Go Prostate adenoma in men: symptoms, treatment, effects of surgery to remove the prostate gland
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BPH

Content:

Prostate adenoma is a benign tumor that develops from the stroma or glandular epithelium of the prostate. By itself, the adenoma does not metastasize, but can eventually degenerate into adenocarcinoma (prostatic cancer).

Many experts, referring to prostate adenoma, prefer to use the term “benign prostatic hyperplasia” (DHBJ), thus emphasizing its polycentric growth against the background of the pronounced dishormonal nature of the changes occurring in the prostate gland.



Prevalence of disease

Prostate adenoma is one of the most common urological diseases in men. Previously, it was rarely found before the age of 54 and usually occurred in 57-60-year-old men.

Currently, the disease is significantly "younger". For example, the initial signs of prostatic hyperplasia are increasingly appearing at the age of 25 years. According to the data obtained during the autopsy of the dead from various diseases, at present, prostate adenoma occurs up to 30 years in 8%, up to 50 years - in 50%, and after 80 years more than 80% of men suffer from adenoma.

It is believed that in China, Japan, prostate adenoma is very rare, and most often in North America, Europe, Egypt and India.

Unfortunately, today the tendency to the appearance of adenoma in young people continues, as well as an increase in the number of cases of this disease as a whole.

Excursion to the anatomy and features of the functioning of the prostate

Anatomy

Under normal conditions, the shape of the prostate gland resembles a chestnut, the size of which varies slightly with age. At 30 she is 3x4 cm and weighs about 16 grams. The prostate is positioned in such a way that its tissues surround the urethra from all sides (for this reason, in adenoma, normal urination first of all suffers). Its nearest "neighbors" in the pelvis are the rectum and bladder, so prostate diseases can affect the general condition and functioning of these organs.

In a newborn boy, the prostate weighs less than 1 gram, and by the age of 30 it increases almost 20 times. After 45–50 years, the prostatic glands gradually atrophy and are replaced by connective tissue, of which this gland is almost completely composed, starting at 65 years of age.

Features of operation

The prostate is a hormone-dependent organ. Its activity is controlled by the so-called hypothalamic-pituitary-gonadal system, and the male hormone testosterone “answers” ​​mainly for its normal growth and functioning.

The most intense hormonal changes in the male body begin after 40–45 years, when testosterone decreases and estradiol increases in plasma. These changes are increasingly progressing towards old age. During this restructuring, periods of destabilization of hormone levels are possible, which may trigger the development of adenoma.

Causes of Prostate Adenoma

The exact answer to the question of why prostate adenoma develops, to date, will not give any of the specialists involved in the study of this disease. The fact is that gland hyperplasia occurs in men, both with violent and low sexual activity, in smokers and non-smokers, alcohol abusers and non-drinkers.

However, it is noted that the age and level of male hormones greatly affect the incidence of adenoma. Hereditary factors and a sedentary lifestyle also contribute to the development of hyperplasia (noted in 60% of cases of adenoma). It was also revealed that adenoma does not develop in castrated men, so castration was at one time suggested as one of the ways to treat BPH.

Many experts believe that the immediate cause of the development of prostate adenoma should be sought in the complex interaction of prostate cells with each other, changing their sensitivity to the effects of hormones, etc.

Stage of the disease depending on the symptoms

Modern medicine identifies 4 stages of development of prostate adenoma.

First stage: compensated form

BPH Gradually increasing, the prostate gland begins to compress the urethra more and more, which immediately affects the nature of urination: urine begins to stand out with difficulty and sluggish flow.

Experiencing constant resistance to normal outflow of urine, the muscles of the bladder gradually hypertrophy, increasing in volume in order to literally "squeeze" urine out.

The most characteristic changes in urination of this stage are:

  • more frequent
  • less free
  • not as intense as before (the urine stream no longer looks like a characteristic parabola, but falls almost vertically).

Night sleep is gradually disturbed, as patients have to get up to urinate 2-3 times per night. However, this fact is usually not alarming, and is easily explained by other reasons, such as insomnia, fluid intake, etc.

In the daytime, the frequency of urination may remain the same, but in most cases, urine begins to stand out only after a certain waiting time (especially in the morning after waking up).

