Adenoma of the prostate is a benign tumor that develops from stromal or glandular epithelium of the prostate. The adenoma does not give metastases, however, you can that with the passage of time, to be reborn in adenocarcinoma (prostate cancer).
For many specialists, in speaking of adenoma of the prostate, prefer to use the term "benign prostatic hyperplasia", thus highlighting its growth in the background of the expressed dishormonal nature that occur in the prostate of the changes.
The causes of the development of the adenoma of the prostate
The exact answer to the question, why it is developed the adenoma of the prostate, to this day does not give you or one of the specialists dealing with the study of this disease. The fact that the hyperplasia of the gland common in men, as the vibrant, and a low sexual activity, smokers and non-smokers, abusers of alcohol and teetotal.
However, it is observed that the age and the level of male hormones a large influence on the frequency of appearance of adenomas. Also the development of the hyperplasia contribute to an inherited factor and sedentary life (observed in 60% of cases of adenomas). It has also detected that the adenoma is not developed to the castrated men, therefore, the castration of a time was proposed as one of the forms of treatment for bph.
Many experts believe that the direct cause of the development of the adenoma of the prostate, must be sought in the complex interaction of the cells of the prostate between them, a change of the sensitivity to the effects of hormones, etc
The stage of the disease based on the symptoms
Modern medicine allocates 4 stages of development of benign prostatic hyperplasia.
First stage: offset form
It is gradually increasing, the prostate gland starts to over compress the urethra, which directly affects the nature of micturition: the urine begins to be separated with difficulty, and weak stream.
Second stage: occasional
At this stage of the bladder to empty completely, and the amount of urine that remains after urination, reaches 1-2 glasses.
The characteristic symptoms of this stage:
- the increase in the volume of the bladder,
- the need to push during the whole urination,
- the stream of urine is separated slowly, in waves,
- due to the presence of periods of rest, when the urine is not separated, the whole act of micturition extends over several minutes.
Third stage: decompensation
Little by little, the body loses the ability to resist the enormous amount of urine that remains constantly due to the increase of adenoma of the prostate. The bladder is distended, so that practically it has not been reduced, and helps to expel urine to the outside, even effort during the act of urination is almost not help.
Fourth stage: terminal
With the progression of the injury process occur are not compatible with the life phenomenon of the renal insufficiency: there is a drastic violation of vodno-elektrolitnogo balance, the increase in the content of nitrogen in the blood, and the person dies of uremia.
The complications of benign prostatic hyperplasia
Even in the early stages, when the prostatic hyperplasia is still relatively low, and the violation of urination by insignificant it was, at occasions may occur retention acute urination or blood in the urine (hematuria). In the future the adenoma of the prostate may increase the education of the stones or of the accession of the infection of the urinary organs. Let's look at some types of complications in more detail.
Acute urinary retention
Acute urinary retention is the state, when it is totally impossible to urinate when crowded to the bladder. It occurs more frequently in the second and third stages of the disease.
The stones of the bladder
Are formed in the stages of development of adenomas, when the bladder starts to remain sufficiently large, the volume of urine. The other way is the migration of the stone from the kidneys of the urteres and the impossibility of its output through the reduction of the lumen of the urethra.
The symptoms of the presence of the stone in the bladder:
- increase in the frequency of urination,
- pain in the area of the head of the penis, the increase in the movement, walking, and disappear in a horizontal position,
- newspaper of the occurrence of the symptom "enganchamiento of the stream of urine".
- the pyelonephritis,the
- epididymoorchitis, etc
Often, the evolution of the infection contribute to the fenmenos stuck in the bladder, as well as the catheterization.
The development of renal failure
It is characteristic of the third and terminal stage of development of adenomas and is associated with a decrease of the formulation of the urine out of the kidneys.
1. Stage hidden in the manifestations periodic dryness of the mouth, weakness, to the delivery of an analysis, sometimes a small violation of the electrolytes of the blood.
2. Payment stage: increased urination, changes in blood tests (increased levels of urea, creatinine).
3. The phase of decompensation:
- dryness in the mouth,
- decreased appetite,
- the general weakness,the
- the decrease of the immunity, which is manifested in the heavy weight over the current conventional of the diseases of cold,
- tremor of the fingers,
- contractions of the muscles,
- pain in the bones and in the joints
- the dryness of the skin,
- bad breath,
- in blood — increased urea, creatinine.
Stress, disorders of the diet, excess physical burden exacerbation of the manifestations of renal failure.
4. Terminal stage:
- the violation of a night's sleep,
- the failure of the conduct,
- psychomotor retardation,
- the emotional lability,the
- the smell of the urine of a sick person,
- the belly swollen,
- the decrease in temperature (hypothermia),
- itching in the skin,
- color grey yellow of the skin and face,
- foul-smelling stools,
- changes in almost all the internal organs and the nervous system due to phenomena of uraemic intoxication.
The diagnosis of adenoma of the prostate
Integrated diagnosis of adenoma on the basis of survey data of the patient, urology of the inspection and an additional series of laboratory-instrumental methods of the survey.
The examination urological
In addition to the external inspection of the genital organs includes the compulsory requirement of a study of the prostate through the rectum.
The methods of laboratory
As a general rule, are assigned: urine analysis, kidney samples, analysis of blood for the determination of antigen, as well as histologically adenoma tissues (if necessary).
