MR Picture of prostate hyperplasia. Treatment of benign hyperplasia of prostate gland depending on the stage

The growth of iron fabric and stroma of the transition zone of prostate, leading to an increase in the organ. Prostate adenoma may cause urinary disorders: a weak urine stream, a sense of incomplete emptying of the bladder, frequent or night urges, paradoxical ichuria. The diagnosis is established according to the level of the PSA, CRUSS, UROFLUMETRY, and IPSS symptoms evaluation questionnaire. Treatment correlates with the volume of glands, age concomitant pathology and severity of symptoms: apply waiting tactics, drug therapy, operational interventions, including minimally invasive techniques.

General

adenoma Prostate, DGPA, DGP) - The general world problem with which one third of men is facing over 50 years and 90% of patients who lived up to 85 years. According to statistics, about 30 million men have urinary dysfunction associated with DGPA, and this figure is increasing every year. Pathology is more common in African Americans with an initially higher testosterone level, 5-alpha-reductase activity, growth factors and expression of androgen receptors (population feature). The inhabitants of Eastern countries, prostate adenoma register less often that, apparently, is related to eating a large number of products containing phytosterols (rice, soy and its derivatives).

Causes of DGPH

Obviously, prostate adenoma is a multifactorial disease. The main factor is a change in the hormonal background associated with natural aging in the normal functioning of the testicles. There are many hypotheses explaining the mechanisms for the development of pathology (the theory of stromal epithelial relationships, stem cells, inflammation, etc.), but most researchers as a fundamental consider hormonal theory. It is assumed that the age prevalence of dihydrotestosterone and estradiol stimulate specific receptors in the gland, which are triggered by cell hyperplasia. Additional background risk factors include:

• Overweight / obesity. The accumulation of adipose tissue, especially in the abdomen, is one of the indirect causes of an increase in prostate. This is due to the reduced testosterone level in men suffering from obesity. In addition, during hypoandroidity, the amount of estrogen increases, which increases the activity of dihydrotestosterone, which contributes to hyperplasia.
• Diabetes. The high level of glucose and insulin resistance accelerate the progression of DGP. The level of glucose at SD is higher not only in the blood, but also in all cells of the prostate, which stimulates their growth. In addition, diabetes mellitus leads to damage to blood vessels, including prostate gland, resulting in an increased prostate. A number of studies demonstrate that among men with diabetes and elevated levels of low density lipoproteins, the DGPA is revealed 4 times more often.
• Features. Eating with a high fat content increases the likelihood of prostate hyperplasia by 31%, and the daily inclusion in the diet of red meat is 38%. The exact role of fatty food in the occurrence of hyperplastic processes is unknown, presumably, it contributes to a hormonal imbalance associated with DGP.
• Heredity. Of course, genetic predisposition is of particular importance: if the male's relatives of the first line, the prostate adenoma with pronounced symptoms was diagnosed early, the risk of its development in the subsequent generation of men increases.

Pathogenesis

Testosterone in the body of men is contained in various concentrations: its level is greater, in the prostate - less. In the age men there is a decrease in testosterone levels, but the level of dihydrotestosterone remains high. A significant role belongs to the prostate enzyme 5-alfeductase, thanks to which testosterone proceeds to 5-alpha dihydrotestosterone. It is most sensitive to the most sensitive androgenic receptors and DNA nuclei of prostate cells, which stimulate the synthesis of growth factors and brake apoptosis (violation of the programmable processes of natural diefing). As a result, old cells live longer, and new ones are actively divided, causing the proliferation of fabric and the growth of the adenoma.

An increased prostate contributes to the difficulty of urination against the background of the narrowing of the prostatic part of the urethra (especially if the growth of the adenoma is directed inside the bladder) and an increase in the tone of smooth muscle fibers of stroma. At the initial stage of pathology, the state is compensated by the strengthened work of the detruder, which is straining, allows the urine to be evacuated completely.