As the prostate grows further and the urethra is strengthened, the following symptoms appear:

  • increased urge to urinate during the day
  • decrease in urine output,
  • increased incidences of irrepressible desire to urinate (the so-called imperative urges),
  • participation of the auxiliary muscles: the patient from time to time strains the stomach at the beginning or at the end of urination for better emptying.

Despite the presence of these symptoms, the kidneys and ureters do not change, and the general condition of an adenoma sufferer can remain stable for many years without any significant signs of disease progression.

However, even at this stage, acute urinary retention may periodically occur.

Second stage: subcompensation or periodic violations

At this stage, the bladder is not fully emptied, and the amount of urine remaining in it after urination reaches 1–2 glasses.

The characteristic symptoms of this stage are:

  • increase in bladder volume
  • the need to strain during the whole urination,
  • urine stream is released intermittently, undulating,
  • due to the presence of rest periods when the urine is not excreted, the whole urination act is stretched for several minutes.

Due to the constant growth of the volume of urine remaining in the urinary bladder, changes in the upper parts of the urinary system gradually begin to occur:

  • ureters expand,
  • Signs of renal failure appear.

Other possible symptoms at this stage:

  • dry skin,
  • thirst,
  • kidneys - a violation of the nitrogen function and the development of the initial stage of renal failure.

The third stage: decompensation

Gradually, the body loses its ability to resist the huge amount of urine, which is constantly due to the increased prostate adenoma. The bladder is over-stretched, so it practically does not shrink and does not help expel the urine to the outside, even straining during urination does not help much.

At this stage, the bladder resembles a fluid-filled balloon that reaches the level of the navel or even higher.

Symptoms characteristic of this stage:

  • feeling of constant desire to empty the bladder,
  • the appearance of severe pain in the lower abdomen,
  • frequent urine excretion in drops or in very small portions.

Gradually, the body adapts to this state, and the pain passes. Urine is constantly "dripping", which creates the impression of incontinence. However, this situation is not due to the fact that the bladder does not hold urine, but because it simply cannot come out in greater numbers because of a large adenoma. This phenomenon is known as “paradoxical urinary retention”.

Changes also occur in the upper urethra:

  • kidney function is significantly impaired, which leads to the development of decompensated renal failure,
  • maximally expand ureters.

Due to the loss of the kidneys cleaning function in the body gradually begin to accumulate slags, which is accompanied by:

  • loss of appetite
  • vomiting, nausea,
  • general weakness
  • characteristic body odor.

Due to the limited fluid intake in this period, patients constantly experience thirst, they have dry mouth, hoarseness. On the part of the psyche, apathy, depression, and anxiety are noted.

Fourth stage: terminal

As the pathological process progresses, phenomena of renal failure that are incompatible with life occur: a sharp disturbance of the water-electrolyte balance occurs, the nitrogen content in the blood increases, and the person dies from uremia.

Complications of prostate adenoma

Even in the initial stages, when the prostate gland hyperplasia is still relatively small and there is little disruption of urination, acute urinary retention may occasionally occur or blood may be detected in the urine (hematuria). In the future, prostate adenoma may be complicated by the formation of stones or the addition of an infection of the urinary organs. Consider some types of complications in more detail.

Acute urinary retention

Acute urinary retention is a condition where it is completely impossible to urinate when the bladder is full. Most often occurs in the second and third stages of the disease.

Causes of acute delay in prostate adenoma:

  • hypothermia
  • abuse of food containing spices,
  • taking diuretics,
  • prolonged urinary retention,
  • constipation
  • overwork,
  • long stay in a lying or sitting position,
  • alcohol intake.

All these conditions contribute to the development of edema of the tissues of an already enlarged prostate, etc.

How manifested:

  • no urine during urination,
  • lower abdominal pain (above the pubis),
  • in the suprapubic area, the appearance of a “bubble ball” - the bulging of an overflowing bladder,
  • anxiety, anxiety on the part of the patient.

Very rarely, acute urinary retention in adenoma passes on its own, so the bladder is emptied by catheterization or surgery.

Hematuria

The appearance of blood in the urine with prostate adenoma occurs spontaneously if bleeding from the dilated veins occurs in the neck of the bladder or urethra is damaged during any manipulation (for example, catheterization).

Hematuria may be small, emerging only under a microscope, or very significant, with the formation of many blood clots and subsequent bladder tamponade. In this case, suffering from adenoma urgently needs to be operated on.

