Prostate adenoma — a benign tumor that develops from the stroma or the glandular epithelium of the prostate. By itself, the adenoma does not spread, but may over time degenerate into adenocarcinoma (prostate cancer).
Many experts, speaking about the BPH, prefer to use the term "benign prostatic hyperplasia", emphasizing thus its growth against the background of significant dishormonal nature of what is happening in the prostate gland changes.
The reasons for the development of BPH
The exact answer to the question, why is developing BPH, today will not give any one of the experts studying this disease. The fact that hyperplasia of the gland occurs in men as violent, and low sexual activity, smokers and nonsmokers, alcohol drinkers and nondrinkers.
However, it is seen that the age and level of male hormones very much affect the incidence of adenomas. Also the development of hyperplasia contribute to hereditary factors and a sedentary lifestyle (noted in 60% of cases of adenoma). The study also showed that BPH does not develop in castrated men, therefore, castration at one time was proposed as one of methods of treatment of BPH.
Many experts believe that the direct cause of the development of BPH should be sought in the complex interaction of cells of the prostate among themselves, changing their sensitivity to the effects of hormones, etc.
The stage of the disease depending on the symptoms
Modern medicine distinguishes 4 phases in the development of benign prostatic hyperplasia.
First stage: compensated form
Gradually increasing, the prostate begins to squeeze the urethra, which directly affects the nature of urination: urine begins to stand out with difficulty and languid stream.
Second stage: recurrent violations
At this stage the bladder is not completely emptied, and the quantity of urine that remains in it after urination, reaches 1-2 glasses.
The characteristic symptoms of this stage:
- the increase in the volume of bladder
- the need to push during urination,
- stream of urine secreted in bursts, in waves,
- due to the presence of rest periods, when urine is not released, the entire act of urination takes several minutes.
Third stage: decompensation
Gradually the body loses the ability to resist the huge amounts of urine that constantly remains because of the increased BPH. The bladder is distended, so almost no shrinking and is not helping to expel the urine out, even straining during the act of urination hardly helps.
Fourth stage: terminal
As the progression of the pathological process arising not compatible with life phenomena of renal insufficiency: there is a sharp violation vodno-elektrolitnogo balance, the increase in the content of nitrogen in the blood, and people die from uremia.
The complications of benign prostatic hyperplasia
Even in the initial stages, when hyperplasia of the prostate is still relatively small and insignificant violation of urination, occasionally may be acute urinary retention or to show blood in the urine (hematuria). In the future, BPH can be complicated by stone formation or accession of infection of the urinary organs. Consider some of the types of complications in more detail.
Acute urinary retention
Acute urinary retention is a condition when it is absolutely impossible to urinate with a full bladder. Most often found on the second and third stages of the disease.
Formed at the stage of development of the adenoma, when the bladder begins to be quite a large amount of urine. Another way is the migration of kidney stones in the ureters and the impossibility of its output through the narrowed lumen of the urethra.
Symptoms of a bladder stones:
- frequent urination,
- pain in the penis head, aggravated by movement, walking and disappearing in a horizontal position,
- periodic appearance of the symptom "laying the stream of urine".
- epididymoorchitis and etc.
Often the development of infection contribute to the congestion in the bladder, and catheterization.
The development of renal failure
Typical for the third and terminal stage of development of the adenoma and is associated with a decrease in production of urine by the kidneys.
1. Stage hidden manifestations: periodic dry mouth, weakness, with the testing — sometimes a small violation of the blood electrolytes.
2. The compensation stage: increased frequency of urination, changes in blood tests (increase in urea, creatinine).
3. Stage of decompensation:
- dry mouth,
- loss of appetite,
- General weakness,
- reduced immunity, which is manifested in a more severe course of ordinary colds,
- tremor of the fingers,
- muscle twitching,
- pain in bones and joints,
- dry skin,
- bad breath,
- in the blood — increase of urea, creatinine.
Stress, irregular diet, excessive physical exertion exacerbate symptoms of renal failure.
- sleep at night,
- inappropriate behavior,
- emotional lability,
- the smell of urine from a patient,
- belly distended,
- temperature decrease (hypothermia),
- skin itching,
- gray-yellow color of the skin and face,
- foul-smelling stools
- changes in almost all the internal organs and nervous system due to the phenomena of uremic intoxication.
Diagnosis of BPH
Comprehensive diagnosis of adenoma is based on the survey data of the patient, urological examination and a number of additional laboratory and instrumental methods of examination.
Besides external inspection of the genital organs must include examination of the prostate through the rectum.
Normally appointed by: urinalysis, renal tests, blood test for determination of antigen and histological study of the tissues of the adenoma (if necessary).