With progression, morphological changes of the bladder wall appear: a portion of muscle fibers is replaced by connective tissues. The capacity of the organ gradually increases, and the walls become thinner. The mucous membrane also undergoes changes: typical hyperemia, trabecular hypertrophy and diverticulus, erosive ulcenes and necrosis. When the secondary infection is acceded by cystitis. Benign hyperplasia of prostate and urine stagnation leads to the reverse current of urin, cystolithiasis, hydronephortic transformation of kidney and CPN.

Classification

Diagnostics

There is a special questionnaire designed to evaluate the severity of the symptoms of the obstruction of the lower urinary tract. The questionnaire consists of 7 issues related to the common symptoms of benign prostatic hyperplasia. The frequency of each symptom is estimated on a scale from 1 to 5. When summing, the total assessment is obtained, which affects further treatment tactics (dynamic observation, conservative therapy or operation): from 0-7 - weakly pronounced symptoms, 8-19 - average, 20- 35 is a serious problem with urination. Instrumental and laboratory diagnostics with DGPH includes:

• Ultrasound.Truys and transabdominal ultrasound prostate and bladder - complementary imaging methods. Ultrasound examination is performed twice - with a bladder filled with a bladder and after the urination act, which allows determining the amount of residual urine. Asymmetry, density, heterogeneity of the structure, enhanced blood supply to the prostate indicate the adenoma.
• Radiography. With radiological diagnosis (excretory urography, cystography), it is not only possible to determine the size of the prostate, but also to evaluate the function of the kidneys, anomalies of development, diagnose the pathology of the bladder, urethra. Research implies intravenous administration Contrast substance.
• Urodynamic studies. Warofloumometry is a simple test for estimating urine flow, graphically shows the rate of bladder release and the degree of obstruction. The study is performed to determine the indications for surgical treatment and tracking the dynamics against the background of conservative therapy.
• PSA study. The prostatecific antigen is generated by the cells of the organ capsule and the periurethral glands. In patients with a benign prostate hyperplasia and prostatitis, the PSA level is increased. The result is influenced by many factors, so one analysis cannot be installed on one analysis.
• Urine tests. In men with adenoma, prostate often diagnose the accompanying inflammation of the bladder, kidneys, therefore, they pay attention to the signs of inflammation - leukocyteuria, proteinuria, bacteriuria. Blood in the urine may indicate varicose changes in the vessels of the bladder neck, their break when there is a stinging. If we change, the urine is seeded to the nutrient media to clarify the composition of the microbial flora and sensitivity to antibiotics.

The differential diagnosis is carried out with a tumor bladder or prostate, cystolithiasis, injury, interstitial and affected cystitis, neurogenic urinary bubble, urethra stricture, prostate sclerosis, meatostenosis, urethra valves, phimosis, prostatitis.

Treatment of DGPH

Therapy of the prostate adenoma correlates with the degree of severity of obstructive symptoms and complications, the choice of treatment tactics affects the patient's age and the concomitant pathology. All existing treatments are aimed at restoring urine adequate derivation. Therapy options include:

• Vigilant wait.This tactic is used in men with light symptoms ≤7 on the IPSS scale and in patients with an IPSS estimate ≤8, the presence of symptoms in which are not considered as violating the quality of life in the absence of complications. Once a year, such patients undergo cubizhes, an analysis on the PSA, a finger inspection. Medicase therapy is not shown, since it does not lead to improved well-being and has large risks that can significantly affect the quality of life (for example, erectile dysfunction against the background of the treatment of alpha-adrenoblockers).
• Drug therapy. With the advent of alpha-adrenoblockers, many patients with prostate gland hyperplasia appeared the opportunity to avoid the operation. Preparations relax muscles in a prostate, urethra and in the neck of the bladder, which is why the power of urine jet rises. Medicase therapy is carried out in patients with severe, moderate and severe urinary impairment from 8 points and higher. Inhibitors of 5-alpidases are prescribed to prevent the progression of obstruction symptoms when urinary. According to the testimony, combined therapy is possible. The inclusion of 5-phosphodiesterase inhibitors improves the separation of urine and has a positive effect on an erectile function.
• Operational treatment. There are several options for surgery: adenomectomy, which refers to radical operations (It can be performed by both open access and laparoscopic) and transurethral resection of the prostate gland. Each operation has its own testimony, advantages and disadvantages. With severe concomitant pathology, when the likelihood of unfavorable outcome is high, epicistostomy is performed as a palliative measure. After the normalization of the state it is possible to resolve the issue of removal of drainage and restoring independent urination.
• Minimally invasive therapy. There are a number of techniques that avoid the adverse effects associated with Turp and adenomectomy. These include laser destruction (vaporization, coagulation) with contact or contactless method, needle ablation, electricity, transurethral microwave therapy (microwave energy), radio frequency aqueous thermotherapy, etc. The large volume of the prostate gland is a contraindication to minimally invasive treatment methods.

