The adenoma of prostate is a disease that starts in men in adulthood and is characterized by benign (benign) paraurethral glands.
The adenoma of the prostate may appear already at the age of 40-50 years. According to the who (world health organization) it is observed an increase of the disease, from 12% in men between the ages of 40 to 49 years of age to 82% in the 80 years. After 80 years of the adenoma of the prostate was found in 96% of cases.
The investigations led to the conclusion that the adenoma of the prostate the negroid race is more frequent, and the inhabitants of japan and china with less frequency. This occurs because of the way the power of the asian countries, in which there is a large number of phyto-sterols, which have properties preventive.
Anatomy of the prostate gland
The iron is found in the pelvis, between the rectum and the pubic Symphysis. Has the head shape of the chestnut. The weight of the prostate in men of 19 to 31 years of age, approximately 16 grams. Of iron in the standard is photoelasticity consistency. The prostate gland is to the right and to the left of fractions. The proportion of united by the isthmus. The isthmus of prostate want to the bottom of the bladder and in part extends into the lumen of the vesicle.
Through the prostate gland passes the urethra. He enters the gland at the base and exits from it earlier than the upper parts. The prostate gland supplied with blood from the cystic and directly the arteries. Vienna prostate constitute around of the brachial plexus.
Why occurs the adenoma of the prostate?
The causes of the development of benign prostatic hyperplasia until the end has not been studied. The studies scientists relate this disease with the age of man (years in men, the more they get sick adenoma of the prostate). At the age of the men very rarely get the prostatic hyperplasia.
With age, changes occur in the neuroendocrine regulation of prostate cancer (after the age of 40 in men the production of testosterone decreases, and secretion of estrogen increases).
There are a number of factors that increase the risk of development of adenoma of the prostate:
- Genetic predisposition (someone in the family was ill of the disease)
- Excess weight (leading to alterations in the metabolism and the endocrine regulation)
- The imbalance of the diet (eating excess salt, sharp, fatty foods).
The investigations have shown the influence of the sexual activity, tobacco use, alcohol consumption, infectious diseases in the development of benign prostatic hyperplasia.
The symptoms of benign prostatic hyperplasia
Symptomatic of a disease depends on the stage of the disease.
There are three stages of the disease
1 stage is characterized by the occurrence of complaints during the complete emptying of the bladder (stage of compensation).
2 phase is characterized by the great violation of work of the bladder in which, after urination is still considerable amount of urine (phase subcompensation).
3 phase develops complete dysfunction of the bladder with the phenomenon of paradoxical ischuria (selection of drops of urine-filled bladder).
All of the symptoms of the disease can be divided into obstructive (related to the difficulty of excretion of urine) and symptoms of irritation.
- Slow urine flow – the speed with which it separates the urine - descent.
- Primary delay of urination – urination does not occur immediately after the relaxation of the sphincter, and after a period of time.
- Should tighten the abdominal muscles – to make the urination patient falls significantly tighten the muscles of the abdomen.
- Intermittent urination – that is to say, the need to urinate during parties (in the standard urination occurs without interruptions until the complete emptying of the bladder).
- The output of the urine drop by drop at the end of urination (usually this does not happen)
- The sensation of not completely emptying the bladder (in the standard after urination men feel completely empty bladder).
That is a dangerous hypertrophy of the prostate?
The adenoma of the prostate can be:
- Acute urinary retention is a serious complication of the disease, which is characterized by the inability to apply the urination. This complication appears more frequently in the second or third stage of the disease. Typically, acute urinary retention develops after the hypothermia, exhaustion, or the long-term presence in the seated position. This complication is treated by catheterization of the bladder.
- Inflammatory processes, which are developed in the background of the adenoma of the prostate. Often they may develop cystitis (inflammation of the bladder) and pyelonephritis. Prevention of complications is the treatment of adenoma of prostate.
- The stones in the bladder – the mineral deposits that appear as a result of incomplete emptying of the bladder. The prevention of this complication is the solution of incomplete emptying of the bladder. If all the stones appeared, must carry out the surgical treatment of benign prostatic hyperplasia with the step of the removal of the stones.
- Hematuria – the appearance of red blood cells in the urine. Hematuria appears due to the no changes of the veins of the neck of the bladder. Hematuria can be macroscopic (red colored urine) and won by a single point (can only be installed in the laboratory). When this complication, you must exclude stones and tumors of the bladder.
The diagnosis of the disease always begins with the collection of the history. In 1997, in paris, at the meeting of the International committee on benign prostatic hyperplasia, is approved the standard algorithm for the diagnosis of patients with adenoma of the prostate. In this algorithm, it includes the total of the score of all the symptoms with a simple questionnaire called (IPSS) and the scale of assessment of the quality of life (QQL). For the evaluation of the IPSS and QQL use points. IPSS 0-7 points, it means the low severity of the symptoms. When 8-19 points moderate severity of symptoms, and 20-35 lifting of the symptomatology.
Also in this algorithm involves the completion of daily urination (frequency and amount), palpation (digital study) of the prostate and the various tools of diagnostic methods.
Palpation of the prostate (digital rectal exam of the prostate).
Palpation of the prostate allows you to determine the size, consistency, tenderness of the prostate (subject to availability of the chronic prostatitis).
The ultrasound scan. With the help of an ultrasound determine the degree of enlargement of the prostate. Evaluate the growth trend of the nodes, the presence of calcifications. Also, the ultrasound allows us to estimate the size of the kidneys, the presence in them of the various changes that accompany the urological diseases.
