigen in
depending on the age of the man.

ATозраст мужчины PSA level, ng / ml
40-49 years 0-2.5
50-59 years 0-3.5
60-69 years 0-4.5
More than 70 years 0-6.5

Instrumental research methods:

  • TRUS – transrectal ultrasound. Allows
    обнаружить увеличение предстательной glands, узелки в ее структуре,
    the presence of stones in the bladder, determine the amount of residual
    urine.
  • Uroflowmetry – determination of urine flow rate at
    urination. AT норме она составляет 15 мл в секунду и выше. With
    reducing it to 10 ml / s can talk about the presence of an obstacle to the current
    urine.
  • X-ray – allows you to identify urolithiasis and
    changes in the renal pelvis system.

Scale I-PSS. It is a questionnaire of 7 questions about various
symptoms of BPH. The patient responds to each of them, assessing the presence
each symptom and its severity from 0 to 5 points. By sum
points the doctor assesses the likelihood of having BPH in this
the patient.

Treatment of benign prostatic hyperplasia
glands

Conservative treatment

  • α – 1 adrenergic blockers. Withменяются для восстановления или
    improve urine flow through the urethra, as these
    drugs cause its expansion, relaxing smooth muscles
    urethra
  • 5-α reductase inhibitors. They slow down the growth of the prostate,
    most reduce its volume. They are usually assigned if the volume
    adenomas are very large. Have a number of serious side effects –
    erectile dysfunction, breast enlargement and reduction
    libido.
  • Herbal preparations – reduce symptoms slightly
    diseases affecting the muscles of the urethra,
    but does not affect the growth of the tumor.

Drugs do not relieve adenoma, but only slow its growth or
relieve symptoms, cure it only with drugs not
seems possible.

Surgery

There are many different operations that can be used for adenoma.
prostate gland.

  • An open prostatectomy is the removal of the prostate lobes,
    abdominal surgery, performed under general anesthesia. Withменяется при
    большой массе предстательной glands (более 60 гр.) и объеме
    residual urine of at least 150 ml. ATозможно проведение вмешательства
    in 2 stages. The first stage removes the prostate gland,
    fistula forms up to the anterior abdominal wall, through which it departs
    urine in the urinal. ATторым этапом восстанавливается нормальный
    отток urine.
  • Transurethral resection (TUR) – the operation is performed without
    any cuts. ATсе манипуляции происходят через уретру.
    The conditions for this type of surgical treatment are
    – the mass of the prostate is not more than 60 grams and the volume of residual urine is less than
    150 ml. AT ходе трансуретральной резекции, как правило, простата
    not completely removed and the patient is prescribed drugs that
    впоследствии будут сдерживать дальнейший рост glands. TOUR less
    invasive intervention compared with open prostatectomy.
    But after this operation, complications are more common, for example,
    bleeding, urinary incontinence, retrograde ejaculation, sclerosis
    шейки мочевого пузыря или стеноз urethra
  • Transurethral microwave therapy – injected through the urethra
    a catheter through which microwaves are fed. Ткань glands сильно
    heats up and coagulates. The method is applied only when
    small adenomas. AT послеоперационном периоде наблюдается местный
    edema and a catheter is installed to remove urine.
  • Transurethral laser vaporization – as follows from
    names, the operation is performed using a laser. Through
    the urethra is inserted into the catheter, when exposed to a laser
    the tumor is evaporated water from its cells, which leads to their
    doom The prostate shrinks in size. Withменение методики
    it is advisable only for small tumors.
  • Transurethral needle ablation through the doctor’s cystoscope
    вводит иглы в ткань prostate Through них подают радиочастотные
    the waves. it нагревает и разрушает ткань опухоли. Method not
    used for large tumor sizes. ATероятные осложнения те
    transurethral microwave therapy is a violation
    urine outflow due to tissue edema.
  • Фоуксированный ультразвук высокой интенсивности (ФУATИ) – с
    a microscopic video camera and emitter are inserted using the probe
    ultrasonic waves. Ultrasound acts thermally and destroys
    tissue. A significant complication is impotence, which
    develops in 1-7% of cases.
  • Balloon dilatation – using a cystoscope injected into the urethra
    balloon with which to expand the lumen of the urethra
    channel. itт метод применяется в случаях, когда консервативное
    treatment is ineffective, and surgical treatment is contraindicated.
    Balloon dilatation can only reduce symptoms, but does not affect
    on tumor growth.
  • Stenting – a method similar to the previous one, only in the lumen
    уретры вводится стент, с его помощью улучшается отток urine.
    The indications for the method are the same as for the balloon dilatation.
  • Cryodestruction – a freezing is introduced using a cystoscope
    head through which liquid nitrogen is fed. Tissue Prostate
    glands замораживаются под действием низких температур и
    are destroyed. To prevent damage to low temperatures urethra
    A warming element is used in its zone.
  • Эмболизация артерий prostate gland. The newest method
    owned by endovascular surgeons. Through бедренную артерию с
    помощью катетера достигают артерий prostate AT их просвет подаются
    small spheres of medical plastic with a diameter of 0.1-0.4 mm.
    They are blown into small arterioles by the blood flow and clog them up.
    Prostate tissues do not receive nutrition and die, thereby
    its significant reduction is achieved.

The result of embolization of the arteries of the prostate gland. Orange
circles marked prostate.

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Ineffective treatments

These include traditional methods of treatment of adenoma.
prostate gland. Among them, the treatment of pumpkin juice, walnuts
nuts, fir water, decoction of hazel, but they will not help
get rid of growing adenoma. This also includes massage.
prostate with adenoma. Such methods will only allow you to lose time and
reach a disease of a higher stage.

All minimally invasive and safest treatments are possible.
only with small adenomas. Which means that the sooner you
consult a doctor if the first symptoms of the disease appear
it will be easier to cure and less likely to be complications.

Prevention of BPH

There are several methods of preventing the development of adenoma:

Diet. Nutrition for adenoma should be balanced
foods must contain a lot of fiber, vitamins and
trace elements.

Among the useful products: There are also products that are recommended to be excluded from
diet:
  • Fruit (they should be about 50% of the diet)
  • Legumes (beans, peas, lentils)
  • Dietary meat (turkey, chicken, rabbit), it is better that they
    were boiled or baked
  • Milk products
  • Vegetables
  • Alcohol
  • Strong tea, coffee
  • Eggs
  • Products with high levels of animal protein
  • Cheese
  • Spice
  • Grilled meat
  • Fat meat

Moderate exercise. Thanks to them not only
venous congestion decreases in the pelvic organs, but also helps
reduce body weight. Recommended walking in the fresh
air, active rest.

Regular visits to the urologist. After 40 years every man should
Once a year, visit a urologist and take an analysis on PSA. It may
help in the early diagnosis of this disease.

Forecast

With timely treatment to the doctor and proper treatment, the prognosis
favorable. With a long course of the disease without medical
помощи прогноз неfavorable. There are complications, infections
urinary system, stones in the bladder are formed,
acute urinary retention develops.

Also in severe cases there is renal failure, which
can lead to death. Do not forget that there is
the risk of malignancy, that is, a benign tumor may
malignant and in that case cancer is already diagnosed
prostate gland.

Автор: Ревус Олеся Григорьевна врач-невролог

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