Prediction and prevention

The forecast for life is favorable, most patients are sufficiently long (lifelong) reception of modern drugs to normalize urination functions. The need for operation occurs only in 15-20% of men. After adenomectomy, the recurrence of the disease does not exceed 5%, the minorivative techniques do not give 100% warranty of healing and can be performed repeatedly. Improved forecasting in the last decade contributed to the introduction of minimally invasive treatment methods, which allows minimizing complications that threaten the lives of patients. For the normalization of an erectile function, an andrologist-sexologist is needed.

Prostate cancer prevention data shows that a low-fat and red meat diet and a high protein and vegetable content can reduce the risk of symptomatic DGPA. Physical activity at least 1 hour per week by 34% reduces the likelihood of nocturia.

Table of contents [show]

Prostate hyperplasia (prostate adenoma) is a common urological disease in which proliferation of prostate cell elements occurs, which is the reason for squeezing the urethra and, as a result, urination disorders. The neoplasm develops from a stromal component or from a glandular epithelium.

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men older than 50 years have symptoms of prostate hyperplasia, in 65 years the disease is found in 50% of male persons, and at an older age - about 85% of men.

The prostate gland (prostate) is a unpaired androgen-dependent tubular-alveolar iron of external secretion, which is placed under the urinary bubble, the initial part of the ureas canal passes through it - the prostate iron circularly covers the neck of the urethra and its proximal department. Reloing glands are opened in the urethra. The prostate comes into contact with the pelvic diaphragm, the ampoule of the rectum.

Prostate gland functions are controlled by androgens, estrogens, steroid hormones and pituitary hormones. The prostate secret generated during ejaculation, taking part in sperm disclosure.

The prostate gland is formed by a glandular cloth, as well as muscle and connective. The process of hyperplasia, i.e. pathological growth, usually begins in the transient zone of prostate gland, after which the polycentric growth of nodes occurs, followed by an increase in the volume and mass of the gland. An increase in the tumor in size leads to the displacement of the prostate tissues of the dust, the growth is possible both in the direction of the rectum and in the direction of the bladder

Normally, the prostate gland does not interfere with the process of urination and the functioning of the urethra in general, since, although it is located around the rear section of the urethra, does not squeeze it. In the development of the prostate hyperplasia, the prostatic department of the urethra dusted, its lumen is narrowed, it makes it difficult to make urine outflow.

One of the main causes of prostate hyperplasia is hereditary predisposition. The probability of the disease increases significantly in the presence of close relatives suffering from prostate hyperplasia.

In addition, risk factors include:

• changes of the hormonal background (primarily a breakdown between androgens and estrogens);
• metabolic disorders;
• infectious and inflammatory processes of the urogenital tract;
• old age;
• insufficient physical activity, especially a sedentary lifestyle contributing to stagnation in a small pelvis;
• supercooling;
• bad habits;
• irrational nutrition (high content in the diet of oily and meat food with an insufficient number of plant fibers);
• the impact of adverse environmental factors.

Depending on the direction of growth, the prostate gland hyperplasia is divided into:

• sub-menu (the neoplasm grows towards the rectum);
• intravenous (tumor grows towards the bladder);
• retrotrigonal (Novoy formation is localized under the triangle of the bladder);
• multicothy.

According to the morphological basis, the prostate hyperplasia is classified on ferrous, fibrous, myomatous and mixed.

