Prostate adenoma - benign growths of glandular structures of the prostate, leading to difficulties in the outflow of urine from the bladder.
In this case, there is difficulty urinating and frequent visits to the toilet. In addition, the stream of urine becomes weaker, perhaps an involuntary discharge. In the later stages of the disease, chronic urinary retention develops. It leads to a general intoxication of the body and ESRD.
It is important to consult a doctor in time for the start of treatment, since the absence of such at the early stages, when the problem can still be solved with the help of pharmacotherapy, leads to the need for surgical intervention when the pathology passes to later stages of development.
The causes of prostate adenoma are not fully established. But it has been established that the main factor predisposing to this pathology is the age of a man. The older he gets, the higher is the probability of occurrence of this disease.
First of all, it is associated with age-related changes in the regulatory function of the endocrine system, which is responsible for the functioning of the sexual sphere. It is noteworthy that the cases of prostatic adenoma development were not recorded in castrated or oskoplennyh men. It is also known that the appearance of pathology is not affected by smoking, sexual orientation, sexual activity and other factors.
Adenoma is a disease that develops with the growth of a benign tumor of the glands surrounding the urethra and located in the prostatic urethra under the bladder.
In men older than 50 years, the probability of developing pathology is 50%, while in older persons it is even higher. Patients after 70% in 75% of cases experience this disease.
What is the difference between prostate adenoma and prostatitis?
Prostatitis and prostate adenoma are completely different concepts, which, however, many confuse with each other.
Prostate adenoma is called hyperplasia (enlargement) of prostate tissue. Prostatitis is an inflammatory process that affects this gland.
|Age features of occurrence||After 40-45 years, in young men almost never occurs||Age of the highest sexual activity - 20-42 years|
|Causes||Manifestations of androgynous insufficiency, manifested during the "male menopause"|
|Processes in the prostate gland||The formation and growth of nodes that compress the urethra||Inflammatory process in prostate tissue|
|Features of treatment||Conservative therapy with drugs, in the advanced stage - surgery (ectomy of the nodes of hyperplasia)||Therapy with anti-inflammatory and antimicrobial agents, analgesics|
Symptoms and first signs of prostate adenoma
Prostate adenoma is the same in all patients. The main symptoms may be irritative or obstructive.
For the first form is characterized by increased urination. In addition, the patient suffers from frequent urge to empty the bladder, urine incontinence and nocturia.
With obstructive prostate adenoma, the process of urination becomes more difficult, and the time of emptying the bladder increases. In addition, a man feels discomfort associated with a feeling of incomplete emptying of MP. In parallel, there is a discontinuity and weakening of the jet of urine, and straining during urination.
In modern urology, prostate adenoma is divided into 3 stages.
In the initial phase of the disease, the dynamics of urination changes. The urges become frequent, but the process itself becomes sluggish, less intense. The patient begins to feel the need to visit the restroom at night.
As a rule, in the first stage, the prostate adenoma does not cause a feeling of particular discomfort in the patient. As for nighttime awakenings, men often associate them with age-related insomnia.
In the daytime, the number of urination acts remains the same, but many men note the emergence of a so-called waiting period. It is especially pronounced in the morning.
Gradually, the number of urge to urinate will increase, and the amount of urine released, on the contrary, will decrease. Then the imperative urge to empty the bladder will begin to arise. It is noteworthy that if earlier the urine jet in a man formed a parabolic curve, then at the first stage of prostate adenoma development, it becomes sluggish, and differs in vertical fall.
Since at the first stage the hypertrophy of the muscles of the bladder occurs, the effectiveness of its emptying remains the same. At the same time, no urine is left in its cavity. The functional state of the kidneys and upper urinary tract also does not change.
Second stage (or subcompensated stage)
For the second stage of the development of prostate adenoma is characterized by an increase in bladder size. At the same time in its walls dystrophic changes begin to occur. Residual urine gradually accumulates in the bladder. At first, its volume is 200 ml, but over time it increases.
During urination, a man has to strain his abdominal muscles, which causes a sharp increase in intravesical pressure. The urination at this stage becomes multi-phase, intermittent and undulating.
