prostate adenoma - Causes, Symptoms and Treatment .MF .
Adenoma of the prostate or BPH - an outdated term, the disease is now classified as benign prostatic hyperplasia (BPH).The disease is characterized by the formation of several small nodules or nodule which is gradually increasing.BPH, unlike prostate cancer, a benign.This is one of the most common urological disease men after 50 years.
Causes of enlarged prostate is not completely clear.The main risk factor for BPH is age - the older the man, the greater the risk of developing adenomas.Young men prostate adenoma is very rare.This is due to age-related changes in endocrine regulation of male reproductive system caused by hyperplasia lacunar glands (neutered or castrated male cases of benign prostatic hyperplasia is not fixed).
scientifically based connection between the occurrence of BPH and sexual orientation, sexual activity, smoking, alcohol consumption, carried over sexually transmitted and other infectious diseases, chronic prostatitis, is not revealed.
adenoma develops as a result o
incidence as high as 50% in men over 50 years, increases in the later age groups and is the most common cause of bladder disorders.
Older than 70 years 75% of women in varying degrees, suffer from benign prostatic hyperplasia.It is believed that over time it develops in 85% of men.
Symptoms of BPH
What makes a man with BPH to seek medical help?First of all, it is the existence of problems with urination and sexual function, characteristic of this disease.Symptoms of adenomas are divided into obstructive and irritative.
Irritative symptoms as frequent urination, urgency and empty non-withholding of urine (in other words - symptoms of irritation), and they are determined by the degree of functional disorders of the neuromuscular system of the bladder.The man appears to get up 1-2 times during the night, which had never been observed.A major role in the formation of enlarged prostate symptoms is the presence of a concomitant inflammation in the prostate, occurs in 70-87% of patients.Concomitant chronic prostatitis appears dysuria, edema and prostate tissue - difficulty urinating.Furthermore, its presence leads to an increasing number of early and late postoperative complications.
in the formation of prostate adenoma symptoms attended detrusor dysfunction symptoms.Currently found that with age, resulting in hemodynamic and hormonal changes in men hypoxia bladder smooth muscle.This leads to a so-called unstable bladder irritative symptoms appropriate.
Thus, in the formation of clinical BPH participate pathological processes in the prostate and bladder, and is not always related to the actual prostatic hyperplasia.Consequently, not all patients require surgical removal of benign hyperplastic prostate.Moreover, in patients with moderate to severe obstructive symptoms after surgery significant improvement does not occur.
Clinical signs and symptoms of BPH are extremely varied and depend on the progression of the disease, physical and mental status, age, social status and health of the patient awareness.Until recently, most physicians believed that the symptoms are fairly typical of an adenoma and 3 correspond to steps (compensated, subclinical, decompensated).
For the first manifestations of BPH include a sluggish stream of urine, and delay the initial phase of urination, increased urgency and the emergence of urgency (not ending urination), especially at night.Over time, these symptoms are increasing, and there are complaints of difficulty urinating, the need to connect and tense your abdominal muscles to empty the bladder.Due to lower the tone of the detrusor in the cavity of the bladder residual urine appears.If the patient does not receive treatment, difficulty urinating becomes constant and predominant symptom.The volume of urine during urination gradually decreases from 200-250 to 30-50 ml urine stream becomes discontinuous, sometimes stands out drop by drop, there is involuntary, uncontrolled outflow of urine through the urethra.The tone of the detrusor is reduced so that the amount of residual urine reaches liters or more.
Unfortunately, men often view these symptoms as age and do not seek medical attention promptly.
complications of prostate adenoma
The course of the disease there are numerous complications: hematuria (urine, blood), acute urinary retention, a variety of inflammation to the damage of urodynamics of the upper and lower urinary tract.
hematuria prostate adenoma is very common and can be micro and macroscopic, initial, terminal and total.The appearance of it is due to venous hypertension in the pelvic vessels and varicose and sclerotic changes of the bladder neck veins.In the event of hematuria is necessary to exclude stones and bladder cancer, as well as the upper urinary tract tumors.
Acute urinary retention may occur at any stage of the disease.It is usually associated with hypothermia or hyperthermia, alcohol intake or impaired bowel function.
Inflammatory complications can come to the fore or aggravate the disease.Cystitis and pyelonephritis, appearing on the background of progressing urodynamics disorders become chronic and may lead to renal failure.Among other inflammatory complications of BPH should be mentioned urethritis, prostatitis, epididymitis, and vesicles.
greatest number of patients with prostatic adenoma has mixed symptoms, when the background of frequent urination day and night marked thinning of the urine stream, there is residual urine and chronic renal failure symptoms.Therefore, a complete examination of patients should be carried out in all cases.
diagnosis of BPH
Diagnosis of benign prostatic hyperplasia in typical cases is not difficult.In recent decades there has been a worldwide trend towards the formation of uniform principles for the evaluation and interpretation of BPH symptoms.In practice, urology fairly widespread division in the obstruction symptoms and irritative symptoms, ie, symptoms of irritation.All obstructive symptoms indicate compression of the bladder neck and prostatic urethral enlarged prostate and an inability to empty the latter, followed by the accumulation of residual urine.An extreme manifestation of this condition is paradoxical ischuria.Isolation of obstructive symptoms and determination of residual urine may serve as a basis for the preliminary presentation of the disease, treatment strategies and prognosis.They should aim at surgery.
Irritative symptoms of BPH:
frequent painful urination, frequent urination at night, urgency, inability to retain urine during urgency.
Irritative symptoms commonly attributed to changes in the function of the detrusor and sphincter of the bladder with prostate cancer.Irritative symptoms although significantly reduce quality of life, less dangerous and can be significantly reduced with proper conservative treatment.However, as a rule, obstructive and irritative symptoms in varying degrees may occur in the same patient, and there is no direct correlation between the severity of the symptoms and severity of the condition according to an objective examination.
