What is prostate adenoma in men and how can it be cured. Prostate adenoma in men, modern and traditional methods of treatment Prostatic hyperplasia - diagnosis

BPH(benign prostatic hyperplasia,) is a benign proliferation of gland tissues, an increase in its volume. The overgrown gland compresses the urethra passing through it, causing urination disorders - this is the main symptom of the disease.

Benign prostatic hyperplasia is detected in 20% of men aged 40, 70% - 60 years, 90% - 80 years. The main reason for the development of BPH is a change hormonal background men (decrease with age in testosterone levels).

Possible complications of BPH

• Attachment of inflammation
• stone formation
• Formation of diverticula (protrusions of the bladder wall)
• Acute urinary retention
• Development of kidney failure

A study of patients with prostate cancer showed that in 80% of cases the development of a malignant process occurred against the background of a long-term benign hyperplasia prostate.

Diagnosis of BPH

The diagnosis of BPH is established urologist based on complaints, anamnesis, medical urological examination of the patient and the results of the examination. Accurate information about the frequency of urination and its volume during the day (with time indication) is important.

Signs of prostate hyperplasia

• Difficulty urinating, sluggish urine stream
• The need to make an effort to start urination
• Feeling of incomplete emptying of the bladder, forcing the man to repeatedly return to the toilet
• Frequent, persistent urge to urinate, including at night

Analyzes and research

General clinical blood and urine tests

Biochemical blood test (urea, creatinine)– exclusion/assessment of renal failure

Determination of the level of prostate-specific antigen (PSA) in the blood (a marker of inflammation and prostate cancer). PSA in benign prostatic hyperplasia is examined regularly. The level and rate of increase of PSA matters.

Biopsy of the prostate(at elevated PSA) to rule out/confirm prostate cancer

Uroflowmetry(measurement of urine flow rate). Double when detecting deviations.

Ultrasonography(ultrasound) of the kidneys and urinary system, prostate gland- transabdominal and transrectal (TRUS), including the study of the volume of residual urine. Allows you to identify / exclude urolithiasis, expansion of the pyelocaliceal apparatus, tumors of the urinary system, diverticula of the bladder, assess the size and shape of the prostate gland.

Echosigns of BPH (detected by ultrasound)

• An increase in the volume of the prostate up to 20 cm3 or more.
• The heterogeneous structure of the prostate gland, the presence of seals (scars), stones - calcifications (traces of inflammation), nodular formations.
• The volume of residual urine more than 50 ml is regarded as pathological.

Survey urography, excretory, retrograde urography- X-ray examination of the urinary system - kidneys, ureters, bladder, urethra, including the use of X-ray contrast agent. Evaluation of the function, structure of the urinary system, the position of the kidneys, etc.

Stages of BPH

BPH 1 - stage of compensation- the prostate gland is 30 or more cm 3 in volume, symptoms from the bladder are absent or minimally expressed. Due to a slight compression of the urethra, the detrusor muscle in the wall of the bladder is hypertrophied, but completely copes with its emptying.

BPH 2 - stage of subcompensation- the prostate enlarges, the pressure of the urethra increases, the muscular wall of the bladder ceases to cope with the complete expulsion of urine, its hypertrophy is replaced by hypotrophy, thinning. Incomplete urination - >80 ml of residual urine remains in the bladder. Difficulty in diverting urine causes its stagnation and expansion of the higher departments - the ureters, calyces and renal pelvis. Gradually, kidney failure develops.

BPH 3 - stage of decompensation - the inability to empty the overfilled bladder, since its stretched detrusor muscle is no longer able to contract. At the same time, there is a drip of urine. It is spontaneously squeezed out drop by drop from the bladder into the urethra due to the constant flow from the kidneys. There is a real threat of acute urinary retention - the impossibility of emptying the bladder with an irresistible desire to urinate. This situation requires emergency surgical care.

Treatment of BPH

conservative

• improving urine flow by relaxing the bladder neck, urethra,
• reduction in the size of the gland
• improvement of the detrusor muscle of the bladder.

Combined pharmacotherapy is used, which is selected individually and adjusted in the course of treatment by a urologist observing the patient.

Surgical

With inefficiency conservative therapy, progression of BPH, severe urinary disorders, an increase in the volume of residual urine, the development of complications (stone formation, hematuria - erythrocytes in the urine, renal failure, etc.) requires surgery.

Practices at the Clinical Hospital on the Yauza modern method surgical - endoscopic laser vaporization, in which access to the prostate gland is carried out through the urethra, and excess gland tissue is evaporated by a laser.

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Prostate adenoma is insidious in that the tumor can grow unnoticed for a person for a long time, sometimes 10 years, slowly worsening the quality of life, in particular, making it difficult to urinate. Shame, laziness, lack of knowledge or simply a frivolous attitude to the gradual deterioration in the process of urination lead to the fact that a man postpones the diagnosis and treatment of prostate adenoma for a long time. As a result, the likelihood be on the operating table, or become disabled, and in the absence of the possibility of obtaining an ambulance medical care, even die as a result of acute urinary retention.

biophysicist, full member of the Academy of Medical and Technical Sciences Fedorov V.A.

prostate adenoma is benign a tumor of the prostate gland or scientifically - benign prostatic hyperplasia (abbreviated as BPH). The disease begins to be detected in 20% of men under 40, at the age of 50-60 years - in 40%, at the age of 61-70 - in 70% of men, and after 70 years - in 80% (Berry, 1994).

It is necessary to immediately clarify that benign tumor the prostate gland cannot degenerate into a malignant, that is, into cancer, as they grow from different parts of the prostate gland. Adenoma is the growth of small periurethral (submucosal) glands of the central zone surrounding the urethra, and prostate cancer develops from large glands located on the periphery, away from the center.

Symptoms of urinary incontinence

Although the disease is called "benign", it manifests itself as a significant deterioration in the quality of life:

• there is a need to urinate at night, and more than once, which leads to sleep disturbance and general overwork;
• increased daytime urination (normal frequency no more than every 2 hours during the day);
• there is no feeling of complete emptying of the bladder;
• difficulty urinating: you need to make extra efforts, urinate in several doses;
• sharp and uncontrollable urge to urinate.

Difficulties in urination are caused by the fact that the tumor, and to a greater extent severe swelling developing in the prostate (especially with 1 and 2 degrees of BPH), compress the urethra. At the same time, efforts to “push out” urine are not enough to completely empty the bladder. Due to residual urine in the bladder, there are repeated frequent urges to empty. This explains the increased frequency of urination, both day and night. Pain when urinating not typical.

The brightness of the manifestation of the above symptoms does not depend on the size of the tumor itself (it can be large, and the quality of life does not decrease significantly). This is often related to the direction of tumor growth. In this regard, it is very important for men after 40 to regularly visit a urologist, especially with changes in the process of urination and carry out preventive measures(For example, ). In the early stages of BPH, there is still a high probability of a positive result from conservative treatment. without surgery.

