BPH is a disease that starts in men in adulthood and is characterized by benign enlargement (hyperplasia) of para urethra of glands.
Adenoma of the prostate may appear at the age of 40-50 years. According to the who (world health organization) is a buildup of the disease, ranging from 12% years men 40-49 years, 82% of the 80 years. After 80 years of BPH occurs in 96% of cases.
Studies led to the result that the prostate adenoma of the blacks is still common, the population, the Japanese, the Chinese often. This is due to the eating habits, the Asian countries, that a number of plant sterols, which are the preceding properties.
Anatomy of the prostate
A gland located in the pelvis between the rectum and the pubic Symphysis. This form is similar to a chestnut. The weight of the gland, the men were 19 to 31 years, approximately 16 grams. Iron is usually photo elasticity consistency. The prostate gland consists of the right and the left lobe. The share using connect to the isthmus. The isthmus of the prostate adjacent to the bottom of the bladder, and partly in the lumen of the bladder.
Through the prostate passes the urethra. Enters the gland at the base, going first to the mountaintop. The prostate is supplied with blood from the bottom of the cystic and the intestinal arteries. The veins of the prostate form a plexus around.
What causes benign prostatic hyperplasia?
The cause of BPH is not fully understood. Scientific studies have also linked the disease than men (the older a man is, the more often they become sick adenoma of the prostate). Young men rarely develop prostate hyperplasia.
Age, changes occur in the neuroendocrine regulation of prostate cancer (after 40 years in men, testosterone production decreases, secretion of estrogen increases).
A number of factors increase the BPH:
- Genetic predisposition (someone in the family was sick this disease)
- Overweight (crunches, metabolism, endocrine regulation)
- The unbalanced diet (excessive eating of salty, spicy, fatty foods).
The conducted research has not demonstrated that the effect of sexual activity, Smoking, alcohol consumption, infectious diseases, the development of benign prostatic hyperplasia.
The symptoms of BPH
The symptomatic picture of the disease depends on the stage of the disease.
Three stages of the disease
1. phase is characterized by the complaints of the occurrence of the complete emptying of the bladder (stage of compensation).
2. phase characterized by a significant disruption in the bladder after urination, which is a significant amount of urine (in the stage of subcompensation).
3. stage developing a full disorder, the bladder, the phenomenon of paradoxical ischuria (selection of drops of urine in the full bladder).
The symptoms of the disease can be divided into obstructive (related to obstruction of urine), and signs of irritation.
- Weak urine flow – the rate at which excreted urine is reduced.
- Primary urinary retention – urination occurs immediately after the relaxation of the sphincter after some delay.
- Need to strain the abdominal muscles , is to exercise the urination of the patient, the strain of the abdominal muscles.
- Intermittent urination , urination the parts (normal urination occurs without interruption until the complete emptying of the bladder).
- Urine drops at the end of urination (OK that's not happening)
- I get the feeling that you don't completely empty your bladder (normal urination after the 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, which is the inability to urinate. This complication is most likely that the second or the third stage of the disease. Usually, acute urinary retention develops after exposure, overwork, or long stay in a sitting position. This complication can be treated with bladder catheterization.
- Inflammation, which developed on the background of BPH. The most likely to develop cystitis (bladder infection) and pyelonephritis. Prevention of these complications timely treatment of BPH.
- Bladder stones – mineral that may occur because the bladder isn't fully emptying. Prevention of this complication is the elimination of incomplete emptying of the bladder. If the stones all appeared necessary to carry out surgical treatment of BPH-related removal of the stones.
- Hematuria – the appearance of red blood cells in the urine. Hematuria due to varicose changes in veins of the bladder neck. Hematuria may be macroscopic (red urine) microscopic (can only be installed in the laboratory). The appearance of this complication is required to exclude stones, bladder tumors.
Diagnosis of the disease always begins with the medical history. In 1997, the Paris meeting of the International Commission problems, prostatic hyperplasia, was accepted as the standard diagnostic algorithm in patients with BPH. This algorithm is included in the total score of all symptoms with a simple questionnaire address (IPS), as well as the quality of the quality of life (QQ). Survey qq about IPS use the points. IPS-0-7 points means that a small manifestation of symptoms. Articles 8 to 19 point – to- moderate symptoms 20-35 severe symptoms.
Also, this algorithm includes completing the voiding diary (frequency, quantity), palpation (digital examination) of the prostate gland as well as various instrumental diagnostic methods.
Palpation of the prostate (digital rectal examination of the prostate).
Palpation of the prostate allows you to determine the size, consistency, tenderness, and the prostate (in the presence of chronic inflammation of the prostate).
Ultrasound. With the help of ultrasound determine the level of enlarged prostate. I appreciate the direction of the growth nodes of the presence of calcifications. Ultrasound also allows us to estimate the size of the kidney, the presence in them of the various changes, concomitant urological diseases.