In the clinical picture of the prostate gland hyperplasia, depending on the state of organs and the structures of the urogenital tract, the following stages are distinguished:

1. Compensation. It is characterized by compensated hypertrophy of the bridge of the bladder, which ensures the complete evacuation of urine, there are no violations of the functioning of the kidneys and urinary tract.
2. Subcompensation. The presence of dystrophic changes in the deprider, signs of residual urine, dysuric syndrome, reducing the renal function.
3. Decompensation. Disorder of the bladder detruder function, the presence of uremia, aggravation of renal failure, involuntary urine release.

The disease develops gradually. The severity of the symptoms of the prostate gland hyperplasia depends on the stage.

The main signs of the early stage of the tumor process are rapid urination, Nikturia. The prostate gland is increased, its borders are clearly defined, the consistency is denselylastic, the urine jet in the process of urination is normal or somewhat sluggish. Palpation of prostate is painless, the median furrow is well palp. The bladder empties completely. The duration of this stage is 1-3 years.

At the subcompensation stage, the urethra necrosis is more pronounced, the presence of residual urine, thickening of the bladder walls is characteristic. Patients make complaints on the feeling of incomplete emptying of the bladder after urination, sometimes - to involuntary allocating a small amount of urine (leakage). The appearance of signs of chronic renal failure is possible. Urine when urination is highlighted by small portions, it may be muddy and contain a blood admission. Due to stagnation in the bladder, stones can form.

Against the background of the prostate hyperplasia, serious pathology of the urinary tract may develop: urolithiasis disease, pyelonephritis, cystitis, urethritis, chronic and acute renal failure, urinary bubble diverticulus.

At the decompensated stage of the disease, the volume of the urine released is insignificant, urine can stand out drops, it is muddy, with blood admixture (rusty). The bladder stretches with a large number of residual urine.

The symptoms of the prostate gland hyperplasia in late stages include a decrease in body weight, a feeling of dryness in the mouth, the smell of ammonia in exhaled air, a decrease in appetite, anemia, constipation.

See also:

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The diagnosis of prostate hyperplasia is based on the data collection of complaints and anamnesis (including family), examination of the patient, as well as a number of instrumental and laboratory studies.

During the urological inspection, the state of external genital organs is estimated. The finger study allows determining the condition of the prostate gland: its contour, soreness, the presence of a groove between the proportions of the prostate gland (is normal), sealing sections.

Assign common I. biochemical analyzes blood (determined by the content of electrolytes, urea, creatinine), general urine analysis (the presence of leukocytes, erythrocytes, protein, microorganisms, glucose). The concentration in the blood of the prostatecific antigen (PSA) is determined, the content of which increases with the hyperplasia of the prostate gland. It may be necessary to carry out the bacteriological sowing of urine in order to eliminate infectious pathology.

The main instrumental methods are:

• a transrectal ultrasound study (determination of the size of the prostate gland, the bladder, the degree of hydronephrosis in its presence);
• wrooflometry (determination of the volumetric rate of urination);
• overview and excretory urography; and etc.

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men over 50 have symptoms of prostate gland hyperplasia.

If necessary, differential diagnosis with bladder cancer or urolithiasis are resorted to cystoscopy. This method is also shown if there is a history of sexually transmitted diseases, long-term catheterization, injuries.

The main objectives of the treatment of prostate hyperplasia are the elimination of urination violations and preventing the further development of the disease, which causes severe complications from the bladder and kidney.

In some cases, limited to dynamic observation of the patient. Dynamic observation implies regular inspections (with an interval of half a year old) by a physician without any therapy. Expectant tactics are justified in the absence of severe clinical manifestations of the disease with the absence of absolute Indications to conduct operational intervention.

Indications K. medical therapy:

• the presence of signs of the disease that deliver anxiety to the patient and reduce the quality of his life;
• the presence of risk factors for the progression of the pathological process;
• preparation of the patient for surgical intervention (in order to reduce the risk of early postoperative complications).

In the composition of drug therapy of prostate hyperplasia can be assigned:

• selective α1-adrenobloclars (effective in the case of an acute urine delay, including postoperative genesis, in which it is impossible to empty the overcrowded bladder for 6-10 hours after surgery; improve cardiac activity with accompanying ischemic heart disease);
• 5-alpha reductase inhibitors (reduce the size of the prostate gland, eliminate macrohematuria);
• preparations based on vegetable extracts (decrease in the severity of symptoms).