There are 3 stages of BPH:

	Symptoms and signs
Stage 1 (compensated)	The tone of the muscles of the bladder is still sufficient to push the urine through the narrowed channel, but you have to make an effort. There is no residual urine. Patients may notice: the act of urination does not begin immediately; the volume of urine excreted at a time decreases; weakening of the pressure of the urine stream, increased frequency of urges during the day, including sudden (imperative); increased urge at night (nocturia), first 1 time per night, then 2-3 times and more often. This stage can be quite long: 10 years or more and depends on the initial state of the organism.
(subcompensated)	At this stage: residual urine is detected (there is no feeling of complete emptying of the bladder); the muscle tone of the bladder is weakened, but it still allows urine to be pushed through the narrowed channel, while significant tension in the muscles of the abdomen and diaphragm is required; urination is intermittent, carried out in several stages with periods of rest; patients do not feel complete emptying of the bladder at the end of the process; the first signs associated with impaired kidney function appear (thirst, feeling of dryness and bitterness in the mouth).
(decompensated)	The resources of the muscular wall of the bladder are completely depleted, the bladder looks like a stretched bag of urine, which is squeezed out only drop by drop. At this stage, such dangerous complications as chronic renal failure, urolithiasis, etc. are almost inevitably detected. There is a high probability of acute urinary retention. In the absence of medical care, the patient may die.

An international classification is also used with an assessment according to the IPSS* scale:

1. Minor stage - 0-7 points.

2. Moderate stage - 8-19 points.

3. Expressed stage - 20-35 points.

*IPSS (International Prostate Symptom Score) - an international system for the total assessment of prostate diseases ().

You can send the completed application form to the address to receive advice on the possibility of using a non-surgical method for the treatment of prostate adenoma and the selection of an apparatus in your case.

An important condition for the effective treatment of prostate adenoma

Under effective and gentle treatment prostate adenoma refers to the removal of edema in the tumor area, slowing down and stopping the growth of the tumor, as a result of which urination is restored and the quality of life improves.

Reducing the frequency of urination and strengthening the jet is achieved primarily due to edema removal in this area. If the problem of urination was caused only by a tumor, then no drug therapy and physiotherapy () would ever improve urination without surgery. However treatment without surgery is possible!

Edema is usually the body's reaction to an excess of dead cells in that area. Obviously, dead cells begin to accumulate for 2 main reasons:

1. The nutrition and protection of each cell deteriorates, they begin to die faster. With age, there are often problems with the blood supply to the pelvic organs, there is a hormonal imbalance (less and less hormones are produced that are necessary to maintain health and youth).
2. The body does not have time to remove dead cells in a timely manner. Dead cells are excreted through the lymphatic vessels, however available resources lymphatic system not enough in order to utilize the increased number of dead cells and completely cleanse the tissues.

In addition, the remnants of dead cells (especially their protein components) are the "building material" for tumor growth. One of the reasons for the development of edema is an attempt by the body to prevent the growth of tumor tissue, but thereby the edema also leads to clamping of the urethra (“”. Vasiliev A.E., Kovelenov A.Yu., Ryabchuk F.N., Fedorov V.A. , 2004).

Conclusion: an important condition for the successful treatment of adenoma - increased lymph flow(lymphatic drainage), which would cleanse the tissues of excess dead cells. This solves two problems at the same time: removal of edema in the prostate gland, slowing down and cessation of tumor growth.

Treatment of prostate adenoma without surgery

Currently, conservative (non-surgical) treatment of prostate adenoma is provided by medicine in 2 ways, as well as their combination.

1. Drug therapy

Medical treatment consists in taking:

The failure rate of drug therapy reaches 30%, and the effectiveness, respectively, is 70%.

The mechanism of action of drugs from each group is different: alpha-1-blockers help facilitate the process of urination, and 5-alpha reductase inhibitors help to inhibit the tumor growth process. The course of treatment lasts at least 6 months, usually a year or more, to get a pronounced effect. After some time, the symptoms of the disease may reappear, and then there is the need for a second course of treatment: this situation may persist until the end of the patient's life.

Possible individual intolerance to the components that make up the drugs. When accepting these funds, it is possible side effects, which is also associated both with the specifics of the mechanism of action of drugs, and with the characteristics of a particular organism. Medications, in their essence, forcibly change the body's priorities, leading to an additional burden on the liver, kidneys, circulatory system, digestive system etc.

As indicated in Russian clinical guidelines with moderate and severe symptoms of BPH (impaired urination), drugs are prescribed simultaneously from both groups. In this case, the minimum treatment budget for a year can be about 15,600 rubles.

2. Vibroacoustic therapy (phonation)

This physiotherapy treatment has no side effects can afford avoid surgery and improve the patient's condition without drugs.

Phonation can also be used in combination with drug therapy. Sound microvibration improves the transport and metabolic processes in tissues, and thereby facilitates the delivery of the drug to the right place, that is, increases the effectiveness of drug therapy.

However, in accordance with long-term observations, the use of only The Vitafon device is usually enough to significantly improve the quality of life and relieve swelling.

When conservative treatment (or drug therapy) fails, surgery remains if general state the health of the patient allows for the operation. Sometimes in elderly people, surgical treatment is not possible due to the presence of severe comorbidities, repeated myocardial infarctions, heart failure, strokes, etc. In this case, as indicated in, it is indicated. This type of physiotherapy, in any case, will create conditions so that the process of urination does not worsen further.

The operation is indicated in the following cases:

• Prostate adenoma in stage 3, when the patient is unable to urinate on his own due to atony (weakened and stretched bladder muscles).
• Patients with a pronounced decrease in the quality of life (regardless of the size of the tumor), assessed on the IPSS scale - 20–35 points.
• Patients in whom the first manifestation of the disease was acute urinary retention in 60% of cases are forced to operate within a year after the detection of BPH.

At the moment, preference is given to this type of operation as transurethral resection(TUR) when a special device is inserted through the urethra resectoscope and the tumor is removed without incision of the bladder. Another type of surgery without an incision in the bladder is laser vaporization when a special device is inserted into the urethra and the laser “evaporates” the tumor in layers. Both with TUR and with laser vaporization, there is a risk that some part of the tumor will not be removed: in this case, a recurrence is possible and then a second operation may be prescribed.

For large tumors, adenectomy(cavitary operation), when an incision is made on the anterior abdominal wall (or access is through the perineum), the bladder is opened and the tumor is removed.