As the pathology progresses, a failure in the passage of urine in the upper urinary tract may occur. Muscles lose their elasticity, and the urinary tract begins to expand. Against this background, the functioning of the kidneys is impaired.
Patients begin to torment the constant thirst, polyuria and other symptoms of chronic renal failure. In case of violation of the compensation mechanism, stage 3 of the disease occurs.
Third stage (decompensated stage)
This stage of prostate adenoma is characterized by an increase in the patient's bladder due to the large amount of urine accumulated in it. Identify this deviation is not difficult. This can be done visually or during palpation.
The upper boundary of the bladder can reach the navel, or reach a higher point. Even with intense pressure of pressing muscles, urination becomes impossible. In this case, the patient experiences a constant desire to empty the bladder. Because of the inability to do this, he suffers from lower abdominal pain, and urine is excreted in the form of drops, or in small portions.
Over time, the increased urge to urinate and pain subsides somewhat. Instead, the so-called paradoxical urinary retention begins to occur. It is characterized by the fact that the bladder overflows with urine, but it stands out only in the form of drops.
At the last stage of the development of the disease, the upper urinary tract expands, and the renal parenchyma is impaired. This failure occurs due to obstruction of the urinary tract, under the influence of which increases the pressure in the cup-pelvis system.
In the third stage, the symptoms of CKD are increasing, and in the absence of timely treatment, there may even be a lethal outcome.
Consequences and complications
When untreated prostate adenoma can develop complications in the form of:
- Acute urinary retention. This is a serious complication of pathology, accompanied by the inability to empty the bladder. Often such a deviation is observed at stage 2-3 of the development of adenoma. Often, acute urinary retention is observed during hypothermia, overwork, or prolonged sitting in a sitting position. To correct the situation can only catheterization of the bladder.
- Inflammatory processes - cystitis or pyelonephritis. These pathologies can only be avoided if the prostate adenoma is treated promptly.
- Concretions in the bladder. In case of incomplete emptying of the body, mineral deposits, stones, begin to form in it. It is possible to prevent their occurrence only if the urinary function is restored. If the stones are already formed, surgical treatment of prostate adenoma is performed, during which stones are also removed.
- Hematuria - blood impurities in the urine. With varicose veins of the bladder neck, a certain amount of red blood cells penetrates into urine. Erythrocyturia can be macroscopic, in which urine becomes red, and microscopic. In the latter case, red blood cells in the urine can be detected only in laboratory tests. Hematuria requires additional diagnostics aimed at eliminating the presence of tumors or calculi in the bladder.
To begin with, a digital prostate examination is performed, after which a smear from the urethra is taken, and a study of the secret of the prostate gland is also performed. This is necessary to exclude bacterial complications of the pathology.
Also, without fail, perform:
- Ultrasound examination, which allows you to determine the size of the prostate gland, to detect calculi and congestive processes in the bladder. In addition, the amount of urine remaining in the bladder is determined, and the functioning of the stoves and the urinary tract are also assessed.
- Uroflowmetry - a procedure during which the time of emptying the bladder and the flow rate of urine are measured. Manipulation is performed using a special sensor.
- Determination of the level of prostate-specific antigen (abbreviated PSA). This diagnostic procedure is necessary to exclude the development of cancer in the tissues of the prostate gland. The value of the indicators in the normal should not exceed the mark of 4 ng / ml of blood. If doubts arise about the reliability of the data, a prostate biopsy is performed.
- Cystography and excretory urography. However, these manipulations in recent years are carried out less frequently due to the emergence of new, minimally invasive, methods of ultrasound diagnostics.
In some cases, in order to differentiate prostate adenoma from other pathologies with similar symptomatology, cystoscopy is performed.
Prostate adenoma treatment
Treatment of prostate adenoma can be both conservative and surgical. The choice of therapeutic technique depends on the stage of the pathology:
- Thus, at the first stage of the development of the disease, patients are prescribed medications, and a mode of physical activity is being developed. In parallel, recommendations are made regarding the general lifestyle and nutrition. A prerequisite - refusal to smoke and alcohol, as well as exclusion from the menu of coffee. The occurrence of urination problems may require additional transurethral electroresection.
