Prostate adenoma

Prostate adenoma, also called benign prostate hyperplasia (DGPZ), is an extremely common disease in men over 40 years of age.With this disease there is a benign growth of the glandular tissue of the prostate, which can lead to compression of the urethra, impaired flow of urine from the bladder, and as a result of this unpleasant sensations during urination.Prostate adenoma can also cause serious problems with the bladder and kidneys.

This article discusses the causes and symptoms of prostate adenoma, as well as modern methods for diagnosis and treatment of this disease.There are many effective methods for treating benign prostate hyperplasia, including not only drug therapy and open surgery, but also minimally invasive surgical treatment methods.If the first symptoms of the disease appear, you should consult a doctor who will take into account your symptoms, the size of hyperplasia, and the general condition of your health and offer you the best option for treatment.

Reasons

To date, it is not quite clear what causes lead to prostate increase.However, this may be due to a change in the balance of sex hormones in the male body.Throughout their lives, men produce both testosterone, male hormone, and a small amount of estrogen, female hormone.As the body ages, the amount of active testosterone in the blood decreases, while the amount of estrogen remains approximately at the same level.Studies have shown that the higher estrogen fraction entering the prostate gland can increase the activity of substances that accelerate the growth of prostate cells.

Another theory shows the role of another male sex hormone - digidrotestosteron - which is important for the development and growth of the prostate at a young age.Some studies have shown that even when the level of testosterone in the blood begins to fall, the prostate gland still has a high level of digidotestosterone, which can push prostate cells to continue to grow.

The prostate gland is located directly under the bladder.The urethra (or urethra), which removes urine from the bladder, passes through the center of the prostate gland.It is because of such an anatomical structure that enlarged prostate is able to block the flow of urine.

The risk factors for enlarging the prostate gland can be:

1. Age.In men under the age of 40, symptoms of prostate enlargement are rarely observed.About 30% of men experience moderate symptoms with 60 years and about 50% by 80 years.
2. DGPZ's presence with relatives.If your blood relatives, for example, have a father or brother, have prostate problems, it means that you can also increase the risk of prostate hyperplasia.
3. Other diseases such as diabetes, cardiovascular disease and erectile dysfunction.Studies have shown that diabetes, erectile dysfunction, and heart disease and blood vessels may in some cases increase the risk of DGPZ.
4. Life.Obesity increases the risk of DGPZ and exercise can reduce this risk.

Nevertheless, the presence of any of the above factors is not the basis to believe that you will definitely develop prostate adenoma.

Symptoms

The severity of the symptoms in different people with prostate adenoma is different.

The general signs and symptoms of DGPZH include:

• Frequent or urgent desire to urinate.
• Increasing urination at night (Nokturia).
• The inability to empty completely.bladder.
• The presence of residual volume of urine in the bladder.
• Low flow of urine or periodic stops during urination.
• The complexity of the onset of urination.
• Urine growth at the end of urination.
• Frequent urinary tract infections.
• The complete inability to urinate (anuria).
• The presence of blood in the urine (hematuria).

It is worth knowing that the size of the prostate gland does not necessarily determine the severity of your symptoms.Some men with a slightly enlarged prostate can have serious symptoms, while other men even with extremely enlarged prostate glands can be insignificant.Almost all patients are characterized by the gradual worsening of symptoms over time.It is extremely rare that the symptoms can be stabilized or even improved over time.

Diagnostics

In case of suspicion of DGPZ, your doctor asks detailed questions about the presence of symptoms of the disease and will have a physical examination.This initial stage may include:

1. A study to identify symptoms and risk factors of the disease.
2. Rectal finger examination.In order to evaluate the size and shape of the prostate gland, the doctor will have to insert a finger into the rectum.This study is extremely informative, which allows you to draw the main conclusion about the state of the prostate gland.
3. Urine analysis.Analysis of the sample of your urine can help eliminate the infection or other conditions that can cause such symptoms.
4. Blood test.Blood test results may indicate kidney problems.
5. Blood test for prostate -specific antigen (PSA).The dog is a protein that is produced only from prostate tissue.When the prostate is healthy, there is a very small dog in the blood.The test can be done in the laboratory, hospital or doctor's office.No special training is required.A rapid increase in dog levels may be a sign that rapid growth of prostate tissue occurs.DGPZH is one of the possible reasons for a high level of PSA.Prostate or prostatitis inflammation is another common cause of high level of the dog.