Despite the fact that during the operation the tumor itself is removed, the quality of life of the patient may remain unsatisfactory. Often retained frequent urination, incontinence, presence of residual urine(according to statistics in 10% of patients), and complications and consequences may also occur:

• bleeding;
• joining the infection;
• impossibility of independent urination and lifelong use of a catheter;
• retrograde ejaculation (sperm is thrown into the bladder during intercourse)
• impotence;
• sclerosis of the neck of the bladder;
• narrowing of the lumen of the urethra (stricture).

In order to speed up the healing process and reduce the risk of postoperative complications, it is recommended to perform phonation both at the stage of preparation for the operation and at the stage of rehabilitation. As shown, the use of phonation with the Vitafon device after TUR allows reduce the frequency of urination, completely get rid of residual urine, reduce the size of the prostate gland by removing postoperative edema. Phonation was originally used in traumatology and treatment postoperative sutures and has shown to be highly effective in accelerating healing.

Phoning in this case is carried out according to. The catheter is not an obstacle for phonation.

Thus, the operation must be carried out strictly according to the doctor's indications. If there are no clear indications for surgery, microvibration makes sense, similar to biological microvibrations. For more than 25 years of use, more than 2 million people have not had a single case of a negative side effect.

On the contrary, the expansion of the list of diseases that can be successfully treated with the help of Vitafon devices occurred precisely due to the identification of side effects. positive effects:

The effectiveness of the treatment of these diseases is confirmed, which For more than 25 years, there are already over 100.

In addition to research, there is also medical practice, which also confirms the high efficiency of the new method of physiotherapy, as evidenced by

Prostate hyperplasia (prostate adenoma) is a common urological disease in which prostate cell elements proliferate, which causes compression of the urethra and, as a result, urination disorders. The neoplasm develops from the stromal component or from the glandular epithelium.

Source: radical.ru

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men over 50 years old have symptoms of prostatic hyperplasia, at 65 years old the disease is found in 50% of males, and at an older age - in about 85% of men.

With timely, properly selected treatment, the prognosis is favorable.

Diagnostics

Diagnosis of prostatic hyperplasia is based on the collection of complaints and anamnesis (including family history), examination of the patient, as well as a number of instrumental and laboratory studies.

During the urological examination, the condition of the external genital organs is assessed. Finger examination allows you to determine the condition of the prostate gland: its contour, soreness, the presence of a groove between the lobes of the prostate gland (normally present), areas of compaction.

A general and biochemical blood test is prescribed (the content of electrolytes, urea, creatinine is determined), a general urine test (the presence of leukocytes, erythrocytes, protein, microorganisms, glucose). Determine the concentration in the blood of prostate-specific antigen (PSA), the content of which increases with prostatic hyperplasia. It may be necessary to conduct a bacteriological culture of urine in order to exclude an infectious pathology.

The main instrumental methods are:

• transrectal ultrasound examination (determination of the size of the prostate gland, bladder, degree of hydronephrosis, if any);
• urofluometry (determination of the volumetric velocity of urination);
• review and excretory urography; and etc.

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men over 50 have symptoms of prostatic hyperplasia.

If necessary, differential diagnosis with bladder cancer or urolithiasis resort to cystoscopy. This method is also indicated in the presence of a history of sexually transmitted diseases, prolonged catheterization, and injuries.

Treatment of prostatic hyperplasia

The main goals of the treatment of prostatic hyperplasia are to eliminate urination disorders and prevent further development of the disease, which causes severe complications from the bladder and kidneys.

In some cases, they are limited to dynamic observation of the patient. Dynamic observation implies regular examinations (with an interval of six months to a year) by a doctor without any therapy. Expectant tactics are justified in the absence of pronounced clinical manifestations diseases with no absolute readings for surgical intervention.

Indications for drug therapy:

• the presence of signs of the disease that cause concern to the patient and reduce the quality of his life;
• the presence of risk factors for the progression of the pathological process;
• preparation of the patient for surgical intervention (in order to reduce the risk of postoperative complications).

As part of drug therapy for prostatic hyperplasia, the following can be prescribed:

• selective α 1 -adrenergic blockers (effective in the presence of acute urinary retention, including postoperative genesis, in which it is impossible to empty the overfilled bladder for 6–10 hours after surgery; improve cardiac activity with concomitant coronary heart disease);
• 5-alpha reductase inhibitors (reduce the size of the prostate gland, eliminate macrohematuria);
• preparations based on plant extracts (reducing the severity of symptoms).

In the case of acute urinary retention, a patient with prostatic hyperplasia is shown hospitalization with bladder catheterization.

Androgen replacement therapy is carried out in the presence of laboratory and clinical signs age-related androgen deficiency.

There have been suggestions about the possible malignancy of prostatic hyperplasia (i.e., degeneration into cancer), but they have not been proven.

Absolute indications for surgical treatment prostatic hyperplasia are:

• relapses of acute urinary retention after removal of the catheter;
• lack of a positive effect from conservative therapy;
• the formation of a diverticulum or bladder stones of large sizes;
• chronic infectious processes of the urogenital tract.

Surgery for prostatic hyperplasia is of two types:

• adenomectomy - excision of hyperplastic tissue;
• prostatectomy - resection of the prostate gland.

The operation can be performed using traditional or minimally invasive methods.

Transvesical adenomectomy with access through the wall of the bladder is usually resorted to in the case of intratrigonal growth of the neoplasm. This method is somewhat traumatic compared to minimally invasive interventions, however, with big share probability provides a complete cure.

Transurethral resection of the prostate is characterized by high efficiency and low trauma. This endoscopic method assumes that there is no need to cut healthy tissues when approaching the affected area, makes it possible to achieve reliable control of hemostasis, and can also be performed in elderly and senile patients with concomitant pathology.

Transurethral needle ablation of the prostate gland consists in the introduction of needle electrodes into the hyperplastic tissue of the prostate gland, followed by the destruction of pathological tissues using radiofrequency exposure.

Transurethral vaporization of the prostate is carried out using a roller electrode (electrovaporization) or a laser (laser vaporization). The method consists in evaporation of hyperplastic prostate tissue with its simultaneous drying and coagulation. Also, for the treatment of prostatic hyperplasia, the method of cryodestruction (treatment with liquid nitrogen) can be used.

Embolization of the arteries of the prostate refers to endovascular operations and consists in blocking the arteries that feed the prostate gland with medical polymers, which leads to its reduction. The operation is performed under local anesthesia through the femoral artery.

In order to reduce the risk of developing prostatic hyperplasia, it is recommended to seek medical help at the first sign of urination disorders, as well as annual preventive examinations by a urologist after reaching 40 years of age.

Endoscopic holmium laser enucleation of prostatic hyperplasia is performed using a 60–100 W holmium laser. During the operation, the hyperplastic prostate tissue is husked into the bladder cavity, after which the adenomatous nodes are to be removed by means of an endomorcellator. The effectiveness of this method approaches that of open adenomectomy. The advantages are a lower likelihood of complications compared to other methods and a shorter rehabilitation period.