TRUST – transrectal ultrasound. This test allows us to study the structure of the prostate, the exact dimensions, as well as to identify signs of chronic prostatitis, and prostate cancer. Transrectal ultrasound examination allows to determine the development of BPH in the very early stages.
Often in patients with very severe hypertrophy of the prostate gland, determine the foci of calcification. The presence in the Central zone of the prostate calcification he says, the end (5) stages of the development of the disease.
Uroflowmetry is a method that can measure the various characteristics of the urine stream. This method must be performed no less than 2 times in terms of bladder filling (150-350 ml) in the case of a natural urge to urinate. The results of evaluation for the purpose of using Uroflowmetry curve, which indicates that the maximum urine flow rate. Flow rate exceeding 15 ml/sec is considered normal. Also evaluate the total time of urination. The norm for volume of urine in a 100 ml – 10 seconds 400 ml of 23 seconds.
Studies have shown that a dependence of the indicators of urination of age. The norm is that the flow rate is reduced, 2 million meters/second every 10 years. This reduction in speed is due to the aging of the bladder wall.
The determination of the residual urine after urination, it is very important to determine the stage of the disease, to determine indications for surgical treatment. Residual urine is determined by ultrasound immediately after voiding. Recently Uroflowmetry coupled with determination of residual urine.
Cystomanometry is a method through which determines the pressure in the bladder. This method allows the measurement of intravesical pressure, different stages of bladder filling and during voiding.
A healthy person starting the urge to urinate occurs when the bladder 100-150 ml of urine, the pressure is equal to 7-10 cm water column. When the bladder volume is filled with 250-350 ml, the urge to urinate increase significantly. In this case, the normal intravesical pressure is 20-35 cm water column. This reaction is called the norm of the bladder reflex.
Increased intravesical pressure (up to 30 inches of water column), the bubble volume of 100-150 ml talking hyper reflexivity (increased reflex of the detrusor). In contrast, the low pressure (10-15 cm water column) when filling the bladder 600-800 ml talks about Hypo-a reflection of the detrusor. Reflexogenic detrusor allows you to appreciate the backup function, the relationship of volume, pressure characteristics of the elastic properties of the detrusor.
Cystography is a method of examination of the bladder using contrast. There are decreasing or increasing cystography. Descending cystography involves the movement of contrast from the top down. This method allows to determine the filling defect in the neck of the bladder. The picture shows that the filling defect is visible as a bump. Rising cystography allows to determine the deformation of the urethra, the prostate area.
Computed tomography, nuclear magnetic resonance imaging , these tests provide more detailed information (correlation with neighbouring authorities) BPH.
Treatment of BPH
- Blockers alpha-adrenergic receptors. These drugs reduce the sound of smooth muscle structures of the neck, of the bladder, prostate, which results in reduction of urethral resistance during voiding. These drugs should be used long-term, more than 6 months. The therapeutic effect occurs after 2-4 weeks of using these drugs.
Treatment herbal medicines are used in people since ancient times. Recently, these drugs are very popular in Europe, in Japan, in the USA.
One of the French preparations the fruit of the American dwarf palm, which has a inhibitory effect on 5-alpha-reductase. The local also anti-proliferative and anti-inflammatory effect.
Studies have proven that the prolonged use of the drug (within 5 years), a significant leads to a decrease in the prostate volume, residual urine volume and relieve symptoms. The device is characterized with good endurance, no side effects.
Another drug, the fruit of the Sabal palm, anti-inflammatory, anti-exudative (to prevent the accumulation of abnormal fluid), anti-androgenic activity (by inhibiting the 5-alpha-reductase). The drug does not affect the level of sex hormones does not alter blood pressure, does not affect the sexual function. Treatment with herbal medicines is carried out in the prostatic hyperplasia of the first and second degrees.
Of BPH surgical treatment
Surgical treatment can be performed in an emergency or in a planned manner. Elective surgery is carried out only after a full examination of the patient.
The prevention of prostate adenoma
- Daily mobility practice (but without undue stress). Physical activity reduces the risk of development of congestive processes in the pool.
- A healthy diet, which involves exclusion from the diet, sour, salty, spicy, smoked products. Obligatory presence of the diet, fruits, vegetables, and vitamins, all of the groups.
- The fight overweight (improves metabolism in all organism).
- To exclude the wearing of hard in the groin area, things: underwear, trousers.
- That ruled out casual sex as a means of prevention of genital infections.
There is a malignant adenoma of the prostate?
Prostate adenoma – a benign tumor, by definition. Not invade surrounding tissue no metastases.
However, with the passage of time, BPH can become malignant. Develop prostate cancer. Usually the "first bell" signs of malignant tumors of the increased blood level of prostate specific antigen. Finally, to help confirm the diagnosis a biopsy.
The prostate cancer, in contrast to adenomas, which are able to germinate in the surrounding tissue, to metastasize. Successful treatment depends greatly on how early it started.