BPH in men: symptoms, treatment

Prostate adenoma — benign tumor that develops in the stroma or the glandular epithelium of the prostate. Actually, the tumor has not spread, but can over time turn into adenocarcinoma (prostate cancer).

Many experts, speaking about the BPH, I prefer to use the term "benign prostatic hyperplasia", thus emphasizing its growth against the background of significant dishormonal nature of what is happening in the prostate gland changes.

Prostate adenoma

The reasons for the development of BPH

The exact answer to the question, why is the development of BPH, today does not give any one of the experts studying this disease. The fact that hyperplasia of the glands occurs in men as violent, and low sexual activity, smokers and non-smokers, drinkers of alcohol and nondrinkers.

However, it is seen that the age and the level of male hormones very much affect the incidence of adenomas. Also the development of hyperplasia contribute to hereditary factors and lack of exercise (reported in 60% of cases of adenoma). The survey also showed that BPH does not develop in castrated men, therefore, castration at one time was proposed as one of methods for the treatment of BPH.

Many experts believe that the direct cause of the development of BPH should seek a complex interaction with the cells of the prostate with each other, changing their sensitivity to the effects of hormones, etc.

The stage of the disease depending on the symptoms

Modern medicine distinguishes 4 stages in the development of benign prostatic hyperplasia.

The first step: the compensated in the form of

Gradually increasing, the prostate begins to squeeze the urethra, which directly affects the nature of urination: urine began to stand up with some difficulty and languid stream.

Second stage: repeated violations

At this stage the bladder is not completely emptied already, and the amount of urine left after urination, to achieve the 1-2 glasses.

The characteristic symptoms in this stage:

  • increase the volume of the bladder
  • the need to push when urinating,
  • the flow of urine excreted in bursts, waves,
  • due to the presence of rest periods, when urine is not released, the entire act of urination takes several minutes.

Third step: failure

Gradually the body loses its ability to resist huge amounts of urine, which is constantly on, because of the increased BPH. The bladder is expanded so that almost no shrinkage, and no help to expel the urine out, while straining during the act of urination is unlikely to help.

Step

The fourth step: the terminal

As the progression of the pathological process arising not compatible with life phenomena of renal insufficiency: there is a sharp violation of vodno-elektrolitnogo balance, increased concentration of nitrogen in the blood, and people die from uremia.

The complications of benign prostatic hyperplasia

Even at the initial stage, when the hypertrophy of the prostate is still relatively small and insignificant violation of urination, sometimes can be acute urinary retention or to show blood in the urine (hematuria). In the future, BPH can be complicated by stone formation or accession to the infection of the urinary organs. Consider some a variety of complications in more detail.

Acute urinary retention

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

Bladder stones

Formed in the stage of development of the adenoma, when the bladder begins to be quite a large amount of urine. The second way is the migration of kidney stones in the ureters and the impossibility of its output through the narrowed lumen of the urethra.

Symptoms of stone in the bladder:

  • frequent urination,
  • pain in the penis head, aggravated by movement, walking and disappearing in a horizontal position,
  • the periodic appearance of symptoms ", making the flow of urine".

Infectious complications

These are:

  • pyelonephritis,
  • epididymitis,
  • prostatitis,
  • cystitis,
  • the urethra,
  • epididymo orchitis, etc.

Often the development of infection contribute to congestion of the bladder, and catheterization.

The development of renal failure

Typical of the third and terminal stage of development of the adenoma and is associated with the decline in production of urine in the kidney.

Symptoms:

1. Step hidden manifestations: regular, dry mouth, weakness, testing — sometimes a small violation of the blood electrolytes.

2. Compensation stage: increased frequency of urination, changes in blood tests (urea, creatinine).

3. In the stage of decompensation:

  • dry mouth,
  • loss of appetite,
  • nausea,
  • vomiting,
  • fatigue,
  • General weakness,
  • reduced immunity, which is manifested in the more severe during the usual colds,
  • with trembling fingers,
  • muscle twitching,
  • pain in the bones and joints,
  • dry skin,
  • bad breath,
  • in the blood — the blood urea, creatinine.

Stress, irregular diet, excessive physical exertion aggravate the symptoms of renal failure.

4. End-stage:

  • sleep at night,
  • inappropriate behavior,
  • drowsiness,
  • emotional lability,
  • the smell of urine in the patient,
  • abdomen distended,
  • the temperature drop (hypothermia),
  • skin itching,
  • gray-yellow color of the skin and face,
  • foul-smelling stools
  • stomatitis,
  • changes almost all the internal organs and the nervous system, because the phenomena of uraemic intoxication.

The diagnosis of BPH

A comprehensive diagnosis of adenoma is based on the survey data of the patient, urological research, and a number of other laboratory and instrumental methods of research.

Urological research

In addition to the external inspection of the genitalia there must be examination of the prostate through the rectum.

Laboratory methods

Usually appointed by: urinalysis, renal tests, tests, determination of antigen and histological examination of the tissues of adenoma (if necessary).