Possible complications and consequences

Against the background of prostatic hyperplasia, serious pathologies of the urinary tract can develop: urolithiasis, pyelonephritis, cystitis, urethritis, chronic and acute renal failure, bladder diverticula. In addition, orchiepididymitis, prostatitis, bleeding from the prostate gland, erectile dysfunction can become a consequence of neglected hyperplasia. There have been suggestions about possible malignancy (i.e., degeneration into cancer), but they have not been proven.

Forecast

With timely, properly selected treatment, the prognosis is favorable.

Prevention

In order to reduce the risk of developing prostatic hyperplasia, it is recommended:

• upon reaching the age of 40 - annual preventive examinations by a urologist;
• timely seeking medical help at the first sign of urination disorder;
• rejection of bad habits;
• avoidance of hypothermia;
• regular sex life with a regular partner;
• sufficient physical activity.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Main points

• benign hyperplasia prostate (BPH)– noncancerous enlargement of the prostate.
• This disease is believed to be part of the normal aging process.
• 50% of men over 60 have clinically significant BPH.
• Prostate cancer and this disease are not connected in any way.
• Symptoms are not necessarily progressive and may change.
• Medical treatment can be very effective.
• Transurethral resection of the prostate (TURP) remains the "gold standard" in the treatment of benign prostatic hyperplasia.

Description

The prostate is a walnut-shaped gland located just below the bladder and in front of the rectum. It covers on all sides the upper part of the urethra (urethra), which is a tube that starts from the bladder and opens outward.

The prostate produces a portion (±0.5 ml) of seminal fluid containing nutrients. The bladder neck and prostate form a genital sphincter that allows for antegrade ejaculation and eruption of seminal fluid outward, rather than backward, into the bladder.

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate. Its development depends on male hormones: testosterone and dihydrotestosterone. Over time, the disease of varying severity affects all men, even those whose testicles and prostates function normally.

Enlargement of the prostate leads to deformation of the urethra, due to which the flow of urine from the bladder is disturbed, and obstructive or irritant (irritative) symptoms appear.

The size of the prostate does not directly affect the severity of symptoms. Sometimes very large prostate disease is asymptomatic, while small prostate disease is characterized by very severe symptoms.

Clinically significant BPH is present in 50% of men aged 60-69 years. Of this number, ±50% are in need of treatment. The risk that a man will have to resort to prostate surgery in his lifetime is 10%.

Causes

The prostate gland consists of glandular structures and stroma. The second element contains smooth muscle fibers and connective tissue. With BPH, all components of the prostate increase, but the stroma, nevertheless, is relatively larger than the rest.

For the growth of the gland, male hormones (testosterone and dihydrotestosterone) are needed. They are not the root cause of the appearance of benign hyperplasia, but without them its development is impossible.

Aging and male hormones are the only confirmed risk factors that can trigger the development of BPH. Every male with a healthy prostate and normally functioning testicles develops this disease if he lives long enough.

The testicles produce 95% of the testosterone in the body. In the prostate gland, this hormone is converted into dihydrotestosterone, to which it is more sensitive than to testosterone. An enzyme called 5-alpha reductase is an intermediate link in the chain of transformation of testosterone into its active form. It is contained exclusively in the secretion of the male gonad. 5-alpha-reductose can be controlled with medications (see "Treatment" section).

Over time, dihydrotestosterone stimulates the formation of growth factor in the prostate, which, in turn, leads to an imbalance between cell growth and their programmed death (apoptosis).

The result of all this is a slow, progressive, enlargement of the prostate gland. Such a clinically pronounced disease is present in the vast majority of older men, however, in itself it does not necessarily cause symptoms or lead to complications.

Symptoms may occur because BPH directly affects the prostate or bladder outlet, resulting in an obstruction (see "Symptoms" below).

Symptoms

BPH may be accompanied by the absence or presence of symptoms. They occur due to mechanical compression of the urethra by an enlarged prostate, secondary bladder changes due to obstruction, or complications of BPH.
Obstruction (blockage) of the bladder outlet can lead to various consequences, such as thickening and instability of the bladder muscles. The instability is thought to cause irritant (irritative) symptoms.

In addition, the narrowing of the lumen of the urethra can lead to insufficient contraction of the muscles of the bladder, or further aggravate their condition. The result of this disorder on the face is obstructive symptoms and insufficient emptying of the urinary bladder. Although the natural aging process is responsible for the appearance of these symptoms, it is the obstruction that will exacerbate both signs of the withering of the male body.

Obstructive symptoms:

• weak stream of urine;
• feeling of incomplete emptying of the bladder;
• intermittent stream of urine;
• Difficulty initiating urination (delay);
• tension during urination.

Irritant (irritative) symptoms:

• Frequency (frequent going to the toilet);
• Urgency (strong urge to urinate that is difficult to suppress);
• Nocturia (the need to wake up at night to empty the bladder).

Symptoms indicating the presence of complications:

• Blood in the urine (hematuria): BPH can cause blood in the urine. However, this disease cannot be considered the culprit of bleeding, except in cases where other, more serious reasons for this have already been excluded.
• Urinary tract infection with symptoms such as burning during urination, pain in the bladder area, fever and frequent urination.
• Urinary retention (complete inability to go to the toilet).
• Urinary incontinence (urinary leakage due to an overfilled bladder that does not empty properly).
• Kidney failure (fatigue, weight loss, increase in total blood volume (hypervolemia), etc.).

Prevalence of BPH

The first microscopic changes of hyperplasia usually appear in the prostate when men approach the age of 35. Ultimately, all men will develop BPH if they live long enough.

Only ±50% of men with a histologically confirmed diagnosis of benign prostatic hyperplasia will develop symptoms. Enlargement of the male gonad does not always lead to obstruction or symptoms.

The clinical syndrome (symptoms and signs) associated with prostate enlargement is known by various names including BPH, LUTS (lower urinary tract symptoms), prostatism and urinary tract obstruction.

50% of men aged 51-60 and 90% over 80 have histological BPH. However, only 25% of fifty-five-year-olds and 50% of seventy-five-year-old men will be bothered by symptoms reminiscent of an enlarged prostate.

Course of the disease

The natural course of development of untreated BPH is variable and unpredictable. There is little reliable information in the medical literature on this subject. But what is clear is that prostatic hyperplasia is not necessarily a progressive disease.

Many studies have shown that in about 30% of patients, symptoms may improve or go away with time. In 40% of men, they remain the same, and in 30% they worsen. In 10% of patients who did not resort to medical care, urinary retention will appear in the future. And 10-30% of patients who reject medicine will eventually need surgery for an enlarged prostate.

Risk factors

Identified risk factors:

• aging;
• testosterone.

Likely risk factors: Genetics.