Bladder stones

They are formed at those stages of adenoma development, when a sufficiently large amount of urine remains in the bladder. Another way is the migration of stone from the kidney to the ureters and the impossibility of its release through the narrowed lumen of the urethra.

Symptoms of a stone in the bladder:

  • frequent urination,
  • pains in the head of the penis, aggravated by movement, walking and disappearing in a horizontal position,
  • intermittent occurrence of the symptom of "laying a stream of urine."

Infectious complications

These include:

  • pyelonephritis,
  • epididymitis
  • prostatitis,
  • cystitis
  • urethritis,
  • epididimoorchitis, etc.

Often the development of infection contribute to congestion in the bladder, as well as catheterization.

The development of renal failure

It is characteristic of the third and terminal stages of adenoma development and is associated with a decrease in urine production by the kidneys.

Symptoms:

1. Stage of latent manifestations : intermittent dry mouth, weakness, with tests - sometimes a small violation of blood electrolytes.

2. Stage of compensation : increased urination, changes in blood tests (increase in the level of urea, creatinine).

3. Stage of decompensation :

  • dry mouth
  • loss of appetite
  • nausea,
  • vomiting
  • fast fatiguability,
  • general weakness
  • reduced immunity, manifested in a more severe course of common colds,
  • finger tremor
  • muscle twitching
  • pain in the bones and joints
  • dry skin
  • bad breath,
  • in the blood - an increase in urea, creatinine.

Stress, dietary disorders, excessive exercise exacerbate the manifestations of renal failure.

4. Terminal stage :

  • sleep disturbance,
  • inadequate behavior
  • lethargy
  • emotional lability
  • the smell of urine from the patient,
  • belly swollen
  • decrease in temperature (hypothermia)
  • itchy skin
  • gray-yellow skin and face
  • fetid stool
  • stomatitis,
  • changes in almost all internal organs and the nervous system due to the effects of uremic intoxication.

Ultimately, renal failure leads to death. The only possible way to prolong the life of a patient is renal replacement therapy (hemodialysis, peritoneal dialysis).

Diagnosis of prostate adenoma

Comprehensive diagnosis of adenoma is carried out on the basis of patient survey data, urological examination and a number of additional laboratory and instrumental examination methods.

Poll

During the interview, the doctor inquires about complaints and also conducts a survey according to the standardized international questionnaire IPSS developed by WHO and its QOL application, which assesses the overall quality of life. It contains questions about the frequency and nature of urination, whether it was necessary to strain during an attempt to urinate, etc.

Urological examination

In addition to the external examination of the genital organs includes a mandatory examination of the prostate through the rectum. It is carried out as follows:

  1. Before you come to the appointment with the urologist, the patient must first empty the rectum.
  2. At the reception, the doctor will put on a sterile medical glove, smear the finger with petroleum jelly and gently insert it into the rectum.
  3. Further, with soft movements, he will perform palpation (palpation) of the posterior prostate wall.

When adenoma prostate gland enlarged, elastic, painless.

Laboratory methods

Diagnosis of prostate adenoma As a rule, they are appointed: general urinalysis, kidney tests, blood test for the determination of prostate-specific antigen, as well as histological examination of adenoma tissues (if necessary).

A general analysis of urine is judged on possible bleeding, joining an infection of the urogenital organs, signs of renal failure.

Kidney tests are also important for detecting insufficient kidney function. Special attention is paid to the level of creatinine and residual nitrogen, which increase with the progression of renal failure.

The level of prostate-specific antigen is determined in order to exclude prostate cancer, which can be observed together with adenoma. In cancer, the level of this antigen rises.

Histological examination is performed by prostate biopsy to exclude the possibility of cancer.

Instrumental methods

Most often for the diagnosis of prostate adenoma the following methods are used:

1. Ultrasound . Gives an idea of ​​the degree of prostate enlargement, its structure, identify nodules in the gland, as well as get an idea of ​​the presence of stones in the bladder and the amount of residual urine. It is performed in the usual way, in which the sensor is placed on the front surface of the abdomen or placed in the rectum (the so-called transrectal examination - TRUS).

2. Radiological methods . These include a radiograph and excretory urography. The latter is done using contrast and allows you to determine the expansion of the ureters, renal pelvis, changing their shape, the presence of protrusions (diverticula) in the wall of the bladder.