- At the second stage of pathology development, surgical removal of adenoma is recommended. As a rule, they resort to minimally invasive surgical approaches, or classical methods.
- The main objective of the treatment of the third stage of prostate adenoma is to ensure the complete outflow of urine and the elimination of the symptoms of azotemic intoxication. In this situation, a percutaneous puncture nephrostomy, cystostomy or other manipulations are performed. After that, all efforts are directed to the normalization of the work of the kidneys, liver, cardiovascular system. Only after that the question of surgical intervention is considered.
Important! Pharmacotherapy cannot completely cure the disease. Its main task is to slow down or completely stop the progression of the pathological process.
In case of prostate adenoma, they use:
- Alpha-blockers, which contribute to the expansion of the urethra. This, in turn, improves the flow of urine. To achieve a stable therapeutic effect, treatment should be carried out for at least six months. The first signs of positive dynamics are noted already after 2-4 weeks from the date of the start of taking the drugs. Basically, such drugs as Prazosin (daily dosage - from 4 to 5 mg), Doxazosin (from 2 to 8 mg per day), Alfuzosin (from 5 to 7.5 mg / day), etc. are prescribed. If after 3- 4 months of treatment does not give the expected results, the doctor should review the treatment regimen.
- Inhibitors of 5-alpha-reductase, which reduce the size of the prostate and stop its further growth. The drugs in this group act directly on testosterone, transforming it into dihydrotestosterone. Finasteride at a dose of 5 mg per day, or Duasterid, helps to cope with the pathology. These drugs are not associated with hormone receptors, so they do not have side effects inherent in hormonal medications. After 3 months of treatment, the prostate is reduced by 20%, after six months - by 30%.
Surgery is the most effective treatment for prostate adenoma today. Surgical intervention is indicated for the development of complications of the disease in the form of acute urine retention, renal impairment, secondary infection, etc.
In addition, the operation is assigned to patients suffering from subjective symptoms that significantly reduce the quality of life - incontinence, frequent urge to empty the bladder, etc. Today, the most effective are the following methods of surgical treatment of prostate adenoma.
Manipulation is performed under general anesthesia. During surgery, resection of the lobes of the prostate gland is performed.
This surgical technique is resorted to in the event that a large part of the prostate gland is affected, and the volume of residual urine is at least 150 ml.
In order to avoid postoperative complications, the intervention in most cases is carried out in 2 approaches. At the first stage, resection of certain zones of the prostate is performed, after which a fistula is formed, through which urine freely enters the urinal tract. At the second stage, the full-fledged outflow of urine is restored completely.
Transurethral resection (TUR)
This surgical method for the treatment of prostate adenoma is more gentle, since no incisions are made to the patient during the procedure. Manipulation is performed through the urethra.
Indications for such an operation are the mass of the urethra not more than 60 g and the amount of residual urine is less than 150 ml. During the procedure, only certain areas of the prostate are removed. After that, the patient is prescribed medications that will prevent its re-growth.
Despite the fact that TUR is considered a minimally invasive surgical technique, it is more likely than open prostatectomy to cause postoperative complications. Thus, patients may experience bleeding, urinary incontinence, bladder neck sclerosis, and other adverse effects of such an intervention.
Transurethral microwave therapy
The essence of this procedure is the introduction of a catheter into the urethra through which microwaves are fed. Under their influence, heating and coagulation of the pancreatic tissue occurs.
This technique is effective only for small adenomas. After surgery, a slight swelling may be observed, so a catheter is inserted to remove the urine from the patient.
Transurethral Laser Vaporization
A catheter is installed through the urethra, after which the tumor is exposed to a laser beam. Under his influence, water from overgrown tissues begins to actively evaporate, as a result of which they die. Due to this, the prostate is reduced in size.
Transurethral laser vaporization is used only for small gland growths.