Potentially possible risk factors:

• western food;
• high blood pressure;
• overweight;
• industrialized environment;
• increased androgen receptors;
• imbalance of testosterone and estrogen levels.

Any healthy man who lives long enough will fall prey to prostate hyperplasia. Time and male hormones (dihydrotestosterone and testosterone) are the only risk factors whose influence on the development of BPH has been established.

Prostate cells are much more sensitive to dihydrotestosterone than to testosterone. An enzyme, 5-alpha-reductase, which is unique to the prostate, converts testosterone to dihydrotestosterone. Those representatives of the strong half of humanity who were castrated in their youth or suffer from a lack of 5-alpha reductase do not experience BPH.

Latest Research show that there is a likely genetic link to BPH. The risk of surgery for a man increases four times if his next of kin was operated on for this disease. The genetic link is especially strong for men with large prostates before the age of 60.

Some medical studies have found that in BPH cells, the number of receptors male hormones(androgen receptors) can be increased. A role environmental factor, as well as nutrition, overweight and industrialized environment, has not been fully elucidated.

The incidence among Eastern men (especially Japanese) is low. Their regional diet is rich in phytoestrogens and may have a protective effect.

When to see a doctor

If you experience any of the following disorders, contact your doctor immediately:

• Inability to urinate (urinary retention);
• Difficulty urinating;
• blood in the urine;
• Urinary incontinence;
• urinary tract infection or other complications of BPH;
• Suspicion of renal failure.

Acute (sudden) inability to urinate causes pain. If this symptom occurs, you should immediately seek medical attention. Urinary retention can slowly develop, gradually weakening the stream, and eventually lead to urinary incontinence due to bladder overflow.

In this scenario, the bladder never empties properly, which can lead to obstructive kidney failure and other complications such as infections or stones.

It is not worth associating the appearance of blood with an enlarged prostate until other, more serious causes (bladder cancer) can be ruled out.

Every man over the age of 50 should have an annual screening for prostate cancer. Blacks, who are at higher risk of developing this type of cancer, and men with a genetic predisposition to it, should start getting regular screenings at age 40. The goal of annual prostate exams is to diagnose prostate cancer at an early stage, when it can still be cured.

As a rule, at an early stage, prostate cancer is asymptomatic. If a man has ever had gonadal surgery for BPH (namely, transurethral resection or open prostatectomy), this does not mean that he is no longer at risk of developing prostate cancer.

Prostate cancer usually starts in the outer part of the prostate that is not removed during surgery for BPH.

Preparing to visit a doctor

You may be asked to complete a questionnaire that will help you assess the severity of your symptoms (using the Prostate Symptom Score). During the physical examination, a digital examination of the rectum will be done.

The healthcare provider will usually order a urinalysis and may ask you to urinate into a device to measure the flow rate. Shortly before a visit to the doctor, it is better not to empty the bladder.

Diagnostics

The diagnosis of benign prostatic hyperplasia is based on the medical history, physical examination, and some confirmatory tests.

Disease history

The symptoms of BPH are divided into obstructive and irritant (see "Symptoms" section). It is impossible to make a diagnosis based on symptoms alone, since many diseases mimic the symptoms of BPH. A thorough medical history can help identify other conditions than BPH that are causing the symptoms.

Diseases similar to BPH:

• urethral stricture (narrowing of the lumen of the urethra in the penis);
• bladder cancer;
• bladder infection;
• prostatitis (chronic infection of the prostate);
• neurogenic bladder (dysfunction of this organ due to neurological disorders such as stroke, Parkinson's disease or multiple sclerosis);
• diabetes.

Urethral stricture can occur as a result of previous injuries, the use of technical means in treatment (referring to the catheter) or infections (gonorrhea). Blood in the urine may indicate the presence of bladder cancer. Burning and pain when urinating may indicate an infection or stones.

Possible cause frequent urination and insufficient emptying may be diabetes, as it affects the muscles of the urinary bladder and functions nervous system.

A scoring scale is used to assess the severity of prostate symptoms. It helps to determine whether further evaluation of the patient's condition is necessary or whether treatment should be started. The American Urological Association Symptom Index is the most commonly used assessment method.

Symptoms are classified according to the total score: 1-7 points - mild symptoms, 8-19 - moderate and 20-35 - severe. If the disorders are mild, then in most cases no treatment is needed. With moderate signs, treatment is required, and in the case of severe manifestations of the disease, surgical intervention is most often resorted to.

Physical examination

During this examination, the doctor assesses the general health of the patient and feels the abdominal cavity for the presence of a full bladder. A digital examination of the rectum is performed in order to determine the size, shape and consistency of the prostate gland. To do this, the doctor inserts the finger of a gloved hand into the rectum. The prostate lies adjacent to the anterior intestinal wall and can be easily palpated in this way. This procedure is slightly unpleasant, but does not cause pain. In BPH, the enlargement is smooth and uniform, while in prostate cancer it is nodular and uneven.

Unfortunately, prostate size alone is poorly correlated with symptoms or obstruction. It happens that men with large prostates show no symptoms and no obstruction occurs, and vice versa, small prostatic hyperplasia can be characterized by severe obstruction with symptoms and / or complications.

An enlarged prostate in itself is not an indication for treatment. The size of the prostate of patients who actually need therapy may influence the choice of treatment. A neurological examination is indicated if the medical history suggests that the cause of the symptoms may be neurological.

Special Studies

In order to eliminate all doubts about the correctness of the diagnosis, check for other causes of symptoms, confirm or refute obstruction and find complications associated with it, special studies are prescribed.

The minimum list of examinations required to diagnose BPH:

• medical history, including symptom severity index (see above);
• physical examination including digital rectal examination (see above);
• Analysis of urine;
• urine flow rate;
• evaluation of renal function (serum creatinine).

Additional tests:

• urodynamic study "pressure-flow";
• determination of the level of prostate-specific antigen (PSA) in blood serum
• ultrasound examination of organs abdominal cavity;
• ultrasound of the kidneys, ureter and bladder;
• transrectal ultrasound of the prostate.

A simple urine test can be done in the office using a test strip. If it indicates a possible infection, a urine culture is taken. If blood has been found in the urine, further testing should be done to rule out other causes of this symptom.

To determine the rate of urine flow, the patient is asked to urinate into a special machine that produces an indicator. Most devices measure urine volume, maximum flow rate, and the amount of time it takes for the bladder to empty. In order for the result to be accurate, at least 125-150 ml of urine is needed at a time.

The most useful parameter is the maximum urine flow rate (Qmax), measured in milliliters per second. Despite the fact that the mentioned parameter is an indirect sign of urinary tract obstruction, it appears that the presence of this disorder is confirmed in the majority of patients whose urine flow rate is less than 10 ml/sec. At the same time, those whose urine flow rate exceeds 15 ml/sec show no signs of obstruction.

