BPH is a disease that starts in men in adulthood and is characterized by benign enlargement (hyperplasia) paraurethral glands.
Adenoma of the prostate may appear at the age of 40-50 years. According to the who (world health organization) there is a buildup of the disease, ranging from 12% for men aged 40-49 years to 82% in 80 years. After 80 years of BPH occurs in 96% of cases.
Studies have led to the result that the adenoma of the prostate in blacks more common, and the inhabitants of Japan and China often. This is due to the dietary habits of Asian countries, which is a large number of phyto-sterols, which have preventive properties.
Anatomy of the prostate
A gland located in the pelvis between the rectum and the pubic Symphysis. It has the shape that resembles a chestnut. The weight of the gland in men from 19 to 31 years, approximately 16 grams. Iron normally has photoelasticity consistency. The prostate gland consists of right and left lobes. The share is connected by the isthmus. The isthmus of the prostate adjacent to the bottom of the bladder and partially into the lumen of the bladder.
Through the prostate passes the urethra. He enters the gland at the base and goes out anteriorly from the apex. The prostate is supplied with blood from the bottom of the cystic and the intestinal arteries. Veins of the prostate form a plexus around it.
What causes benign prostatic hyperplasia?
The causes of BPH are not fully understood. Scientific studies have linked the disease as men age (the older a man is, the more often they become ill with adenoma of the prostate). At a young age men rarely develop prostate hyperplasia.
With age, changes occur in the neuroendocrine regulation of prostate cancer (after 40 years in men production of testosterone decreases, and secretion of estrogen increases).
There are a number of factors that increase the risk of developing BPH:
- Genetic predisposition (someone from the family was sick with this disease)
- Overweight (leads to disruption of metabolism and endocrine regulation)
- Unbalanced diet (eating excess salty, spicy, fatty foods).
The conducted research did not prove the influence of sexual activity, Smoking, alcohol consumption, infectious diseases in the development of benign prostatic hyperplasia.
The symptoms of BPH
The symptomatic picture of the disease depends on the stage of the disease.
There are three stages of the disease
Stage 1 is characterized by the occurrence of complaints in the complete emptying of the bladder (stage of compensation).
Stage 2 is characterized by significant disruption of the bladder after urination which is a significant amount of urine (the stage of subcompensation).
Stage 3 developing a complete dysfunction of the bladder with the phenomenon of paradoxical ischuria (urine drop by drop from a full bladder).
All the symptoms of the disease can be divided into obstructive (related to obstruction in urine output) and signs of irritation.
Obstructive symptoms are:
- Weak urine flow – the rate at which excreted urine is lowered.
- Primary urinary retention – urination occurs immediately after the relaxation of the sphincter, and after some delay.
- You need to strain your abdominal muscles to exercise the urination of the patient have to strain your abdominal muscles.
- Intermittent urination, that is urinating in parts (normal urination occurs without interruptions until the complete emptying of the bladder).
- Urine output drops at the end of urination (OK this is not happening)
- The feeling of not fully emptying your bladder (normal after urination men feel that the bladder is completely empty).
How dangerous is BPH?
BPH can be complicated:
- Acute urinary retention is a severe complication of the disease characterized by the inability to urinate. This complication is most likely to occur in the second or third stage of the disease. Typically, acute urinary retention develops after exposure, overwork or prolonged stay in a sitting position. This complication can be treated with bladder catheterization.
- Inflammationwhich developed on the background of BPH. Most likely to develop cystitis (bladder infection) and pyelonephritis. Prevention of these complications is the timely treatment of BPH.
- Bladder stones is a mineral deposits that appear due to incomplete emptying of the bladder. Prevention of this complication is the elimination of incomplete emptying of the bladder. If the stones still appeared necessary to carry out surgical treatment of BPH with associated removal of stones.
- Hematuria – the appearance of red blood cells in the urine. Hematuria appears due to varicose changes veins of the bladder neck. Hematuria may be macroscopic (red urine), and microscopic (can only be installed laboratory). The appearance of this complication it is necessary to exclude stones and bladder tumors.
Diagnosis of the disease always begins with the medical history. In 1997 in Paris at the meeting of the International Committee on issues of prostate hyperplasia, was accepted as the standard diagnostic algorithm of patients with BPH. This algorithm included the total score of all symptoms with a simple questionnaire called (IPSS) and the rating scale of quality of life (QQL). To assess and QQL IPSS use the points. IPSS 0-7 points means a slight manifestation of symptoms. With 8-19 points – moderate symptoms, and 20-35 severe symptoms.
Also this algorithm includes completing the voiding diary (frequency and volume), palpation (digital examination) of the prostate and various instrumental methods of diagnosis.
Palpation of the prostate (digital rectal examination of the prostate).
Palpation of the prostate allows to determine the size, consistency, tenderness of the prostate (in the presence of chronic prostatitis).
Ultrasound. With the help of ultrasound determine the level of an enlarged prostate. Assess the direction of the growth nodes, the presence of calcifications. Ultrasound also allows us to estimate the size of the kidneys, the presence in them of various changes, concomitant urological pathologies.
