Adenoma of the prostate — a benign tumor that develops from the stroma or the epithelium glandular prostate. By itself, the adenoma does not spread, but it is possible that with time degenerate into adenocarcinoma (prostate cancer).
Many experts, speaking of the BPH, we prefer to use the term "benign prostatic hyperplasia", highlighting as well its growth in the context of significant dishormonal nature of what is happening in the gland of the prostate changes.
The reasons for the development of BPH
The precise answers to the question, why is developing BPH, today don't give you any, one of the experts studying this disease. The fact that the hyperplasia of the gland occurs in men as violent, and the low sexual activity, smokers and nonsmokers, drinkers of alcohol and nondrinkers.
However, it is observed that the age and the 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 men castrated, 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 the cells of the prostate between them, changing its sensitivity to the effects of hormones, etc.
The stage of the disease according to the symptoms
Modern medicine distinguishes 4 phases in the development of benign prostatic hyperplasia.
First stage: compensated form
Slowly growing, the prostate begins to squeeze the urethra, which directly affects the nature of urination: urine starts to differentiate itself with some difficulty and languid stream.
Second stage: repetition of infractions
In this stage the bladder is not completely emptied already, and the amount of urine remaining after urination, get 1-2 cups.
The characteristic symptoms of this stage:
- the increase in the volume of the bladder
- the need to push during urination,
- stream of urine secreted in bursts, in waves,
- due to the presence of periods of rest, when the urine is not released, the entire act of urination takes several minutes.
Third stage: decompensation
Gradually, the body loses the capacity to resist the massive amount of urine that constantly remains due to the increase of the BPH. The bladder is distended, so that almost no shrinking and is not helping to expel the urine, even of the effort during the act of urination difficult to help.
Fourth phase: terminal
As the progression of the pathological process arising not compatible with the life phenomena of renal insufficiency: there is a strong violation vodno-elektrolitnogo balance, the increase in the content of nitrogen in the blood, and people die of uremia.
The complications of benign prostatic hyperplasia
Even in the initial stages, when the hyperplasia of prostate is still relatively small and insignificant violation of urination, sometimes can be acute retention, urinary or a sample of blood in the urine (hematuria). In the future, BPH can be complicated by stone formation or adherence of the infection of the urinary organs. Consider some of the types of complications in more detail.
Acute retention urinary
Acute retention urinary is a condition when it is absolutely impossible to urinate with a full bladder. Most often found on the second and third phases of the disease.
The stones in the bladder
Format in the phase 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 production through the narrow lumen of the urethra.
Symptoms of having stone in the bladder:
- frequent need to urinate,
- pain in the penis head, aggravated by movement, walking, and disappears in a horizontal position,
- periodic appearance of the symptom "to the flow of the urine".
- epididymoorchitis, etc.
Often, the development of the infection contribute to the congestion in the bladder, and catheterization.
The development of renal failure
Typical of the third and terminal stage of development of the adenoma and is associated with a decreased production of urine by the kidneys.
1. Stage hidden manifestations: periodic dryness of the mouth, weakness, with the testing — sometimes a small violation of the blood electrolytes.
2. The compensation scenario: an increase in the frequency of urination, changes in blood tests (increase in urea, creatinine).
3. Phase of decompensation:
- dryness of the mouth,
- loss of appetite,
- General weakness,
- reduce the immunity, which is manifested in a more severe course of ordinary colds,
- tremor of the fingers,
- twitching muscle,
- pain in bones and joints,
- dry skin,
- bad breath,
- in the blood — increase of urea, creatinine.
Stress, irregular diet, excessive physical exertion worsen the symptoms of kidney failure.
4. The end of the stage:
- sleep in the night,
- inappropriate behavior,
- emotional lability,
- the smell of the urine of the patient,
- belly distended,
- the temperature decreases (hypothermia),
- skin itching,
- gray-yellow color of the skin and the face,
- foul smelling stools
- changes in almost all the internal organs and the nervous system due to the phenomenon of uremic poisoning.
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.
In addition to the external inspection of the genital organs should include examination of the prostate through the rectum.
Methods of laboratory
Usually designated by: urinalysis, renal tests, blood test for determination of antigen and study a histological tissue of the adenoma (if necessary).