Moreover, patients with low values ​​measured before undergoing surgery feel better after it, compared with those with higher urinary flow rates. It must be understood that a low value of this parameter does not indicate what exactly is the cause of a weak urine flow - obstruction or impaired function of the bladder muscle.

The level of creatinine is determined in the serum of the taken blood sample. The result obtained gives an idea of ​​how the kidneys function. Creatinine is one of the waste products excreted by the kidneys. If the level of this substance is elevated due to urinary tract obstruction, then it is better to drain the bladder with a catheter, which will allow the kidneys to recover before starting prostate surgery.

The pressure-flow urodynamic study is the most accurate method to determine the presence of urinary tract obstruction. Bladder pressure and urine flow pressure are measured simultaneously. Obstruction is characterized high pressure and weak flow. This is an invasive test, for which sensors are inserted into the bladder and rectum. Many scientists do not recommend this procedure for patients with severe prostate symptoms. At the same time, such a study is indispensable if there are doubts about the diagnosis.

Indications for urodynamic study:

• any neurological disorder, such as a seizure, Parkinson's disease, and multiple sclerosis;
• acute symptoms, but normal rate urinary velocity (>15 ml/sec);
• long-term diabetes;
• previous failed prostate surgery.

The level of prostate-specific antigen (PSA) in the blood serum increases in the presence of BPH. There are controversies associated with the use of this test to detect prostate cancer. The American Urological Association, like most urologists, recommends that serum PSA levels be checked every year in patients over 50 years of age, whose life expectancy is 10 years.

Representatives of the black race and men with a genetic predisposition to prostate cancer should undergo such a study, starting at the age of 40. PSA levels rise before prostate cancer becomes clinically apparent. Thanks to this, it is possible to establish an early diagnosis and start timely treatment.

Abdominal ultrasound may be helpful in detecting hydronephrosis (enlargement) of the kidneys and determining the volume of urine that remains in the bladder after the patient has defecated. This indicator does not directly explain the appearance of other symptoms and signs of prostatism, and on its basis it is impossible to predict the outcome of surgery.

It is also not known whether a large residual volume of urine indicates impending bladder or kidney problems. Most experts believe that it is necessary to more carefully monitor patients with a high value of this indicator if they prefer non-surgical therapy.

Renal failure with obstruction results from progressive enlargement of the kidneys (hydronephrosis). Ultrasound examination of patients with increased level Serum creatinine can determine if the deficiency is due to obstruction or other factors.

Transrectal ultrasound of the prostate is not always done in patients with benign hyperplasia. But still, during this examination, you can very accurately measure the volume (size) of the prostate. The main function is to help do a biopsy of the gland in case of suspected cancer of this organ.

Treatment

Follow-up, drug therapy and surgery are the main treatment options. Patients who are not suitable for surgery and have not received positive treatment results medicines, insert indwelling catheters, perform intermittent (periodic) self-catheterization, or install an internal urethral stent (read on). Complications arising from BPH are usually an indication for surgical operation. Therefore, patients with complications are not treated by dynamic observation or medications.

home treatment

Dynamic observation is a strategy of non-emergency treatment, which consists in medical monitoring of the patient's health at regular intervals. The course of benign prostatic hyperplasia is not necessarily progressive. In many patients, symptoms are stable or may even improve. Dynamic observation is suitable for men with a minimal arsenal of symptoms and not experiencing any complications. Patients may be checked annually, have their symptoms scored, have a physical examination, and have their urine flow rate measured. If the patient is undergoing this treatment at home, they should not take tranquilizers, over-the-counter medications, and sinus remedies, which can aggravate symptoms and lead to urinary retention.

To improve the symptoms of BPH, consider these recommendations. Drink alcohol and caffeinated drinks in moderation, especially in the late evening before going to bed. Tranquilizers and antidepressants weaken the muscles of the bladder and prevent complete emptying. Cold and flu medicines typically contain decongestants that increase the tone of the smooth muscles in the bladder neck and prostate, leading to worsening of symptoms.

Phytotherapy is the use of plant extracts for medicinal purposes. Recently, this method of treating the symptoms of BPH has attracted the attention of the press. The most popular extract was the dwarf palm (also known as saw palmetto). The mechanism of action of herbal medicine is unknown, and its effectiveness has not been proven. It is believed that the extract of this plant has an anti-inflammatory effect that reduces swelling of the prostate, and inhibits hormones that control the growth of prostate cells. It is possible that the positive results obtained from the use of plants are only a consequence of the "placebo" effect.

Medical treatment

There are two groups of drugs that have shown their effectiveness in the treatment of benign prostatic hyperplasia. These are alpha blockers and 5-alpha reductase inhibitors.

Alpha blockers
The prostate gland and bladder neck contain a large number of smooth muscle cells. Their tone is under the control of the sympathetic (involuntary) nervous system. Alpha receptors are called receptors nerve endings. Alpha blockers are medications, which block alpha receptors, thereby lowering the tone of the muscles of the prostate and bladder neck. As a result, the rate of urine flow increases and the symptoms of prostate disease improve. Alpha receptors are also found in other parts of the body, in particular in blood vessels. Alpha blockers were originally developed to treat high blood pressure. Not surprisingly, the most common side effect of these medications is orthostatic hypotension (dizziness caused by a drop in blood pressure).

The list of commonly used alpha blockers includes:

• prazosin;
• doxazosin;
• terazosin;
• tamsulosin.

The last drug is a selective α1A-adrenoceptor blocker, designed specifically to inhibit the alpha receptor subtype, located mainly in the bladder and prostate.

Alpha-blockers are effective in treating patients with a residual urine volume of less than 300 ml and who do not have an absolute (vital) indication for surgery. Most studies have shown that symptoms have been reduced by 30-60% with these drugs, and urine flow has moderately increased. All of the above alpha-blockers, taken in therapeutic dosages, have the proper effect. The maximum result is achieved within two weeks, and persists for a long time. 90% of patients tolerate the treatment well. The main reasons for stopping treatment are dizziness due to hypotension and lack of efficacy. Direct studies, the subject of which was the comparison of various alpha-blockers with each other, have not been conducted. Therefore, claims that any of them are better than the others are not substantiated. As a rule, treatment should be carried out throughout life. A less commonly reported side effect is abnormal or retrograde (reverse) ejaculation, which is experienced by 6% of patients taking tamsulosin.

5-alpha reductase inhibitors
The enzyme 5-alpha reductase converts testosterone to its active form, dihydrotestosterone, in the prostate gland. Finasteride prevents this transformation from occurring. Taking this drug relieves the symptoms of BPH, increases the rate of urine flow, and reduces the size of the prostate. However, such improvements can be called no more than modest, and they are achieved in a period of up to six months. Recent studies have shown that finasteride may be more effective in men with large prostates, but less effective in patients with small gonads. The remedy in question does indeed reduce the incidence of urinary retention. Thanks to him, the need for prostate surgery is reduced by 50% in four years. Side effects include: breast enlargement (0.4%), impotence (3-4%), decreased ejaculate volume, and a 50% drop in PSA levels.

