Prostate adenoma — a benign tumor develops in the stroma or the glandular epithelium of the prostate. In itself, the adenoma is not widespread, but it may be that, in time, degenerate into adenocarcinoma (prostate cancer).
Many experts speak of BPH, prefer to use the term "benign prostatic hyperplasia", stressing that the increase in the background of a significant dishormonal nature of what is happening in the prostate changes.
The reasons for the development of BPH
The exact answer to the question, why is it that the developing BPH, today does not give any of the experts studying this disease. The fact that hyperplasia of the gland occurs in men as violent, low sexual activity, smokers and nonsmokers, alcohol drinkers, and nondrinkers.
However, it can be seen that the age and level of the male hormones very much affect the incidence of adenomas. Even the development of hyperplasia contribute to hereditary factors, and sedentary lifestyle (note the 60% of cases the adenoma). The study also showed that the BPH does not develop in castrated men, therefore, castration at a time is proposed methods of treatment of BPH.
Many experts believe that the direct cause to the development of BPH should be sought in the complex interaction of cells of the prostate gland between each other, changing the sensitivity to the effects the 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 in the form
Gradually increasing, the prostate begins to squeeze the urethra, which directly affects the nature of the urination: urine starts to stand out is difficult, languid stream.
Second stage: repeated violations of
At this stage, the bladder is not completely emptied, the amount of urine left after urination, reach 1-2 glasses.
The characteristic symptoms of this stage:
- the increase in the volume of the bladder
- the need to stand during urination,
- stream of the urine is secreted in the series, the waves,
- due to the presence of other periods, when the urine is not allowed to the whole law of urination for a few minutes.
Third stage: decompensation
Gradually the body loses the ability to resist the huge amount of urine that constantly remains because of the increased BPH. The bladder is distended, that it almost does not shrink, will not help remove the urine, even straining during the act of urination is hardly helping.
Fourth stage: the terminal
As the progression of the pathological process in not compatible with life's phenomena, renal insufficiency: there is a sharp violation of vodno-elektrolitnogo balance, the increase in the content of nitrogen in the blood people die from uremia.
The complications of benign prostatic hyperplasia
Even in the initial stage, when the prostate is still relatively small, minor violations of urination, occasionally it may be acute urinary retention, or to show blood in urine (hematuria). In the future, BPH can be complicated the stone formation of, or accession to, the infection of the urinary organs. Consider some of the types of complications detailed.
Acute urinary retention
Acute urinary retention is a condition, which it is absolutely impossible to urinate with a full bladder. The most commonly found, the second and third stages of the disease.
Formed on the stage of development of the adenoma, when the bladder begins to be quite a large amount of urine. Another way is that migration of kidney stones in the ureter, the impossibility of the output of the narrowed lumen of the urethra.
Symptoms, which stone in the bladder:
- frequent urination,
- pain in the penis head, aggravated by movement, walking, and disappear in the horizontal position,
- periodic appearance of the symptoms "of the stream of urine".
These are the following:
- epididymo orchitis, etc.
Often the development of infection contribute to the congestion of the bladder, catheterization.
The development of renal failure
Characteristic of the third, final stage of development of the adenoma, is associated with decreased production of the urine by the kidneys.
1. Stage hidden manifestations: periodic dry mouth, weakness, the test — sometimes a small violation of the blood electrolyte.
2. The compensation section: more frequent urination, changes in blood tests (increase in urea, creatinine).
3. Stage of decompensation:
- dry mouth,
- loss of appetite,
- General weakness,
- reduced immunity, which manifests itself in the more severe of course, the common cold,
- tremor of the fingers,
- muscle twitching,
- pain in bones, joints,
- dry skin,
- bad breath,
- the blood increase of urea, creatinine.
Stress, irregular nutrition, excessive physical exertion can exacerbate the symptoms of renal failure.
- sleep at night,
- inappropriate behavior,
- emotional lability,
- the smell that the urine of the patient,
- abdomen distended,
- the temperature decrease (hypothermia),
- skin, itching,
- gray-yellow color of the skin face
- smelly stool
- it changes almost all the internal organs, the nervous system of the phenomena of uraemic intoxication.
Diagnosis of BPH
A comprehensive diagnosis of adenoma based on the survey data of the patient, a urological examination, and a number of additional laboratory and instrumental methods of examination.
In addition to the external inspection of the genitalia should include examination of the prostate through the rectum.
Usually marked out: urine test, kidney test, test definition of antigen and the histological examination of the tissues of the adenoma (if necessary).