Most often for the diagnosis of BPH by means of the following methods:
2. X-ray methods.
Treatment of benign prostatic hyperplasia
There is currently no method of treatment of hyperplasia of prostate, because in each case, it is necessary to consider many factors, for example:
- the General condition and age of the patient,
- their consent to the operation,
- the stage of adenoma,
- the degree of impairment of urodynamics,
- there are signs of prostate cancer,
- the possibility of a hospital.
In General, adenoma of the prostate may be treated as conservative and efficient. The choice of treatment depends on the stage of development of the adenoma:
- In the first stage. Normally, at this stage, the hyperplasia prostatic is treated by a conservator: appointed drugs, the recommendations for the treatment and style of life to bring a lifestyle physically active, avoid eating spices and other irritating foods, smoked meats, eliminate alcohol, coffee. If you have problems of urination can be recommended transurethral electrical resection.
- In the second stage. The gold standard of the assistance in this stage — the removal of the adenoma with surgery using different minimally invasive and classic techniques.
- In the third stage. Here the main task is to ensure a good drainage of the urine to remove the toxicity. In this case, the use of puncture nephrostomy, cystostomy, etc normalize the condition of the liver, kidneys, cardiovascular system, and then decide on the possible subsequent surgical treatment.
Drugs used to treat adenoma does not lead to its complete disappearance. Must be applied permanently, regularly, in the contrary case, 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 the easing of the pressure on the urethra and ease the flow of urine to the outside. This is an alpha-adrenergic blocking agents long-term (sustained) and short action.
2. Drugs that block the conversion of testosterone to its active form, and thus to reduce the volume of the prostate (inhibitors of 5-alpha-reductase).
3. Herbal remedies. Currently, herbal preparations because of the low efficiency and the lack of demonstrated 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 that are assigned to the plant assets. It is believed that have anti-inflammatory effect, reduce edema, inhibit the conversion of testosterone to its active form and stops the growth of adenoma.
4. The combination of funds. Currently, the "gold standard" is a co-medication of the first two groups of 3-4 years. This allows almost immediately to improve the urination and after a few years by a quarter to reduce the volume of the prostate.
Carried out in parallel treatment of opportunistic infections — cystitis, prostatitis, pyelonephritis, urethritis.
Are radical methods of treatment of benign prostatic hyperplasia and are widely used in urology. These include:
1. Open adenomectomy. Can be interpreted in several ways, the most famous of which is adenomectomy. Through a conventional surgical incision allows access to the gland of the prostate and made his removal. Normally, it is used in case of impossibility of use of less traumatic methods.
2. Endoscopic surgery. 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 the tissue of the prostate;
- transurethral electro-vaporization — all access to the prostate through the urethra is provided, and then use the current fabric is heated to high temperature and evaporation, and the small blood vessels form a network structure;
- transurethral incision in the area of prostatic Department of the urethra to make the cut, so that the light 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 make sure that the main artery of the prostate is sealed with a special polymer, facilitating the access through the femoral artery.
4. Cystotomy. It is used as an intermediate stage of treatment in order to relieve the organs of the urinary system of excessive amounts of the accumulation of urine urgently, and remove the toxicity.
Although the surgical treatment is the best and, often, the only method of successful treatment, there are a number of complications, such as:
- urinary incontinence,
- the formation of adhesions to the ureter or merger,
- frequent need to urinate,
- the preservation of a significant amount of urine residual volume
- reflux of semen in the bladder
- impotence, etc.
The most famous among them:
- Balloon dilation of the prostate (expands the narrow of the area with a balloon).
- Stenting of the urethra (at the level of the narrowing 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 gland with ultrasound of high frequency.
- Transurethral needle ablation in the prostate needle set small, and in addition, influence of radio waves to heat and destroy prostate tissue.
- Destruction of tissue of prostate with an laser.
All of these methods occupy a position intermediate between the medical and surgical treatment and are used to relatively quick recovery of urination and with less side effects and better tolerability.
To all those who suffer from BPH, it is recommended to regularly perform special exercises that improve the blood circulation of organs pelvic, avoiding the stagnation of blood, for example, "walking on the buttocks" in a few minutes.
It is also necessary to normalize your weight and your daily diet to introduce foods rich in zinc and selenium — sardines, salmon, herring, pumpkin seeds, buckwheat and oatmeal, olive oil, thyme and parsnips.