Surgery (prostatectomy)

This is the most common urological procedure. Only in the United States of America, 200,000 operations are performed annually. BPH prostatectomy involves removing only the inside of the prostate. This surgery is different from radical prostatectomy for cancer, which removes all of the prostate tissue. Prostatectomy is the best and fast way improve symptoms of benign prostatic hyperplasia. However, it may not alleviate all irritative bladder symptoms. Unfortunately, this is more true for older men over 80 years of age, when bladder instability is considered the cause of most of the symptoms.

Indications for prostatectomy:

• urinary retention;
• renal failure on the background of obstruction;
• recurrent urinary tract infections;
• large residual volume of urine (relative indication);
• unsuccessful drug therapy (turned out to be ineffective or accompanied by severe side effects);
• patients who are not enthusiastic about the prospect of undergoing drug therapy.

Transurethral resection of the prostate (TURP)
This operation is still considered the "gold standard" in the treatment of BPH, which is equal to all other treatment options. TURP is performed using a resectoscope, which is inserted through the urethra into the bladder. A wire loop that conducts electric current is cut out of the prostate tissue. The catheter is left for one or two days. The hospital stay is usually three days. TURP is usually painless or causes little discomfort. On the third week after surgery, the patient fully recovers.

Significant improvement after this operation is observed in 93% of men with severe symptoms, and 80% with moderate disorders.

Complications associated with TURP can include:

• the mortality rate is less than 0.25%;
• bleeding requiring transfusion - 7%;
• stricture (narrowing) of the urethra or neck of the bladder - 5%;
• erectile dysfunction - 5%;
• incontinence - 2-4%;
• retrograde ejaculation (during ejaculation, seminal fluid enters the bladder) - 65%;
• the need for another transurethral resection - 10% within five years.

There are several types of TURP:
Transurethral incision of the prostate/prostatectomy/bladder neck incision.
As with TURP, an instrument is inserted into the bladder. Instead of a loop, an electric knife is used to make one or more incisions in the prostate to relieve pressure on the urethra. Sex gland tissue is not removed, and if removed, then a very small piece. Results achieved with small prostate prototomy (
Transurethral vaporization of the prostate
This type of resection is performed using a resectoscope inserted through the urethra. However, in this case, the tissue is not cut off, but exposed to powerful electrical energy. As a result, the tissue is evaporated with minimal blood loss. Potential benefits of electrovaporization include shorter catheter wear, shorter hospital stay, and lower cost compared to TURP or laser prostatectomy.

Open prostatectomy
Larger prostates are less suitable for TURP because complications often occur due to the longer resection time. Open prostatectomy is the treatment of choice if the prostate is larger than 70-80g. A transverse incision is made in the lower abdomen to expose the bladder and prostate. The capsule of the gonad is dissected, and benign hyperplasia is husked. It is possible to open the bladder and exfoliate the prostate through it. To do this, one catheter is placed into the bladder through the urethra, and the second through the lower abdomen. The catheters are left in place for four to five days. This operation gives good results, but it is more severe than TURP. The hospital stay and rehabilitation period is longer and the complications are slightly worse. But at the same time, open prostatectomy is considered very effective way removal of BPH tissue. And only a small number of patients subsequently have difficulty with the normal emptying of the bladder.

Minimally invasive treatments for BPH

Despite the success of TURP, scientists are constantly looking for less invasive, safer and less expensive procedures that can be performed in one day under local anesthesia without leaving the person overnight in the hospital. A variety of energy sources were tested for point heating of the prostate tissue and its destruction. Laser, microwave thermotherapy, high-intensity focused ultrasound therapy, radiofrequency therapy and transurethral needle ablation of the prostate (TUIA) are based on this principle. All these types of manipulations lead to fewer complications during therapy, but are characterized by less efficiency and greater postoperative troubles. The hospital stay is shorter than with TURP, but the catheter time is longer. As a result, many patients require retreatment, which is usually done with TURP. Various laser methods are also used to treat the prostate gland. The latest and most promising invention is holmium laser therapy, similar to TURP in that the prostate tissue is actually removed. According to studies, blood loss with this therapy is significantly less than with transurethral resection.

Fight against obstruction

There are patients for whom any type of surgical intervention is contraindicated. To help such patients, intraurethral stents are placed in the prostatic part of the male urethra to keep it open. This allows the patient to pass urine normally. Stents can be inserted under local anesthesia. In the short term, this method gives good results. Due to displacement and other complications, these devices are removed in 14-33% of cases. Of course, it is better not to wear an indwelling catheter all the time. But they are the only salvation for people who are sick, debilitated or bedridden. As an alternative, they offer
intermittent (periodic) self-catheterization, which the patient, or the person caring for him, can do himself.

Disease Prevention

Unfortunately, it is impossible to prevent the development of benign prostatic hyperplasia. It is not known whether long-term treatment with finasteride, started before clinical manifestations of the disease, has a significant effect on pathological process BPH. Before use, you should consult with a specialist.

Content

Any disease of the prostate gland leads to problems of male sexual health. Prostate adenoma is a common disease among the male part of the world's population. According to WHO statistics, every third man in the world over the age of 40 is susceptible to this disease or has prerequisites for its occurrence. Urologists note the annual "rejuvenation" of the disease. Treatment for prostate adenoma includes various methods"fight" with this disease.

What is prostate adenoma

Prostate adenoma is a common male disease that manifests itself in the form of a nodular growth of tissues, the appearance of a neoplasm, an increase in the gland. This disrupts the ability of the normal physiological process of urination due to the constriction of the sphincter.

But the difficulty in performing the act of urination is not the only trouble that occurs with prostate adenoma.Patients with this disease also acquire kidney failure, which increases the poisoning of the body with toxins. The work of the stomach worsens, there are disturbances in the activity of the liver and excretory system. There are signs of gastritis, cholecystitis, colitis and other diseases.

The urinary system ceases to function normally, which causes the accumulation of harmful nitrogenous substances in the body. Used to treat benign prostatic hyperplasia different methods sparing for the body are non-surgical.