After conducting an initial examination and the necessary tests, your doctor may recommend further studies to confirm the availability of DVGPH and exclude other conditions.These tests may include:

1. Urodynamic examination.In this study, the patient is urinated in a container attached to a special apparatus that measures the strength and volume of the flow during urination.The results of the test help to monitor the dynamics of the development of the disease, determining whether your condition becomes better or better.
2. Test for the residual volume of urine.This test shows whether you can completely empty your bladder.The test can be performed using an ultrasound examination or by introducing a catheter into the bladder after helping to measure how much urine is left in your bladder.
3. Maintain a 24-hour urination diary.Registration of urination and the amount of urine can be especially useful if more than one third of your daily urination occurs at night.
4. Trarectal ultrasound.At the same time, the UZ-Zond is introduced into the rectum to measure size and evaluate the state of the prostate.
5. Examination of the bladder (cystoscopy).In this study, a flexible catheter with a camera at the end (cystoscope) is inserted into the urethra, allowing the doctor to see the inner surface of the urethra and bladder.
6. Prostate biopsy.Prostate tissue samples may be taken to exclude prostate cancer.

Treatment

There are many different options for treating prostate adenoma.You and your doctor have to decide which treatment is the most.Sometimes the combination of different procedures works best.Mild cases of DHCH may not need treatment.

The main types of treatment for prostate adenoma are:

• Active observation of the disease.
• Drug therapy.
• Small invasive surgery.
• Surgical interventions.
• Active monitoring.

If your doctor prefers this option, then your illness will be carefully monitored without using medication or surgical procedures.At the same time, you will be considered annually.If your symptoms worsen or new symptoms appear, your doctor may offer you active treatment.Men with mild symptoms can be good candidates for active monitoring.Men with moderate symptoms who do not bother them are also good candidates.

The advantage of this approach is that there are no side effects, but it is likely that it is more difficult to reduce the symptoms.

Medical therapy

Alpha blockers

Alpha blockers are medicines that relax the muscles of the urethra, prostate and bladder.They improve urine leakage and reduce the symptoms of DHCH while without affecting the prostate size.Alpha-blockers include alfusosin, terrazosin, doxazosin and tamsulosin.

One of the advantages of alpha blockers is that they start working immediately after acceptance.Side effects may include dizziness, fatigue and ejaculation problems.

Men from moderate to severe DGPZ and men who are worried about their symptoms are good candidates to start therapy with alpha blockers.

5-alpha reductase inhibitors

5-alpha reductase inhibitors are medicines that block the production of dihydrotestosterone, the male hormone that can accumulate in the prostate and cause its growth.These drugs lead to a decrease in prostate size and increase urine leakage.Such drugs include Fineorid and Dutasteride.

These drugs significantly reduce the risk of developing DHCH complications.They also reduce the likelihood of needing surgery in the future.Side effects include erectile dysfunction and reduction of libido (sexual urge).At the same time, you will need to continue to take tablets to prevent the symptoms of the disease from repeatedly on the onset of the disease.

Combination therapy

In combination therapy, alpha blockers and 5-alpha reductase inhibitors are used jointly.Possible combinations of drugs include finsteride and doxasosin or duasteride and tamsulosin.Your urologist may also prescribe a combination of alpha blockers and medicines called muscarinic receptors if you have symptoms of bladder hyperactivity.In hyperactive bladder, bladder muscles are uncontrolled and cause an increase in urination, sudden desires for emergency urine and urinary incontinence.Anti -mascarine drugs are medicines that relax the muscles of the bladder.

Combination therapy significantly improves symptoms and prevents worsening in the condition of DHGPH.However, it is worth remembering that any medicine can cause side effects.Taking two medicines, you can have more side effects than if you have only taken one medicine.

Alternative methods of treatment

Self -medication, the use of traditional medicine or treatment with the help of various herbs (herbal medicines) is not recommended for medical workers.Many studies show that the use of such treatment is not effective, and in some cases irreparable harm can bring.In addition, herbs and biologically active nutritional supplements (nutritional supplements) do not undergo the same process of testing as medicines.As a result, the quality and cleanliness of the supplements sold without a prescription can vary.

Small surgical interventions

Minimally invasive interventions are performed with minimal anesthesia and suggest a faster recovery.Quite often the procedure can be performed right in the doctor's office or at an outpatient center.

Immediate relief of the symptoms of the disease is the most important advantage of minimally invasive surgery.In many men, after minimally invasive intervention is performed, urine leakage and bladder control are improved.If you have problems with urination, obstruction of the urinary tract, bladder stones, blood in the urine, the presence of the residual volume of the urine in the bladder after emptying or not noticed the effect of medication, then the minimal invasive intervention may be the next step in the treatment of the disease.

However, it is worth knowing that any surgical interventions, including minimally invasive, have the risk of side effects, including:

• Urinary tract infections.
• Blood in the urine.
• Burn during urination.
• The need for more frequent emptying of the bladder.
• Sudden urination.
• Erectile dysfunction.