The instrumental methods
Most often for the diagnosis of adenoma of the prostate, are used the following methods:
1. The ultrasound scan.
2. X-ray methods.
The treatment of benign prostate hyperplasia
Currently, there is no single method of treatment of benign prostatic hyperplasia, as each case is necessary to take into account many factors, for example:
- the general condition and age of the patient,
- your consent for the operation,
- the phase of an adenoma,
- concomitant diseases,
- the degree of involvement of urodinamiki,
- if there are signs of prostate cancer,
- the possibility of having or of another institution.
In general, adenoma of the prostate gland can be treated as a conservative and quickly. The use of one or the other method of treatment depends on the stage of development of the adenoma:
- A first phase. Normally, at this stage of the prostatic hyperplasia is conservative through: are assigned to medications that are given recommendations on the mode and style of life — lead a lifestyle that is physically active, avoid the consumption of spices and other irritants, cold meats, eliminate alcohol, coffee. If you have trouble urinating, it may be recommended to transurethral electrical resection.
- The second phase. The gold standard of the assistance in this stage — the removal of the adenoma with the operation, using a variety of minimally invasive and classical methodology.
- The third phase. Here the main objectives is to ensure a good flow of urine, to remove the intoxication. In this case the use of the puncture nephrostomy, cystostomy, etc Following normalized state of the liver, the kidneys, the cardiovascular system, and then decide the question of a possible future, the line of treatment.
The pharmacological treatment
Medications used for the treatment of the adenoma, they do not give rise to their total disappearance. It is necessary to apply continuous, regular, otherwise, the adenoma will begin to make progress. Usually prescribed drugs of the following groups:
1. The drugs relaxing the tonus of the smooth muscles in the area of the neck of the bladder and of the prostate, which leads to a weakening of the pressure on the urethra and the relief of reflux of urine to the outside. Is a alpha-blockers long-term (prolonged) and of short duration.
2. Medications that block the conversion of testosterone to active form and thereby reduce the volume of the prostate (blockers of the 5-alpha-reductase).
3. To herbal. Today, herbal preparations account for the low yield and lack of proven clinical effect in many european countries and the united states for the treatment of adenomas are not used. However, in some countries are assigned herbal remedies. It is believed that they have an anti-inflammatory action, reduce the swelling, they block the conversion of testosterone into an active form and stops the growth of adenomas.
4. Combined means. At present, the "golden rule" is the set of administering medications to the first two groups, in the period of 3-4 years of age. This allows, almost immediately, improve urination and after several years in a room to reduce the volume of the prostate.
In parallel, we performed the treatment of co-morbidities — cystitis, prostatitis, pyelonephritis, urethritis.
Operational and treatment methods
They are radical in the methods of treatment of adenoma of prostate, and are widely used in urology. Them concern:
1. Open adenomectomy. It can be run in several ways, the most well-known of which is the adenomectomy. Through the normal a surgical incision will be guaranteed access to the prostate and is effected its removal. As a general rule, it is used in case of impossibility of the use of less traumatic methods.
2. Endoscopic surgery. All of them are made with the help of surgical instruments, supplies directly into the urethra under the control of video equipment. Them concern:
- transurethral resection of the prostate (TURP), which is the "gold standard" surgical treatment of adenomas — in the moment of your celebration through the urethra a special tool is doing the cutting and cut the tissue of the prostate;
- transurethral electro-vaporization — all related to the access to the prostate through the urethra, and then with the help of the power of the fabric will be heated to high temperatures, and evaporate, and small blood vessels form a structure;
- transurethral incision — in the area of the prostatic division of the urethra to make the cut, thanks to the lumen of the urethra extends, this operation is effective in the case of adenoma of small size.
3. Embolization of the arteries of the prostate. This operation is performed by the vascular surgeons and boils down to the fact that the arteries of the prostate obstruct special polymer, ensuring access to them through the common femoral artery.
4. Cystotomy. It is used as an intermediate stage of treatment to relieve the organs of the urinary tract, in excess of the amount accumulated in the urine in an emergency order and remove the poisoning.
Although surgical treatment is the best and often the only method of successful treatment, there are a number of complications, which include:
- incontinence of urine,
- the formation of adhesions in the ureter or its merger,
- increase in the frequency of urination,
- the preservation of large amounts of volume of residual urine,
- shot of semen in the bladder,
- impotence, etc
The most well-known among them:
- Balloon dilatation of the prostate (narrowed of the expanded balloon).
- The placement of stents in the urethra (in the area of narrowing is inserted a sufficient elastic element, which prevents the narrowing of the lumen of the urethra).
- The evaporation of the tissues of the prostate microwave — zone of coagulation.
- Kriodestruktsiya (freezing of the prostate tissue and subsequent necrosis).
- The evaporation of the tissues giperplazirovannah breast ultrasound of high frequency.
- Transurethral needle ablation of the prostate are installed small needle, and then influencing radio waves, heat up and damage the tissues of the prostate.
- The removal of the tissues of the prostate with laser.
All of these methods occupy a position intermediate between the medicines and the surgical treatment, and are used to the relatively quick recovery of urinating with the least side effects and better tolerability.
The style of life
Everyone who suffers of hypertrophy of the prostate, it is recommended to periodically make special exercises that improve the circulation of the blood to the organs of the pelvis and hinder the stasis of the blood, for example, "walking on the buttocks" in a matter of minutes.
It is also necessary to normalize your weight, while in the daily diet of food to introduce foods rich in zinc and selenium — sardines, salmon, herring, pumpkin seeds, buckwheat and oat flour, olive oil, celery and parsnips.