Most often the diagnosis of BPH the following methods:
2. X-ray methods.
Treatment of benign prostatic hyperplasia
There is currently no single method of treatment, prostatic hyperplasia, because in all cases it is necessary that a number of factors, for example:
- the general condition, age of the patient,
- the contribution to the operation,
- the stage of the adenoma,
- the extent of the damage, urodynamics,
- are there any signs for prostate cancer,
- the possibility of a hospital.
Usually the prostate adenoma can be treated as a conservative, effectively. The choice of treatment depends on the stage of development of the adenoma:
- In the first stage. Usually at this stage, the prostatic hyperplasia treated the conservative: the selected drugs, recommendations for treatment, lifestyle leads to a physically active lifestyle, avoid eating spicy and other irritating foods, smoked meats, eliminate alcohol, coffee. If difficult urination is also recommended transurethral electric resection.
- In the second section. The gold standard for the help in this section — removal of the adenoma, the surgery using different minimally invasive classical techniques.
- In the third section. Here the main task is to ensure good drainage of urine to remove the toxicity. In this case, use puncture nephrostomy, cystostomy, etc to normalize the condition of the liver, kidney, circulatory system, and then decide on the possible further surgical treatment.
Drugs used to treat adenoma does not lead to the complete disappearance. It should be applied continuously, periodically, or the adenoma begins to progress. In general, the medication of the following groups:
1. Drugs relaxing smooth muscle tone in the neck of the bladder, prostate, which relieves pressure on the urethra, and light the urine flow to the outside world. This is a alpha-adrenergic-blocking agents, long-term (permanent) and short-acting.
2. The medications that block the conversion of testosterone to the active form and thereby reduce the volume of the prostate (blockers 5-alpha-reductase).
3. Herb. Currently, herbal products, low efficiency and lack of proven clinical advantage, that many of the developed European countries and the United States, the treatment of the adenoma is not used. However, in many countries you are assigned to plant devices. They believe that the anti-inflammatory effect, reduces oedema, inhibits the conversion of testosterone to the active form, stops the growth of adenoma.
4. The combined funds. Currently, the "gold standard" co-medication of the first two groups 3-4 years. This allows you to almost instantly improve urination after a few years a quarter, to reduce the volume of the prostate.
Carried out in parallel treatment of opportunistic diseases, cystitis, prostatitis, pyelonephritis, urethritis.
Radical methods of treatment of benign prostatic hyperplasia, as well as widely used in urology. These are the following:
1. Open adenomectomy. This can be done in various ways, among which the most well-known of the adenomectomy. Through a traditional surgical incision allows access to the prostate is made for its removal. Usually used in cases, it's impossible to use less traumatic methods.
2. Endoscopic surgeries. All of them carried out with special surgical instruments, which are entered directly into the urethra under control of the video. These are the following:
- transurethral resection of the prostate (TURP), which is the "gold standard" for the surgical treatment of the adenoma — during the implementation of the urethra through a special device incision, and then cut the prostate tissue;
- transurethral electro-vaporization — access to the prostate through the urethra is provided, then use the current material is heated to a high temperature and then simmer, small blood vessels form a network structure;
- transurethral incision in the area of the prostatic Department of the urethra to the incision, 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 by vascular surgery, as well as to ensure that the artery to the prostate is sealed with a special polymer, which is access through the femoral artery.
4. Cystotomy. Used as an intermediate stage of treatment in order to relieve the organs of the urinary system an excessive amount of accumulated urine urgently remove toxicity.
Although the surgical treatment is the best, often the only method of successful treatment for many complications, including:
- urinary incontinence,
- the adhesions with the formation of the ureter or fusion,
- frequent urination,
- the preservation of a significant amount of residual urine volume
- reflux of the semen bladder
- impotence, etc.
The most famous of these:
- Balloon dilatation of the prostate (expands the narrowed area with a balloon).
- Stenting of the urethra (the area of the reducer is inserted sufficiently elastic element, which prevents the narrowing of the urethra).
- Evaporation of the prostate by microwave — microwave coagulation.
- Cryosurgery (freezing the prostate tissue and subsequent necrosis).
- The evaporation of the tissues giperplazirovannah the thyroid-ultrasound high frequency.
- Transurethral needle ablation of the prostate needle set small, also affects the radio waves that heat and destroy prostate tissue.
- Destruction of prostate tissue, the laser.
These methods occupy an intermediate position between the medical and surgical treatment and are used to relatively quick recovery urination fewer side effect, better stamina.
Everyone who suffers from BPH, it is recommended to regularly perform special exercises to improve your blood circulation in the pelvic organs, preventing stagnation of the blood, for example, "walking on the buttocks" in a few minutes.
It is also necessary to normalize the weight and the daily diet is to introduce foods rich in zinc, selenium, sardines, salmon, herring, pumpkin seeds, buckwheat, oatmeal, olive oil, celery, parsley.