TRUS – transrectal ultrasound. This study allows us to study the structure of the prostate, to its exact dimensions as well as to identify signs of chronic prostatitis or prostate cancer. Transrectal ultrasound examination allows to determine the development of BPH in the very early stages.
Quite often in patients with very severe hyperplasia of the prostate determine the foci of calcification. The presence in the Central zone of the prostate calcification tells about the end (5) stages of development of the disease.
Uroflowmetry is a method that can be used to measure various characteristics of the urine stream. This method must be performed at least 2 times in the conditions of filling of the bladder (150-350 ml) and in the event of a natural urge to urinate. To evaluate the results using Uroflowmetry curve, which marks the maximum urine flow rate. Flow rate exceeding 15 ml/sec is considered normal. Also evaluated the total time of urination. The norm for volume of urine in a 100 ml – 10 seconds for the 400 milliliters of 23 seconds.
Studies have shown that there is a dependency of the indicators of urination of age. The norm is that the speed of flow is reduced to 2 milliliter/second every 10 years. This reduction in speed is due to the aging of the bladder wall.
The determination of residual urine after urination is of great importance to determine the stage of the disease, and to determine indications for surgical treatment. Residual urine is determined by ultrasound immediately after voiding. Recently Uroflowmetry is combined with determination of residual urine.
Cystomanometry is a method by which determine the pressure inside the bladder. This method allows measuring the intravesical pressure at different stages of bladder filling and during voiding.
In a healthy person starting the urge to urinate occurs when the bladder 100-150 ml of urine, the pressure is equal to 7-10 inches of water column. When the bladder volume is filled up to 250-350 ml, the urge to urinate increases sharply. In this case the normal intravesical pressure is 20-35 centimeters of water column. This reaction of the bladder is called the norm-reflexive.
Increased intravesical pressure (above 30 inches of water column) at the bubble volume of 100-150 milliliters speaks of hyperreflexivity (increased reflex of the detrusor). Conversely low pressure (10-15 cm water column) when filling the bladder to 600-800 milliliters talks about Hypo-reflection of the detrusor. Reflexogenic detrusor allows to evaluate its backup function, and the relationship between volume and pressure is characterized by the elastic properties of the detrusor.
Cystography is a method for examination of the bladder using contrast. There are descending and ascending cystography. Descending cystography involves the movement of contrast from top to bottom. This method allows to determine the filling defect in the neck of the bladder. The picture shows the filling defect is visible as a bump. Rising cystography allows to determine the deformation of the urethra in the prostate area.
Computed tomography and magnetic nuclear resonance , these studies provide more detailed information (correlation with neighbouring authorities) about BPH.
Treatment of BPH
Blockers of alpha adrenergic receptors. These drugs reduce the tone of smooth muscle structures of the neck of the bladder and prostate, which results in reduction of urethral resistance during voiding. These drugs must be used long-term more than 6 months. The therapeutic effect occurs after 2-4 weeks of use of these drugs.
Treatment herbal drugs
Treatment herbal medicines were used by people since ancient times. Recently these drugs have become very popular in Europe, Japan and the USA.
One of the French preparations from the fruit of the American dwarf palm tree, which has an inhibitory effect on 5-alpha reductase. The local also has antiproliferative and anti-inflammatory effect.
Studies have proven that prolonged use of the drug (within 5 years), leads to a significant reduction of prostate volume and residual urine volume and relieve symptoms. The tool is characterized by good tolerability and no side effects.
Another drug that is made from the fruit of the Sabal palm tree, has anti-inflammatory, antiexudative (prevents the accumulation of pathological fluid), antiandrogenic activity (by inhibiting 5-alpha-reductase). The drug does not affect the level of sex hormones does not alter blood pressure, does not affect sexual function. Treatment herbal medicines is carried out at hyperplasia of the prostate of first and second degree.
Surgical treatment of BPH
Surgical treatment can be carried out in emergency or in a planned manner. Elective surgery is carried out only after a full examination of the patient.
Prevention of prostate adenoma
- Daily mobility and exercise (but without undue stress). Physical activity reduces the risk of development of congestive processes in the pelvis.
- A healthy diet, which involves exclusion from the diet of sour, sharp, salty, smoked products. Obligatory presence in the diet of fruits and vegetables as well as vitamins of all groups.
- The fight against excess weight (improves metabolism in all organism).
- To exclude the wearing of tight in the crotch area things: underpants, pants.
- To exclude casual sex as a means of prevention of genital infections.
Is there a malignant adenoma of the prostate?
Prostate adenoma – a benign neoplasm, by definition. It doesn't invade neighboring tissues and does not metastasize.
However, over time, BPH can become malignant. Develops prostate cancer. Usually the "first bell" that signals the development of malignant tumors is the increased blood level of prostatic specific antigen. Finally helps to confirm the diagnosis a biopsy.
Prostate cancer, in contrast to adenomas, which are able to germinate in the surrounding tissue and to metastasize. Successful treatment depends greatly on how early it was started.