Minimally invasive surgery methods include:

1. Increasing prostatic urethra (or PUL methodology) - this procedure uses a special device to install small implants in the prostate gland.These implants are lifted above and keep the extended prostate in this position as the pressure on the urethra decreases and the leakage of urine improves.In this case, the destruction or removal of the tissue of the prostate gland does not occur.Pul can be done with both local and general anesthesia.Most patients notice an improvement in symptoms within 2 weeks.In some cases, pain or burning can occur with urination, blood in the urine, or a constant strong desire to urinate.Usually these side effects take place within two to four weeks.Good candidates for promoting prostatic urethra may be patients who have a history of other health problems or patients for whom surgery is of high risk.
2. Transurethral microwave thermotherapy (or TUMT method) - this procedure uses microwaves to destroy the prostate tissue.First, the doctor introduces a catheter through the urethra into the prostate gland and then sends microwaves built into the catheter to heat the selected sections of the prostate.High temperature destroys excess prostate tissue.This procedure usually does not require anesthesia, the risk of side effects is minimal.
3. The method of treating prostate pathologies with the help of water vapor convection ablation (Resum therapy) - This procedure uses heat to destroy the excess prostate tissue.In this case, the sterile water inside a special portable device is heated to a temperature just above the boiling point when it becomes steam.This hot steam then causes rapid cell death.Treatment can be performed in the doctor's office under local anesthesia.After the procedure, you may have an impurity of blood in the urine for a while, you will also need to use a catheter for a few days.The painful or frequent urination after the procedure should pass after about 3 weeks.Sexual side effects, such as erectile dysfunction, are unlikely.

Traditional surgery

Surgical interventions with the removal of part of the prostate tissue are performed with the ineffectiveness of other methods of therapy, with extremely expressed symptoms (for example, with complete inability to urinate).These include:

• Transurethral Prostate Resection (Turp)

  Turp is one of the most common DHC operations.During this surgery, after performing anesthesia, the surgeon introduces a special thin tool through the head of the penis into the urethra.Using this tool, the doctor eliminates the excessive tissue of the prostate gland.After the procedure, it is usually necessary to use a catheter for 1-2 days.The effect of such treatment usually lasts 15 years or more.Like any other surgery, TURP has side effects and anesthesia used in intervention, is associated with a certain risk.The side effects of TURP may include retrograde ejaculation, erectile dysfunction, urinary tract infection after surgery and urinary incontinence.Full recovery takes 4 to 6 weeks.

• Prostate laser enucleation

  With this intervention, the surgeon puts a thin instrument through the penis in the urethra.The laser placed in the instrument destroys excess prostate tissue.At the same time, as with transurethral prostate resection, no redundancies should be made.Recovery after laser enucleation is very fast, but then for a few days you may have an impurity of blood in the urine and frequent or painful urination.This procedure also requires anesthesia, which is associated with certain risks.

• Prostate removal operations

  Currently, prostate removal operations during DGPZ are extremely rare with the ineffectiveness of all other methods of therapy.Such operations are associated with significant risks and side effects, including urination, erectile function disorders and serious complications during surgery itself.

Complications

The lack of timely medical care in DGPG can lead to the development of serious complications, which include:

• Sudden and complete inability to urinate (delayed urine, anuria).In this condition, you may need to enter a catheter in the bladder to ensure that urine leakage is leaked from a crowded bladder.In some cases, surgery may also be required to reduce urine retention.
• Urinary tract infections.The inability to completely empty the bladder can increase the risk of infection in the urinary tract.
• Bladder stones.The stones in the bladder are also formed due to the inability of the bladder completely.Stones can cause the development of infections, irritation of the bladder, blood impurities in the urine and additional difficulties in the leakage of urine.
• Damage to the bladder.With incomplete emptying, the bladder can be stretched, which over time leads to a weakening of its muscle wall.As a result, the bladder becomes unable to compress properly, which becomes the cause of additional difficulties in emptying it.
• Kidney damage.Slowing urine can lead to an increase in bladder pressure and the opposite of urine outflow to the kidneys, which can lead to their direct damage or increase the risk of infectious diseases.Such complications are extremely serious and can remain for life.

In most men with increased prostate gland, these complications develop extremely rarely, but it should be remembered that many complications, including acute urinary retention or kidney damage, can pose a serious threat to your health and life.If any symptoms of the disease occur, consult a doctor immediately.

Diet and prevention of the development of prostate adenoma

Unfortunately, there is no reliable way to prevent the development of prostate adenoma, but the rate of prostate enlargement can lose weight from weight loss and proper nutrition with a high content of fruits and vegetables in the diet.This may be due to the fact that excess fat in the body can increase the level of hormones and other blood factors and stimulate prostate cell growth.Constant physical activity also helps to control the weight and level of hormones, thus reducing the risk of developing prostate adenoma.