Non-surgical treatments

Non-surgical methods of treatment of prostate adenoma are aimed at combating the disease without removing the affected gland. There are several types of non-surgical treatment:

• Minimally invasive
• Medical
• Folk ways

Minimally invasive treatments

1. Urethral dilation with a balloon, which dilates the urethra and promotes a normal outflow of urine. The duration of the effect of the procedure is up to 6 months.
2. Stenting. It differs from the introduction of a balloon in that an elastic, durable stent is inserted into the urethra, which expands the lumen of the urethra, improving the ability to excrete urine. The stent is installed for a different period of use, both temporarily and permanently.
3. Local thermal effect on certain parts of the gland. Using devices with various types of radiation: ultrasonic, radio and microwave. The radiation temperature is selected individually in the range of 40 - 120 ° C and destroys only the focus of diseased cells without damaging healthy tissues.
4. Thermal ablation provides for the action on the gland of ultrasonic waves of a certain range - from 50 to 100 kHz. This method destroys diseased cells, they die after the procedure.
5. Laser vaporization is based on the effect of a directed laser beam on the problem area. As a result of the procedure, the liquid from the cells evaporates, the surface of the wounds heals, and the size of the gland decreases.
6. Embolization of the arteries of the prostate is the latest non-surgical treatment. When it is used, special medical spherical devices block the arteries, stopping the access of nutrients to the gland. In connection with a decrease in nutrition, the iron "loses weight" and is blown away.

The urologist selects minimally invasive methods of treating prostate adenoma individually for each patient.

Medical methods of treatment

In the treatment of adenoma, various medications are used:

• Alpha blockers. They act on the muscles around the urethra, relaxing them and facilitating the excretion of urine. Improvements are noticeable within a few days after treatment with omnic, a new effective drug.

• 5-alpha reductase inhibitors, which reduce the production of the hormone dihydrotestosterone, which affects the growth of prostate cells. Preparations of this group are taken for a long time - 3-4 months.
• IN mistletoe therapy medicines based on white mistletoe are used. The plant is rich in alkaloids and activates the work immune system, which destroys swollen and inflamed cells.
• In photodynamic treatment, intravenously used sensitizing drugs, which linger in tumor cells longer than in healthy cells. Further, under the influence of a laser beam of a certain length, a biochemical reaction occurs in these cells with the formation of oxygen free radicals, locally destroying the tumor.
• In the system peptidotherapy biologically active substances - peptides are used. Preparations with their content contribute to the restoration of the antitumor immune defense of the body and reduce the risk of the dynamics of the disease. Active peptides kill tumor cells.

Alternative medicine remedies are varied and their recipes have been passed down by word of mouth for hundreds of years. Here are some recipes for the treatment of prostate adenoma, subject to an established diagnosis:

• A good result gives fir oil. 5-6 drops of oil are added to the body cream, and the perineum is lubricated daily with this mass. The ointment is not applied to the scrotum and anus.
• A decoction of fir bark: 2 tbsp. spoons of fine bark pour - 200 ml of water, heat in a water bath for 35 - 40 minutes, cool. Drink 0.5 cup 30 minutes before meals twice a day for 14 days.
• Herbal mixture of white mistletoe, burdock root, corn stigmas, goose cinquefoil, pepper knotweed. Mix 15 g of each herb, and pour 200 ml of boiling water over 1 tablespoon of the mixture. Cool down naturally. Take up to 3 glasses daily for a month.
• There are pumpkin seeds. They contain the trace element zinc. It prevents cell growth and swelling of the gland.

Surgical treatments

Surgical methods are used in cases big size prostate and the period of development of the disease, as well as at a later stage of tumor development. They are produced in stationary conditions after examination.

There are the following methods of surgical solution of the problem:

• Transurethral resection (TUR). This method is more effective than other options for surgical intervention, positive result observed in 90 out of 100 patients. Under anesthesia, tumor cells are removed with a special device, urination improves 3-4 days after the operation.
• Transurethral incision (TUI) is used for a small enlargement of the gland and is considered a gentle surgical procedure - after it, patients do not experience complications. At the time of the operation, several incisions are made on the prostate gland, with the help of which the cause of difficulty urinating is eliminated. Sometimes a second procedure is required to completely cure the patient.
• Open adenomectomy is effective in cases of large prostate size. In addition, experts recommend the use of such treatment if the patient has complications: bladder stones, tissue damage by stones, narrow urethral lumen. When performing a surgical operation, a doctor makes an incision in the skin in the lower abdomen in order to “get” to the diseased gland. Adenomectomy involves the removal of the inside of the gland.

Symptoms of adenoma

Symptoms of the disease that signal the presence of the disease:

• Difficulty in the physiological process of urination, especially at its beginning
• Frequent "requirement" of the body to empty the bladder
• Feeling of incomplete emptying of the bladder
• Weak stream of urine during the act of urination, or interrupted process, urinary retention
• Pain during urination
• Uncontrollable urge, frequent nighttime urge to urinate, urinary incontinence

Causes and factors causing the disease of prostate adenoma

There are many reasons for the occurrence of prostate adenoma, here are the most common of them:

• Age changes
• Hormonal failure in the body as a result of complications after past diseases
• Decreased production of sex hormones
• Genetic predisposition that is inherited
• Individual physiological features structures of the genitourinary system
• Hypothermia, chronic inflammation of the kidneys, ureters, bladder

There is a risk of developing the disease and if the patient:

• No regular sex life
• Genital trauma
• Improper nutrition
• Drinking large amounts of alcohol
• Low physical activity
• Taking a large number of medications and reducing the protective reaction of the body's immune system

Stages of prostate adenoma

According to medical analyzes and clinical studies, three stages of the development of the disease are revealed:

Stage 1 - compensated - is determined by a weak stream of urine during urination. There is a frequent desire to go to the toilet, especially at night. The complete release of the bladder occurs with the help of the detrusor - the muscular wall of the bladder and its ability to perform compensatory contractions. The duration of the first stage is purely individual, sometimes up to 10-12 years.

Stage 2 - subcompensated. At this stage, significant squeezing of the bladder disrupts the functioning of the urinary system, does not allow even "pulsation" of the walls of the bladder at the time of emptying. Symptoms of a “non-empty” bladder appear, the act of urination takes place in several stages, in small portions, spontaneous excretion of urine and its incontinence appear. At this stage, renal failure begins to develop.

Stage 3 - decompensated - is manifested by the stagnation of a large amount of urine in the bladder, the walls of which are stretched because of this, involuntary emptying, - drop by drop, painful sensations. The general condition of the body worsens, weakness, blood loss, weight loss, lack of appetite, constipation, anemia, excretion of urine vapor along with breathing appear.

Prevention of adenoma

To prevent and detect prostate adenoma, urologists recommend the following preventive measures:

• Be sure to visit a urologist once a year.
• Remove fried, fatty and spicy foods from the diet.
• Avoid high energy foods.
• Refuse to use alcoholic beverages and smoking.
• Increase motor activity - daily exercises, every other day classes in the pool or gym, walking.
• Keep track of weight, avoiding the appearance of fat deposits.

The main condition for curing prostate adenoma is a timely visit to a doctor and a course of treatment. From the video below you will learn about modern medical bio therapeutic methods treatment of the disease.

Anonymous 590

Very clear and helpful article.

3 days Answer