3. Uroflowmetry . This study is carried out using a special apparatus, which is a funnel, which is connected to a computer or recorder. An hour before the procedure, you need to drink 1 liter of pure non-carbonated water, and then urinate in the apparatus funnel. A curve is drawn on the paper or monitor screen, according to the nature of which the doctor will get an idea of ​​the functioning of the urethra and the sphincter of the bladder.

According to the testimony, other urodynamic studies are also conducted, for example:

  • multichannel urodynamics,
  • urethral profilometry,
  • video dynamics,
  • "Pressure-flow".

4. Urethrocystoscopy . Allows you to visually assess the nature of the narrowing of the urethra and to identify possible changes in the bladder.

The obtained results help to determine the tactics of treatment, choosing the most effective method for each specific case. It is believed that in the case of prostate adenoma, the following results of laboratory and instrumental studies should be alarming:

  • prostate specific antigen above 1.4 ng / ml,
  • prostate volume over 40 cm 3
  • according to the IPSS questionnaire more than 7,
  • maximum urine flow rate less than 10 ml / s.

Treatment of prostate adenoma

В настоящее время не существует единого метода лечения гиперплазии простаты, потому что в каждом случае приходится учитывать многие факторы, например:

  • общее состояние и возраст пациента,
  • его согласие на операцию,
  • стадию аденомы,
  • сопутствующие заболевания,
  • степень нарушения уродинамики,
  • имеются ли признаки рака простаты,
  • возможности того или иного лечебного учреждения.

В целом, аденома простаты может лечиться как консервативно, так и оперативно. Использование того или иного метода лечения зависит от стадии развития аденомы:

  1. Первая стадия . Обычно на этом этапе гиперплазия предстательной железы лечится консервативным путем: назначаются медикаментозные средства, даются рекомендации по режиму и образу жизни — вести физически активный образ жизни, избегать употребления специй и прочих раздражающих продуктов, копченостей, исключить алкоголь, кофе. При возникновении затруднений мочеиспускания может быть рекомендована трансуретральная электрорезекция.
  2. Вторая стадия . Золотой стандарт оказания помощи на этой стадии — удаление аденомы с помощью операции, используя различные малоинвазивные и классические методики.
  3. Третья стадия . Здесь основные задачи — это обеспечение хорошего оттока мочи, чтобы снять азотемическую интоксикацию. В этом случае используют чрезкожную пункционную нефростомию, цистостомию и т. п. Далее нормализуют состояние печени, почек, сердечно-сосудистой системы, а потом решают вопрос о возможном дальнейшем оперативном лечении.

Медикаментозное лечение

Препараты, использующиеся для лечения аденомы, не приводят к ее полному исчезновению. Их необходимо применять длительно, регулярно, иначе аденома начнет прогрессировать. Обычно назначаются препараты следующих групп:

1. Лекарственные средства, расслабляющие тонус гладкой мускулатуры в области шейки мочевого пузыря и простаты, что приводит к ослаблению давления на уретру и облегчению оттока мочи наружу. Это α-адреноблокаторы длительного (пролонгированного) и короткого действия:

  • доксазозин,
  • празозин,
  • теразозин,
  • альфузозин,
  • тамсулозин и прочие.

2. Препараты, блокирующие превращение тестостерона в активную форму и тем самым уменьшающие объем простаты (блокаторы 5-α-редуктазы):

  • дутастерид,
  • финастерид.

3. Phytopreparations. Currently, herbal preparations due to low efficacy and lack of proven clinical effect in many developed European countries and the United States for the treatment of adenoma are not used. However, in a number of countries, herbal remedies are prescribed, which include lipidosterol extracts, for example, Serenoa repens, Pygeum africanum, etc. They are believed to have anti-inflammatory action, reduce puffiness, block the conversion of testosterone to the active form and stop the growth of adenoma.

4. Combined funds. At present, the “gold standard” is the joint intake of drugs of the first two groups for 3-4 years. This allows you to almost immediately improve urination and, after several years, reduce the volume of the prostate gland by a quarter.

In parallel, the treatment of concomitant diseases - cystitis, prostatitis, pyelonephritis, urethritis.

