BPH is a disease that starts in men in adulthood and is characterized by benign enlargement (hyperplasia) of the paraurethral glands.
Adenoma of the prostate may appear at the age of 40-50 years. The Who (world health organization) is the accumulation of disease, ranging from 12% for men aged 40 to 49 years 82% in 80 years. After 80 years of BPH occurs in 96% of cases.
Studies have led to the conclusion that adenoma of the prostate in black are more common, and the inhabitants of Japan and China often. This is due to the eating habits of Asian countries, with a large number of plant sterols, which have preventive properties.
Glands located in the pelvis between the rectum and the pubic symphysis. It is the shape, which resembles the chestnut. The weight of the gland in males from 19% to 31 years, with about 16 grams. Iron is normally photo elasticity consistency. The prostate gland consists of right and left lobes. The stock are interconnected by the isthmus. The isthmus of the prostate adjacent to the base of the bladder and partially into the cavity of the bladder.
Through the prostate passes the urethra. He comes from glands in roots, and goes out anteriorly to apex. The prostate gland is supplied with blood from the bottom of the cystic and the intestinal arteries. The veins of the prostate form a plexus around it.
What causes benign prostatic hyperplasia?
The causes of BPH are not fully understood. Scientific studies have linked the disease as men age (the older a person is, the more often they get sick adenoma of the prostate). Young men rarely develop prostate hyperplasia.
Age related changes in the neuroendocrine regulation of prostate cancer (after 40 years in men, testosterone production decreases, and the secretion of estrogen increase).
There are several factors that increase the risk of BPH:
- Genetic predisposition (someone in the family is sick with this disease)
- Overweight (leads to disruption of metabolism and the endocrine regulation)
- An unbalanced diet (eating too much salty, spicy, fatty foods).
Conducted the study does not prove the effect of sexual activity, Smoking, alcohol consumption, infectious diseases development of benign prostatic hypertrophy growth.
The symptoms of BPH
The symptomatic picture of the disease depends on the stage of the disease.
There are three stages of the disease
Stage 1 is characterized by the occurrence of complaints to the complete emptying of the bladder (stage of compensation).
2. stage is characterized by significant disturbances in the bladder after urination, which is a significant amount of urine (the stage of subcompensation).
Stage 3 developing a complete malfunction of the bladder the phenomenon of paradoxical ischuria (choice drops of urine in the full bladder).
All the symptoms of the disease can be divided into obstructive (related to obstruction of urine secretion) and signs of irritation.
Obstructive symptoms are:
- Weak urine flow – rate, which is excreted the urine the lower.
- The primary urinary retention – urination occurs immediately after the relaxation of the sphincter, and after a delay.
- You need to strain your abdominal muscles is to use the urination of the patient have to strain your abdominal muscles.
- Intermittent urination – that is, the urination part (normal urination occurs without interruption, until complete emptying of the bladder).
- Urine output drops at the end of urination (OK, this is not happening)
- The feeling of not completely emptying the bladder (normal after urination in men the feeling that the bladder is completely empty).
How dangerous is BPH?
BPH can be complicated:
- Acute urinary retention is a serious complication of the disease, which is characterized by the inability to urinate. This complication is most likely to occur in the second or third stage of the disease. Typically, acute urinary retention develops after exposure, overwork or long-term stay in a sitting position. This complication can be treated with bladder catheterization.
- Inflammation, which is developed on the background of BPH. Likely to develop cystitis (bladder infection) and pyelonephritis. Prevention of these complications is the timely treatment of BPH.
- Bladder stones – mineral deposits, which are due to incomplete emptying of the bladder. Prevention of this complication is to remove the incomplete emptying of the bladder. If the stones still appeared necessary to carry out the surgical treatment of BPH involves removal of the stones.
- Hematuria – the appearance of red blood cells in the urine. Hematuria appears due to varicose changes in veins of the bladder neck. Hematuria can be macroscopic (red urine), and microscopic (can only be installed in the laboratory). The appearance of this complication is necessary to leave the stones and bladder tumors.
Diagnosis of the disease always begins in the history of medicine. In 1997 in Paris at the meeting of the International committee on issues, benign prostatic hyperplasia, was accepted as the standard diagnostic algorithm for BPH. This algorithm involved a total score of all symptoms with a simple questionnaire called (IPSS) and rating scale quality of life (QQL). Evaluate and QQL IPSS use points. IPSS 0-7 points means a slight manifestation of symptoms. With 8-19 points – moderate symptoms, and 20-35 severe symptoms.
Also, this algorithm includes pre-voiding diary (frequency and volume), palpation (digital examination) of the prostate and the various instrumental methods of diagnosis.
Palpation of the prostate (prostate prostate).
Palpation of the prostate can be used to determine the size, consistency, tenderness of the prostate (in the presence of chronic prostatitis).
Ultrasound. With the help of ultrasound determine the level of enlarged prostate. To assess the direction of growth of the nodes, the presence of calcifications. Ultrasound also allows us to estimate the size of the kidneys, the presence in them of various changes, other urological diseases.