In the case of an acute urine delay, the patient with the prostate hyperplasia shows hospitalization with the coating of bladder catheterization.

Replacement androgen therapy is carried out in the presence of laboratory and clinical signs of the age deficit of androgen.

There were assumptions about the possible malignancy of the prostate gland hyperplasia (i.e., reborn in cancer), but they were not proved.

Absolute indications for surgical treatment of prostate hyperplasia are:

• recurrences of acute urine delay after the removal of the catheter;
• absence positive effect from conservative therapy;
• formation of a diverticule or stones of the bladder of large sizes;
• chronic infectious processes of the urogenital tract.

Surgical interference over the prostate hyperplasia is two species:

• adenomectomy - excision of hyperplasted tissue;
• prostatectomy - resection of the prostate gland.

The operation can be carried out by traditional or minimally invasive methods.

To transvisical adenomectomy with access via the bladder wall, they are usually resorted in the case of an intractional growth of the neoplasm. This method is somewhat traumatized compared to minimally invasive interventions, however, with a large share of probability provides complete cure.

Transurethral resection of the prostate gland is characterized by high efficiency and low trauma. The endoscopic method It assumes the absence of the need to disseminate healthy tissues when approaching an affected area, makes it possible to achieve reliable hemostasis control, and can also be performed in patients of elderly and senile age in the presence of concomitant pathology.

The transurethral needle ablation of the prostate gland is to be introduced into the hyperplasned tissue of the prostate gland of needle electrodes, followed by the destruction of pathological tissues using radio frequency effects.

Transuretral vaporization of the prostate is carried out by means of a roller electrode (electrical position) or laser (laser vaporization). The method is to evaporate the hyperplasned tissue of the prostate gland with its simultaneous drying and coagulation. Also, for the treatment of prostate hyperplasia, the method of cryodestruction (treatment with liquid nitrogen) can be used.

The embolization of the prostate arteries refers to endovascular operations and lies in the blockage of arteries with medical polymers that feed the prostate gland, which leads to its decrease. The operation is carried out under local anesthesia access through the femoral artery.

In order to reduce the risk of developing prostate hyperplasia, timely appeal for medical help at the first signs of urination disorder, as well as annual preventive inspections with a urologist upon reaching 40 years have been reached.

Endoscopic golm laser enucleation of the prostate gland hyperplasia is carried out using a 60-100 W 50-100 W Holmium laser. In the course of the operation, the hyperplazed fabric of the prostate into the urinary bubble cavity is caused, after which the adenomatous nodes are subject to removal by an endomocel. The effectiveness of this method is approaching such with adenomectomy open. The advantages are the lower chance of developing complications in comparison with other methods and a shorter rehabilitation period.

Against the background of prostate hyperplasia, serious urinary tract pathologies can develop: urolithiasis, pyelonephritis, cystitis, urethritis, chronic and acute renal failure, urinary bubble diverticulus. In addition, the consequence of the launched hyperplasia may become orchoepididimitis, prostatitis, bleeding from the prostate gland, erectile dysfunction. There were assumptions about possible malignancy (i.e., reborn in cancer), but they were not proved.

With timely correctly selected treatment, the prognosis is favorable.

In order to reduce the risk of developing prostate hyperplasia, recommended:

• upon reaching 40 years - annual preventive inspections with a urologist;
• timely appeal to medical care at the first signs of urination disorder;
• rejection of bad habits;
• avoiding supercooling;
• balanced diet;
• regular sexual life with a regular partner;
• sufficient physical activity.

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In this article, we will talk about prostate hyperplasia, which is for the disease, how it manifests itself, the causes, symptoms, methods of diagnosis and treatment.

Prostate gland hyperplasia is an increase in the size of the body belonging to the men's sexual system.

The disease is more known as prostate adenoma and is a benign change in gland tissue.

The main contingent of illness falls on men over 40 years of age experiencing a negative impact of provoking factors.