Transurethral Needle Ablation
The procedure is performed using a cystoscope, through which the doctor inserts needles into the tissues of the prostate gland. Through these needles, radiofrequency waves are fed, under the influence of which the tumor heats up and collapses.
The technique is used for small tumors. Complications may be the same as with transurethral microwave therapy.
High-intensity focused ultrasound is a procedure during which, using a special probe, a small camera and an instrument that radiates an ultrasonic wave are inserted.
Ultrasound has a thermal effect, destroying abnormal tissue. After such treatment, patients may develop impotence (in 1-7% of cases).
A balloon is inserted through the cystoscope into the urethra, through which the lumen of the urethra expands. This technique is used with the ineffectiveness of conservative treatment of pathology, as well as in case of impossibility to carry out the operation.
The method is a bit similar to the previous one, but in this case a special stent is inserted into the urethra with which the normal flow of urine is ensured.
During the manipulation, liquid nitrogen is used to freeze neoplasm tissues, as a result of which they are destroyed. In order not to damage the healthy tissues of the urethra, a special heating element is placed in its zone.
Embolization of the arteries of the prostate gland
During the procedure, small plastic balls are used, which are inserted into the arteries of the prostate through a special catheter. Together with the bloodstream, they reach the small arterioles and close them tightly. Due to the lack of blood supply, the pathological tissues stop growing and then die.
What could be the consequences of surgery for prostate adenoma?
Surgical treatment of prostate adenoma can cause a patient to have complications in the form of:
- Bleeding during surgery. They occur in 2-3% of cases, and are the most serious consequence of surgical treatment. Many patients need a blood transfusion procedure.
- Bleeding after surgery, accompanied by the formation of blood clots, which subsequently disrupt the normal flow of urine. Such consequences can be eliminated only by repeated intervention, carried out by the endoscopic or laparotomic method.
- Stagnation of urine due to its delay. She, in turn, is happening against the background of the dysfunction of the muscular layer of the bladder.
- Infections of the genitourinary system (inflammatory processes in the testes and their appendages, prostate, kidney cups and pelvis, etc.). A similar complication occurs in 5-22% of cases.
- Violations of the process of urination, provoking even greater difficulties than were observed in the patient before. This complication is due to an abnormal excision of abnormal prostate tissue. This problem is solved only by repeated resection.
- Retrograde ejaculation, in which there are difficulties with the release of seminal fluid out due to its injection into the bladder.
- Erectile dysfunction. It occurs in 10% of patients, but is not always the result of surgical treatment of prostate adenoma.
- Narrowing of the urethral canal, which occurs in 3% of cases, and requires micro-invasive intervention using endoscopic techniques.
It is extremely rare for patients to experience urinary incontinence, which can also pass by itself. But only if it was caused by a disruption of the muscles of the bladder.
Prognosis and prevention
In order to avoid the development of prostate adenoma, men are recommended:
- avoid hypodynamia, which leads to stagnation of blood in the pelvic organs;
- adjust the diet to include easily digestible foods;
- avoid obesity;
- refuse to wear tight jeans, pants and underwear, which squeezes the genitals;
- avoid casual sex to prevent the development of STDs;
- after reaching the age of 40, regularly undergo prophylactic examinations by a urologist, and take a blood test for PSA for early detection and timely initiation of therapy for prostate adenoma.
The maximum restriction of the use of harmful products and the inclusion in the daily menu of food enriched with vegetable fiber, significantly reduces the risk of developing this disease. It is better to abandon strong tea and coffee in favor of natural juices, teas, or decoctions of medicinal plants — mint, lemon balm, chamomile, hibiscus, tea rose petals, etc. , steam or baked fat-free meat.
From when the disease was detected, depend on the prognosis for recovery. If the pathology was detected at an early stage of development, and treatment began immediately, the predictions are considered the most favorable. But they worsen sharply if you ignore the symptoms and postpone the visit to the doctor.
In severe cases, the development of CRF occurs, as well as the malignancy of adenoma, which leads to prostate cancer. The process of malignancy of the prostate gland is observed in the late stages of the disease, as well as ignoring the patient's recommendations of the attending physician regarding the treatment and prevention of prostate adenoma.