TRUS – transrectal ultrasound. This study gives us the opportunity to explore the structure of the prostate, its exact dimensions as well as identify the signs of chronic prostatitis or prostate cancer. Transrectal ultrasound examination allows to determine the development of BPH in a very early stage.
Quite often, patients with very severe hypertrophy of the prostate to determine the foci of calcification. The presence of the central zone of the prostate calcification to tell end (5) stages of the disease development.
Uroflowmetry is a method that can be used to measure different properties of the urine stream. This method is performed at least 2 times in terms of bladder filling (150-350 ml) and if the natural urge to urinate. Evaluate the results using the Uroflowmetry curve, which represents the maximum urine flow. The flow rate is more than 15 ml/s is considered normal. Will also be assessed throughout the period of urination. The norm for volume of urine in a 100 ml – 10 seconds 400 milliliters of 23 seconds.
Studies have shown that there is a dependence of the indicators of urination of age. The norm is that the speed of flow is reduced to 2 ml/second every 10 years. This reduction in speed is due to the aging of the bladder wall.
Determination of residual urine after urination is of great importance, to determine the stage of the disease, and to determine the indications for surgical treatment. Residual urine is determined by ultrasound immediately after voiding. Recently, the Uroflowmetry is combined with determination of residual urine.
Cystomanometry is a method through which to determine the pressure in the bladder. This method allows to measure pressure in the bladder at various stages of bladder filling and during urination.
In a healthy person starting the urge to urinate occurs when the bladder 100-150 ml of urine, the pressure is as large as 7-10 inches of water column. When the bladder volume is filled up to 250-350 ml, the urge to urinate increases sharply. In this case, the normal bladder pressure is 20 to 35 cm of the water column. This reaction is called the norm of the bladder reflex.
Increased bladder pressure (over 30 inches of water column) bubble, the number of 100-150 milliliters talks about hyper-reflexivity (increased reflex detrusor muscle). On the other hand, low pressure (approx. 10-15 cm water column) when the filling of the bladder 600-800 ml talking about the Hypo-a reflection of the bladder. Reflexogenic bladder can be used to assess its backup function, and the relationship between volume and pressure is characterized by the elastic properties of the bladder.
Cystography is a method for examination of the bladder using contrast. There is a descending and ascending cystography. Descending cystography involves the movement of contrast from the top down. This method allows to determine the filling defect in the neck of the bladder. In the picture filling defect is visible after a bump. Ascending cystography allows to determine the deformation of the urethra in the prostate region.
Computed tomography and nuclear magnetic resonance , these studies provide more detailed information (correlation between neighbouring authorities) about BPH.
For the treatment of BPH
Blockers alpha-adrenergic receptors. These drugs reduce smooth muscle structures of the neck of the bladder and prostate, which leads to a reduction in urethral resistance during voiding. These medications must be used long-term more than 6 months. The therapeutic effect occurs after 2-4 weeks the use of these drugs.
Treatment herbal medicines
Treatment herbal medicines have been used by people since ancient times. Recently these drugs have become very popular in Europe, Japan and the USA.
One of the French preparations the fruit of the American dwarf palm, which has an inhibitory effect on 5-alpha-reductase. The local is also has anti-proliferative and anti-inflammatory effect.
Studies have shown that long-term use of the drug (within 5 years), leading to significantly reduce prostate volume and residual urine volume and relieve symptoms. The tool is characterized by well-tolerated and no side effects.
Another drug, which is made from the fruit of the Sabal palm, is anti-inflammatory, anti-exudative (to prevent the accumulation of pathological fluid), antiandrogenic activity (by inhibiting the 5-alpha-reductase). The drug does not affect the level of sex hormones does not alter blood pressure, does not affect sexual function. Treatment with herbal medicines is performed hyperplasia of the prostate in the first and second degree.
Surgical treatment of BPH
Surgical treatment can be carried out for emergency or as planned. Surgery is performed only after a full examination of the patient.
Prevention of prostate adenoma
- Daily movement and exercise (but without undue stress). Physical activity reduces the risk of development of congestive processes of the pelvic.
- A healthy diet, which includes exclusion from the diet of sour, salty, spicy, smoked products. Mandatory presence in the diet of fruits and vegetables, as well as vitamins of all groups.
- The fight against excess weight (to improve the metabolism of the whole organism).
- Off wearing tight in the crotch area things: underpants, pants.
- Leave casual sex as a means of prevention of genital infections.
Whether malignant adenoma of the prostate?
Prostate adenoma – a benign tumor, by definition. It does not invade neighboring tissues and do not metastasize.
However, over time, BPH can become malignant. To develop prostate cancer. Usually the "first bell" that signals the development of malignant tumors is increased in the blood of prostate specific antigen. Finally, to help confirm the diagnosis a biopsy.
Prostate cancer, in contrast to adenomas, which can germinate in the surrounding tissue and to metastasize. Successful treatment depends greatly on how early it had begun.