Depending on the degree of development of hyperplasia and response to therapeutic treatment, the doctor may offer surgical interference or continue the elimination of pathology by medication.

Benign neoplasm (DGPH) starts growth from a small node, with an increase in which problems begin with urination.

The growth of benign neoplasms is not accompanied by a metastasis to other organs, although running process Expanding does not exclude the rebirth of it in malignant.

To judge the beginning of the rebirth of adenoma in carcinoma, it is possible about the analysis of blood in the content of the tumor marker in it.

The absence of a blood marker and an increase in the prostate in the image during the ultrasound undertakes are starting points for diagnosing the disease.

Initial stage.

Prostate is located in the field of small pelvis, under the bladder and above the pelvic bottom from the front from the rectum.

Iron surrounds from all sides of urethra and seed-eyed ducts, her form resembles chestnut.

Prostate gland fabrics are represented by iron-sided epithelium, which are several times less compared to fibrous connective and muscle tissues.

With a benign hyperplasia, not secreting epithelium increases, and fibroids muscle tissue.

Irony epithelium contains three types of cells:

1. Secretorial, producing the secrets of the gland and the constituent most epithelial tissues. Represented by prismatic epithelium.
2. Basal, components of secretory and capable of further differentiation in secretory cells.
3. Neuroendocrine, capable of accumulating a small amount of hormones produced in other glands (somatotropic hormone, serotonin, thyroid hormones).

Fibrominous tissue includes cells (smooth muscle, endothelial, fibroblastic) and non-cell elements (protein molecules of the intercellular medium - elastin and collagen, basal membrane, etc.).

The prostate is placed in a capsule from the fibrous tissue, from which the junction of the gland is leaving the connective tissues, dividing iron epithelium on separate compartments connecting to the slices.

The functionality of the gland is determined by the secretion of the liquid coming into the urethra in the front of it, called the prostatic one.

In this place, the prostate fluid is subject to mixing with the secrets of the testicles, seed bubbles and the formation of ejaculate.

All structures form a viscosity, acid-alkaline balance and the volume of ejaculate.

In the diagnosis of prostate hyperplasia, an important role is played by the secret of the prostate of glycoprotein nature - a simplecifical antigen that promotes sperm silence after ejaculation before fertilization.

To maintain a certain acid-alkaline balance, prostate secretory cells produce a number of chemicals: citric acid, fibrinolysin, phosphates and dihydrophosphates.

The innervation of the prostate gland is carried out by the autonomous and somatic nervous system.

The latter, in turn, controls the process of urination, provides muscle reductions in the pelvis diaphragm.

The sympathetic department of the vegetative nervous system has twigs in the muscles of the prostate, the body of the bladder, the neck of the bladder and the urethral sphincters.

The parasympathetic department of the VNS excites the bubble body cholinoreceptors under the influence of the parasympathetic sprig of acetylcholine released in the synaptic slit.

A benign increase in prostate gland (DGPA) begins with a central share, after which the pathological process covers lateral shares.

Further growth is due to the hyperplasia of parauretral glands, which increase their dimensions to the outer part of the prostate.

As a result, there is a shift in the nearby organs: the inner sphincter of the bladder is shifted upward, the terminal part of the urethra is lengthened.

Iron increases towards the ampoule of the rectum.

By type of hyperplasia, prostate distinguish 3 types, the basis of which lies the direction of growth in relation to the bladder:

1. The sub-form at which the adenoma is shifted towards the rectum.
2. Internally form. Growth is observed towards the bladder.
3. The retrotrigonal form is symptomatically the most dangerous, since urine delay is carried out at once for two reasons. The first block occurs on the way to the sphincter of the bladder. The second obstacle is found in the mouths of the ureters. Over time, the connection between the two types of locks creates a triangle between the mouths of the ureters and the inner circular muscle of the bladder. The triangle got the name poleo.

Single type of prostate hyperplasia in the practice of monitoring adenomas is often found, but a mixed view of the disease is found.

The development of prostate adenoma can be divided into 4 stages depending on the dislocation of nodal education, the degree of increasing and nature of development, the degree of violation of urine excretion.