Most often for the diagnosis of BPH using the following methods:
2. X-ray methods.
Treatment of benign prostatic hyperplasia
Currently there is no single method of treatment of prostate hyperplasia, because in each case it is necessary to consider many factors, for example:
- the General condition and age of the patient,
- his consent to the operation,
- the stage of adenoma,
- the degree of impairment of urodynamics,
- are there any signs for prostate cancer,
- the possibility of a hospital.
In General, adenoma of the prostate may be treated as conservatively and efficiently. The choice of treatment depends on the stage of development of the adenoma:
- The first stage. Usually at this stage, the prostatic hyperplasia is treated by a conservative: appointed medications, recommendations for treatment and lifestyle to lead a physically active lifestyle, avoid eating spices and other irritating foods, smoked meats, eliminate alcohol, coffee. If you are experiencing difficulty urination can be recommended transurethral electrical resection.
- The second stage. The gold standard of assistance at this stage — removal of the adenoma with surgery using different minimally invasive and classic techniques.
- The third stage. Here the main task is to ensure good drainage of urine to remove toxicity. In this case, use puncture nephrostomy, cystostomy and etc. Next, normalize the condition of the liver, kidneys, cardiovascular system, and then decide on the possible further surgical treatment.
Drugs that are used to treat adenomas, it is not lead to its complete disappearance. They must be applied permanently, regularly, otherwise the adenoma begins to progress. Usually prescribers of the following groups:
1. Medications, relaxing smooth muscle tone in the neck of the bladder and prostate, which leads to easing the pressure on the urethra and ease the flow of urine to the outside. This is an alpha-adrenergic blocking agents long-term (prolonged) and short-acting.
2. Drugs that block the conversion of testosterone to its active form and thereby reduce the volume of the prostate (a blocker of 5-alpha-reductase).
3. Herbal remedies. Currently herbal medicines for the low effectiveness and lack of proven clinical benefit in many developed European countries and the United States for the treatment of the adenoma are not used. However, in a number of countries are assigned to plant assets. They are believed to have anti-inflammatory effect, reduce edema, inhibit the conversion of testosterone to its active form and stops the growth of adenoma.
4. The combined funds. Currently, the "gold standard" is a co-medication of the first two groups for 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.
In parallel treatment of opportunistic diseases — cystitis, prostatitis, pyelonephritis, urethritis.
Are radical methods of treatment of benign prostatic hyperplasia and are widely used in urology. These include:
1. Open adenomectomy. It may be performed in various ways, the most famous of which is adenomectomy. Through a conventional surgical incision allows access to the prostate gland and made its removal. Usually used in case of impossibility of use of less traumatic methods.
2. Endoscopic surgeries. All of them are performed using special surgical instruments that are introduced directly into the urethra under control of the video equipment. These include:
- transurethral resection of the prostate (TURP), which is the "gold standard" of surgical treatment of the adenoma — during its implementation through the urethra a special tool incision and cut off the prostate tissue;
- transurethral electro-vaporization — all access to the prostate through the urethra is provided, and then use the current fabric is heated to a high temperature and evaporate, and small blood vessels form a network structure;
- transurethral incision in the area of prostatic Department of the urethra make the cut, so that the lumen of the urethra widens, this operation is effective in the case of adenomas of small size.
3. Embolization arteries prostate. This operation is performed by vascular surgeons and is to ensure that the artery of the prostate is sealed with a special polymer, providing access through the femoral artery.
4. Cystotomy. Used as an intermediate stage of treatment in order to relieve the organs of the urinary system from excessive amounts of accumulated urine urgently and remove toxicity.
Although surgical treatment is the best and often the only method of successful treatment, there are a number of complications which include:
- urinary incontinence,
- the formation of adhesions in the ureter or fusion,
- frequent urination,
- the preservation of a significant amount of residual urine volume
- reflux of semen into bladder
- impotence, etc.
The most famous among them:
- Balloon dilatation of the prostate (expands the narrowed area with a balloon).
- Stenting of the urethra (in the area of narrowing is inserted sufficiently elastic element, which prevents the narrowing of the urethra).
- Evaporation of the prostate by microwaves — microwave coagulation.
- Cryosurgery (freezing the prostate tissues and following necrosis).
- Evaporation of the tissues giperplazirovannah gland with ultrasound of high frequency.
- Transurethral needle ablation — easy set small needle, and then, using a radio waves that heat and destroy prostate tissue.
- Destruction of prostate tissues with a laser.
All of these methods occupy an intermediate position between medical and surgical treatment and are used to relatively quick recovery urination with fewer side effects and better tolerability.
To all who suffer from BPH, it is recommended to regularly perform special exercises, which improve blood circulation of pelvic organs and prevent stagnation of blood, for example, "walking on the buttocks" in a few minutes.
It is also necessary to normalize your weight and daily diet to introduce foods rich in zinc and selenium — sardines, salmon, herring, pumpkin seeds, buckwheat and oatmeal, olive oil, celery and parsnips.