Instrumental methods

Most often, the diagnosis of BPH using the following methods:

1. Ultrasound.

2. X-ray methods.

3. Urofloumetriya.

4. Urethrocystoscopy.

Treatment of prostate benign hypertrophy

Currently there is not a single method for the treatment of benign prostatic hyperplasia, because in each case it is necessary to consider many factors, for example:

  • The general condition and age of the patient,
  • his consent to the operation,
  • step adenoma,
  • the basic disease
  • the degree of impairment of urodynamics,
  • are there any signs of prostate cancer,
  • the possibility of the hospital.

Usually adenoma of the prostate can be treated as conservatively and efficiently. The choice of treatment depends on the stage of development of adenoma:

  1. In the first step. Usually at this stage, the prostatic hyperplasia is treated with a conservative: the name used for medications, recommendations for care and lifestyle leads to a physically active lifestyle, avoid eating spices and other irritating foods, smoked meats, eliminate alcohol, coffee. If you have difficulty in urination may be recommended transurethral electrical resection.
  2. In the second stage. The gold standard help at this stage — the removal of the adenoma surgery using different minimally invasive and classic techniques.
  3. The third step. Here the main task is to ensure good drainage of urine to remove toxicity. In this case, use puncture nephrostomy, cystostomy, etc. to normalize the condition of the liver, kidneys, cardiovascular system, and then decide it is possible to further surgical treatment.
Medication

Medication

Drugs used to treat adenoma does not lead to its complete disappearance. They must be applied permanently, regularly, otherwise the adenoma begins to progress. In general, the drug provisions of the following groups:

1. Medications to relax the smooth muscle tone of the bladder neck and prostate, which leads to ease the pressure on the urethra and ease the flow of urine outside. This is an alpha-adrenergic receptor blockers on long-term (long-term) and short-acting.

2. Drugs that block testosterone and its active form and thereby reduce the volume of the prostate (inhibitors of 5-alpha-reductase).

3. Herbal remedies. Currently, herbal medicines, because of the low efficiency and lack of proven clinical benefit in many of the developed European countries and the united states for the treatment of adenoma is not used. However, several countries have addressed the institution's funds. They are believed to have anti-inflammatory effect, reduces swelling, prevents the conversion of testosterone to its active form and stops the growth of adenoma.

4. The combined funds. Currently, the "gold standard" is co-medication of the first two groups 3-4 years. This allows almost immediately to improve urination and a few years after the quarter to reduce the volume of the prostate.

Is carried out in parallel treatment of opportunistic diseases — cystitis, prostatitis, pyelonephritis, urethritis.

Operative treatment

Are radical methods of treatment of benign prostatic hyperplasia and is widely used in urology. These are:

1. Open adenomectomy. It can be performed in different ways, the most famous of which is adenomectomy. Through a conventional surgical incision allows access to the prostate gland and made its removal. Usually used in the event that the impossibility to use less traumatic methods.

2. Endoscopic surgeries. They all performed using a special surgical instrument, which is entered directly into the urethra in the management of video equipment. These are:

  • transurethral resection of the prostate (TURP), which is the "gold standard" surgical treatment of adenoma — its implementation during the course of the urethra through a special tool to slit and cut the prostate tissue;
  • transurethral electro-vaporization — all access to the prostate through the urethra is provided, and then use the current fabric is heated to a high temperature and to evaporate, and small blood vessels form a network structure;
  • transurethral incision of the prostate Department of the urethra to do the surgery, so that the lumen of the urethra widens, this function is effective in the case of adenomas of small size.

3. Arterial Embolization of the prostate. This operation is performed with a vascular surgeon and must ensure that the artery of the prostate is sealed with a special polymer, which provides access through the femoral artery.

4. Cystotomy. Intermediate stage of treatment can be used to relieve the organs of the urinary tract excessive amounts of accumulated urine urgently and to remove toxicity.

Action

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

  • urinary incontinence,
  • the formation of adhesions of the ureter or the merger,
  • frequent urination,
  • the preservation of a significant amount of residual urine volume
  • reflux of semen into bladder
  • impotence, etc.

Bezoperatsionnye methods

The most famous of them:

  1. Balloon dilatation of the prostate (expand the narrowed area balloon).
  2. Stenting of the urethra (the area of narrowing is set sufficiently elastic element, which prevents the narrowing of the urethra).
  3. Evaporation of the prostate microwave — microwave coagulation.
  4. Cryosurgery (freezing the prostate tissue and subsequent necrosis).
  5. Evaporation of the tissues giperplazirovannah gland with ultrasound of high frequency.
  6. Transurethral needle ablation of the prostate needle set small, and further, the influence of radio waves to heat and destroy prostate tissue.
  7. Destruction of prostate tissue by laser.

All of these methods occupy an intermediate position between the medical and surgical treatment, and is used by a relatively quick recovery urination with less side effects and better tolerability.

A way of life

To all who suffer from BPH, it is recommended to regularly perform special exercises, which improve blood circulation in the pelvic organs, preventing stagnation of blood, for example, "walking on the buttocks" for a few minutes.

It is also necessary to normalize the weight and the daily diet use of foods rich in zinc and selenium — sardines, salmon, herring, pumpkin seeds, buckwheat and oatmeal, olive oil, celery and parsnip.