The clinical picture at different stages is as follows.

The first stage.

In the absence of treatment, the first stage, referred to as compensatory, lasts from one year to 2-3 years.

Palpation does not bring painful sensations, in the course of its carrying out iron, it is spoiled with noticeable clear boundaries.

An increase in size is detected, it is good forgiven. central part glands in the form of a furrow. The consistency is more dense than at normal condition.

The residual urine during urination is not detected in the bladder. The patient often urinates, especially at night.

The urinary cue arise often, but the jet pressure is sluggish.

Second stage.

Received the name subcompensation, since the bladder is not emptied completely. The patient feels urine residues, but can not remove them.

The urinary cue becomes very frequent, although urine is allocated by small portions.

Urine ceases to be transparent, besides Muti, blood can appear in it. Constant phenomena in the bladder cause disorders of the kidneys.

Sometimes independently the patient is not able to test the urination, for which they resort to urethral catheters.

The thickness of the bladder walls becomes thicker, sometimes the overcrowded bladder highlights the urine arbitrarily.

Third stage.

In the last stage of decompensation, the thickening of the wed bubble walls reaches the maximum. Watering is disturbed with muddy, with blood.

Independent inkjet urination is difficult, watering drip apart by the urethra.

Symptoms of urination disorders are satisfied with serious disorders of the kidneys, leading to renal failure.

Patients are reduced in weight, have an unhealthy skin color, feel frequent malaise, suffer from constipation.

From the mouth of patients with prostate hyperplasia 2 and 3 degrees the unpleasant urine smell, mucous oral cavity dry.

Skin patients have unhealthy shades, devoid of a brush. When analyzing blood anemia is revealed.

Fourth stage.

It is the continuation of thirds only in terms of the complexity of treatment is much higher.

Given the consequences and burden of treatment with the launched forms of hyperplasia of the prostate gland, the visit to the doctor should be applied immediately after the appearance of the first signs of pathology.

Combining symptoms that can manifest themselves on each of the three stages, any sign from the next list should alert a man:

• weakening of the jet when urinating up to drip removal;
• the beginning of urination is accompanied by the problems of physiological, and then a psychological nature;
• little breaks between urinary urges;
• lack of continuous jet during urination;
• during urination, it is necessary to strain the abdominal and pelvic muscles in an involuntary order;
• the impossibility of complete emptying of the bladder;
• on the coming from the toilet there is a re-desire to overcome;
• chronic stagnation of urine leads to an increase in the colonies of causative agents of infection, hitting many organs of the urinary system;
• stagnation of urine leads to urolithiasis in the kidneys and urinary tract;
• chronic pathology in the kidneys;
• summifying an increased prostate urethra, as a result, urine is derived either by a thin sluggish jet, or removal occurs by individual portions.

As you should not leave the symptoms when they are separate, rather than a comprehensive manifestation, and it would be unreasonable to install an independently diagnosis without a comprehensive survey.

The historical approach to the explanation of the prostate gland hyperplasia was based on two points of view in constant contradiction.

One half medical lights argued that the only reason for the prostate adenoma lies at the age of men: the older, the greater the probability of manifestation of common pathology gOOD SYSTEM.

Supporters of another point of view adhered to opinions on the negative impact of abiotic environmental factors.

In support of the opinion of age-related changes in the prostate is the change in the hormonal balance between androgens and estrogens in the elderly to the side of the female sex hormones.

Testosterone deficiency cannot be ignored by the functionality of the cellular structures of the testicles, seed bubbles and the prostate gland.

As a result, a decrease in the secretion of the contents of ejaculate with gender glands.

The violation of the functionality of the prostate gland will generate anatomical pathology after this, including the prostate adenoma.

The direct link between the factors of the medium and the prostate gland hyperplasia was not detected.

To reject the negative effect of the abuse of alcoholic beverages, tobacco, drug use, transported venereal diseases and the consequences of infectious attacks, unconventional sexual orientation on the state of the genitourinary system as a whole and on the prostate gland in particular is not worth it.