Surgical treatment

They are radical methods of treating prostate adenoma and are widely used in urology. These include:

1. Open adenomectomy . It can be performed in various ways, the most well-known of which is transvezikurianaya adenomectomy. Through a conventional surgical incision, access to the prostate gland is provided and its removal is made. As a rule, it is used in case of impossibility to use less traumatic methods.

2. Endoscopic surgery . All of them are performed with the help of special surgical instruments introduced directly into the urethra under the control of video equipment. These include:

  • transurethral resection of the prostate (TUR), which is the “gold standard” of surgical treatment of adenoma - during its passage through the urethra, an incision is made with a special tool and the prostate tissue is excised;
  • transurethral electrovaporization — access to the prostate is also provided through the urethra, and then with the help of a current, the tissues are heated to a high temperature and evaporated, and small blood vessels are coagulated;
  • transurethral incision - an incision is made in the area of ​​the prostatic urethra, due to which the lumen of the urethra widens, this operation is effective in the case of a small adenoma.

3. Embolization of the arteries of the prostate gland . This operation is performed by vascular surgeons and boils down to the fact that prostate arteries are blocked with a special polymer, providing access to them 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 from excessive amounts of accumulated urine on an emergency basis and to eliminate intoxication.

Although surgical treatment is the best and often the only method of successful treatment, there are a number of complications, including:

  • urinary incontinence,
  • formation of adhesions in the ureter or its fusion,
  • frequent urination,
  • preservation of a significant amount of residual volume of urine,
  • sperm in the bladder,
  • impotence, etc.

Non-operational methods

The most famous among them are:

  1. Balloon dilatation of the prostate (narrowed area is dilated with a balloon).
  2. Stenting of the urethra (a sufficiently elastic element is inserted into the narrowing area, which prevents the narrowing of the lumen of the urethra).
  3. Microwave coagulation of the prostate tissues - microwave coagulation.
  4. Cryodestruction (freezing of prostate tissue and their subsequent necrosis).
  5. The evaporation of the tissues of a hyperplastic gland by high-frequency ultrasound.
  6. Transurethral needle ablation - small needles are placed in the prostate, and then, acting on radio waves, they heat and destroy the prostate tissue.
  7. Removal of prostate tissue using a laser.

All these methods are intermediate between medical and surgical treatment and are used for relatively quick recovery of urination with fewer side effects and better tolerability.

Lifestyle

Anyone suffering from prostate adenoma is recommended to regularly perform special exercises that improve blood circulation in the pelvic organs and prevent blood stasis, for example, “walking on the buttocks” for a few minutes.

You also need to normalize your weight, and in the daily diet to enter foods rich in zinc and selenium - sardines, salmon, herring, pumpkin seeds, buckwheat and oatmeal, olive oil, celery and parsnips.


| January 19, 2014 | | 9 220 | Uncategorized
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Jo Collis: Now how did the doctor discover the prostate cancer did he cause it most likely most likely when he did the biopsy now if the gene-specific test says that you have cancer yes you have prostate cancerif your prostate serum test is high that just means you have a high sex drive and can get an erection so if you're at the prospector me stage and they didn't do a gene specific test they're not interested in your health they're only interested in castrating are you

Misty3133: I’m one month out from this procedure and feel great. At 54 years old and still active I felt it was my best option.almost ready for sexual activity,the urine leak is a set back for that so we wait......My surgeon does two hundred plus a years and is very reputable,I’m fortunate to have him on my side!!

RAVINDRA KUMAR SINGHAL: About 1.5 inch urethra was excised. Is it it possible to restich It without lacerating it. What if this gap becomes impossible to be filled up by pulling up the urethra as it is not elastic.

GJZZTRRE TTMMGGRR ERTZHG YENARTD: WAAAAAAAW.... THANKS SIR.... YOU ARE REAL MARVEL...🧡💛💚💙 YOU ARE UNIQUE JEWEL..💚💛🧡💜 PLEASE !!!!! PLEASE !!!! PLEASE !!!! CONTINUE

drnanang: A friend is due for this operation in Nov this yr. How long on the average does this surgery take? This is a complex procedure!!!!. Very detailed and educative procedure

Igor Sidelkovsky: This was great, I have been researching "prostate massage methods" for a while now, and I think this has helped. Have you heard people talk about - Weyenry Menliver Booster - (do a google search )? It is a good exclusive guide for learning Prostate Massage secrets minus the hard work. Ive heard some decent things about it and my brother in law got great success with it.

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