Obstructive symptoms adenoma:
difficulty beginning urination, urine flow in patients with thin, "sluggish" and discontinuous.The patient is forced to make an effort for urination, said the feeling of incomplete bladder emptying.
Currently scale developed symptoms in the disease of the prostate (I-PSS), which quantifies the degree of severity of the patients themselves.This questionnaire, being extremely simple, widely supported urologists around the world.total symptom assessment system for prostate diseases (I-PSS) is a questionnaire, which is offered to fill in the patient.It must respond to 7 clear questions by selecting one of the six responses, depending on the severity of each symptom from 0 to 5 points.The sum score could range from 0 to 35 points.By results of the questionnaire, patients are divided into 3 groups: 0-7 points - with mild symptoms;8-19 points - moderate symptoms;20-35 points - with severe symptoms.
Compared to the American Urological Association, the percentage of those with severe symptoms predominates in Russia.
Physical examination includes a digital rectal examination compulsory.At the same time draws attention to the size of the prostate, symmetrical lobes, the presence or absence of seals, roughness or smoothness of the surface, pain research.Rectal examination of the patient is available for each physician in any conditions.For most men, each share corresponds to the size of the prostate nail phalanx of a finger.Iron freely circled a finger, it is uniform consistency, boundaries clear, easily differentiated from the surrounding tissue.The surface of the prostate smooth, rectal mucosa mobile, painless study. rectal examination is very important in terms of exclusion prostate cancer.It is important also to fulfill and external examination and palpation of the abdomen, as is often revealed chronic urinary retention or percussion (tapping his fingers) and by palpation (probing) is determined by the bladder.
In identifying benign prostatic hyperplasia is necessary to assess renal function: common urine analysis, biochemical blood tests for urea or creatinine, if possible - renal ultrasound to clarify the status of the upper urinary tract
for further examination in terms of surgical treatment of BPH is performed ultrasoundprostate rectal probe, uroflowmetry - non-invasive research method to fairly objectively assess the voiding parameters in individual patients, and, if indicated, cystoscopy and intravenous urography.
treatment of prostate adenoma
- minimally invasive (HIFU-therapy)
- operative (transurethral resection of the prostate, laser vaporization and so forth.)
main method of treatment of prostate adenoma is the operative method.It is indicated in all patients who have identified infravezikplnaya obstruction, and the success of the operation depends largely on the stage of disease and presence of complications.Unfortunately, a very large percentage of patients seeking help in the later stages of the disease in the presence of gross violations of urodynamics up to acute urinary retention and renal dysfunction.In such cases, for a successful radical operation requires long preparation.
primarily to normalize the flow of urine is performed cystostomy - creating external fistula bladder surgically.This simple operation in combination with anti-inflammatory treatment can significantly improve the condition of patients, normalization of kidney function and reduce postoperative complications.
absolute indications for surgical treatment of BPH:
- urinary retention (inability to empty the bladder after catheterization at least one attempt);
- repeated massive hematuria caused by BPH;
- renal failure caused by BPH;
- bladder stones due to BPH;
- recurrent urinary tract infections caused by BPH;
- large diverticula of the bladder caused by BPH.
radical surgery for prostate adenoma, a transurethral or open access, should be performed routinely after full clinical examination.
Many people are trying by any means to delay the operation, enthusiastically meeting every new tool for medical treatment of BPH.Often they are neglected relative indications for surgery and are absolute indications, one of which, the most common is the acute urinary retention.For this reason, almost every third patient with BPH treatment starts with overlay suprapubic urinary fistula for acute or chronic urinary retention. presence of bladder outlet obstruction is an indication for surgical treatment .
"gold standard" in the treatment of BPH worldwide is transurethral resection of the prostate.The use of epidural anesthesia has greatly reduced the number of contraindications for surgery.TOUR performed in patients who have prostate volume up to 60 cubic meters.When you see the larger volume, which is measured by the rectal ultrasound probe, is shown open surgery -. prostatectomy.
one time in the literature was carried out the idea of wickedness and non-cystostomy, although now we can safely say that a number of patients, this operation is absolutely shown.It is necessary to remove the patient's state of intoxication and urinary tract rehabilitation, as well as for patient preoperative preparation (heart, lungs, etc.).cystostomy effect exceeds all the inconveniences associated with the temporary presence of suprapubic drainage.
When patient treatment of acute urinary retention and the diagnosis of adenoma benign prostatic hyperplasia (after a rectal examination) duty surgeon is recommended to resolve the issue of the possibility of radical surgery in the near future.If there are no contraindications for TUR or prostatectomy should be possible to send the patient to the radical surgery faster.Not recommended bladder catheterization for more than two days, because there is infection of the urethra and bladder, significantly complicating the postoperative period.If there are contraindications to perform radical surgery (cardiovascular system, lungs, symptoms of renal failure, urinary tract infection) should be performed cystostomy may puncture and hold the appropriate preoperative preparation.
absolute indications for surgical treatment of BPH
Surgery remains the best and only choice for patients who have developed serious complications of BPH.However, analysis of long-term results after surgery shows that 25% of patients are not satisfied with the treatment, because many of the symptoms of the disease symptoms in them were.Almost every fourth patient after TUR notes frequent urination, 15.5% - do not hold urine, and residual urine is determined in 6.2% of patients.A marked reduction in symptoms after surgery observed mainly in patients with severe disease and severe obstructive symptoms.
Therefore defined the following absolute indications for surgery: urinary retention (inability to empty the bladder after at least one catheterization attempts), repeated massive hematuria due to benign prostatic hyperplasia, kidney failure due to BPH, bladder stones due to an adenoma,