TRUS – transrectal ultrasound. This study allows to study in detail the structure of the prostate, accurate on its dimensions, as well as identifying the symptoms of chronic prostatitis or prostate cancer. ETR allows you to determine the development of the adenoma of the prostate and in the first few dates.
Very often patients with a very marked hyperplasia of the prostate determine the foci of calcification. The presence in the central zone of the prostate calcification says about the end (5) the stage of development of the disease.
Uroflowmetry– the method used for the measurement of the different features of the stream of urine. This method, you should carry out not less than 2-fold in conditions of filling of the bladder (150-350 ml), and occurs when the natural desire of passing urine. For the evaluation of the results using Uroflowmetry curve, the one that held the maximum speed of urine flow. The speed of flow, that exceeds the 15 milliliters per second, is considered normal. It also evaluates the total time of urination. The norm for volume of urine in 100 milliliters of 10 seconds, for 400 ml – 23 seconds.
Studies have shown that there is a relationship of indicators of urination of age. In the standard it is considered that the flow rate is reduced to 2 millimeters/second every 10 years. This decrease in speed is explained by the aging of the bladder wall.
The definition of residual urine after urination is of great value to determine the stage of the disease, as well as for the definition of indications for the prompt treatment. Residual urine is determined with the help of an ultrasound immediately after voiding. Lately Uroflowmetry combined with the definition of the residual urine.
Cystomanometry – method with which to determine the pressure within the bladder. This method allows to measure intravesical pressure at different stages of filling of the bladder, and also during urination.
In a healthy person's initial urgency in urination occurs when there is a bubble of 100 to 150 milliliters of urine, and the pressure is 7-10 inches of water column. When the capacity of the bladder is filled to 250 to 350 milliliters, urgency in urination abruptly and intensifies. When this normal intravesical pressure is 20 to 35 inches of water column. This reaction of the bladder is called normo-therapeutic.
The increase of the intravesical pressure (above 30 inches of water column) with the volume of the bubble from 100 to 150 milliliters speaks of hyperreflexivity (updated the reflex of the detrusor). And on the contrary a decrease of the pressure (10 to 15 centimeters of water column) during the filling of the bubble up to 600-800 ml speaks of the hypo-reflection detrusor. Reflexogenic detrusor, allows to evaluate the function of backup, and the relationship between the volume and pressure characterized elasticheskie the properties of the detrusor.
Cystography – the method of the research of the bladder with the use of contrast. There are descending and ascending cystography. Decreased cystography involves the movement of contrast from top to bottom. This method allows to determine the filling defect in the area of the neck of the bladder. In the capture of this filling defect is seen as the hillock. Ascending cystography allows to determine the deformation of the urethra in the prostate area.
The computed tomography and the nuclear magnetic resonance-the resonance – these studies offer more detailed information (the relationship with the neighbors of the act) of the adenoma of prostate.
The treatment of benign prostatic hyperplasia
The pharmacological treatment
Alpha-blockers adrenoceptor antagonist. These drugs decrease the tone of smooth muscle structures of the neck of the bladder and of the prostate, which leads to reduced urethral resistance during micturition. These medications, you must apply a length of more than 6 months. The therapeutic effect is observed in 2 to 4 weeks of the application of these drugs.
The treatment phyto-pharmaceuticals
The treatment of phyto-medicines are used the comes from antiquity. In recent times, these medications have become very popular in the european countries, japan and the united states.
One of the French drug of the fruit of the saw palmetto, which has an inhibitory effect of 5-alpha-reductase. It also has local anti-proliferative and anti-inflammatory effect.
Studies have shown that the continued use of the drug (for 5 years), leads to the decrease of the volume of the prostate and residual urine volume, and also relieves the symptoms of the disease. The tool is characterized by good tolerance and absence of side effects.
Of another medication, made from the fruit of a palm, Palmetto, has anti-inflammatory properties, antiexudative (prevents the pathological accumulation of fluid), anti-androgenic action (by inhibiting the 5-alpha reductase). The drug does not influence the level of sex hormones, does not change the level of the blood pressure, it does not affect sexual function. The treatment of phyto medicines go to the benign prostatic hyperplasia first-and second-degree.
The surgical treatment of benign prostatic hyperplasia
The surgical treatment can be carried out by the indications of an urgent or routine basis. Elective surgery is performed only after a complete examination of the patient.
The prevention of benign prostatic hyperplasia
- Journal of the mobility and physical activity (but without excessive loads). Physical activity reduces the risk of a stagnation of the processes in the pelvis.
- The healthy diet, which involves exclusion from the diet of acidic, salty, acute, smoked products. The obligatory nature of the presence in the diet of fruits and vegetables, as well as vitamins of all groups.
- The fight against the overweight (improves the metabolism in the whole body).
- To exclude the use of the in the area of the crotch of things: underwear pants.
- Exclude casual sexual relationships as a means of prevention of sexual infections.
If it is malignant adenoma of the prostate?
The adenoma of the prostate – neoplasm, benign, by definition. She not grows in neighboring tissues and does not metastasize.
However, with time, the adenoma of the prostate may be malignant. Is prostate cancer develops. Normally, the "first bell," signaling on the development of a malignant tumor, becomes the increase of blood levels of prostate-specific antigen. Finally help to confirm the diagnosis of the biopsy.
Prostate cancer, unlike adenomas, it is able to germinate in the surrounding tissues and metastatic spread. The success of the treatment largely depends on how early has already started.