Make a conclusion relative to the true cause of prostate hyperplasia on the basis of the phenomena described allows you to translate the scales in the direction of age-related changes, not neglecting by external provoking factors.

Adenoma Prostate can develop for a long time, without revealing themselves symptomatic.

Separate lack of signs are not taken into account while the sluggish acute process is going.

Explicit signs begin to disturb when pathology takes a chronic character.

Annual planned examination of the prostate allows you to identify an increase in the prostate gland at an early stage, during a period of small symptomatic manifestation.

Another factor that has an early increase in prostate gland - heredity.

If a man has experienced cases of adenoma prostate, a survey of the urologist should begin with 30 years with mandatory annual diagnostics.

On time, the observed deviations allow you to completely prevent the development of hyperplasia or delay the long-term pathology.

The disease first begins to develop by 35 years in some men, although the nature of the changes is noticeable only under the microscope.

It is at this age that men should undergo dispensarization, during which the state of the prostate gland is carefully monitored.

If a man is a long-liver, then in 100% of cases an increased prostate sizes are found.

Approximately half of the male population, of all ill-fallen hyperplasia, prostate complains of manifested unpleasant signs, the rest of the half does not feel the presence of the disease, i.e. Prostate hyperplasia passes asymptomatic.

For this half of men, the disease occurs without obstructive changes.

The clinical picture of the prostate gland hyperplasia is described in the literature and medical maps as the urination impairment syndrome, the obstruction of the urethra, the symptoms in the field of the lower urinary tract.

Nine out of ten old men at the age of 90 and half of men of pre-mentioning age are found from histological confirmation of benign changes in the prostate.

Symptoms of hyperplasia are clearly manifested by a quarter of men aged 55 years with a diagnosed increase in prostate gland and in half of seventieth-year-old patients.

Long absence of treatment of benign hyperplasia of prostate threatens serious consequences for man health due to urine delay:

• attacks of urolithiasis in the bladder;
• infectious damage to the organs of the urogenital system;
• damage to the kidney channels with the formation of renal failure;
• malignization benign tumor and the development of a malignant process in the prostate gland.

Appeal to the doctor with the appearance of symptoms and the purpose of proper treatment with a benign hyperplasia make it possible to draw up a favorable forecast.

The flow of the disease in the absence of treatment can develop in different scenarios.

The option is not excluded when the hyperplasia will not appear symptomatically and will not receive further development in the stages. Predict progress or its lack of doctors are not taken.

Statistics show that the third part of men with a detected benign hyperplasia of prostate forgets about the diagnosis due to the improvement of the situation or complete recovery.

The same number of patients noted the deterioration of the situation, the remaining representatives of the strong floor do not detect the progress or regression of the disease.

Each tenth sick, in the absence of drug treatment, with time, notes reinforcing problems with urination.

As many men who did not want to carry out therapeutic treatment are forced to resort to surgical interference in the prostate area.

The main factors for increasing the size of the prostate gland are an irreversible process of age-related changes in the hormonal ratio of testosterone and estrogen.

It is not excluded from the list of possible factors of launching pathology hereditary predisposition.

In the conditions of modernity, the main reasons for the progress of the prostate hyperplasia began to be considered by the following factors:

• irrational nutrition with a predominance in the daily diet of fast food;
• hypertonic disease;
• hyperglycemia;
• obesity of all degrees;
• excess in the environment maximum permissible concentrations of harmful chemical compounds;
• reducing testosterone levels;
• increased receptors that perceive testosterone due to its deficit.

Two androgen are produced by the testicles: testosterone and dihydrotestosterone.

The sensitivity of prostate follicles to androgens is unequal: Dihydrotestosterone deficiency is perceived by cells more acutely.

Normally, testosterone turns into a homologous hormone dihydrotestosterone under the influence of the enzyme from the group of oxy subcutase - 5-alpidedase.

Men, transformed in childhood in ENUOV or suffering from congenital deficit of 5-alpidedase, benign changes in the prostate gland do not detect.

Men operated on the prostate gland, notice that in his pedigree there were already cases of operated prostate or deaths as a result of the absence of treatment of the disease.

Especially often, hereditary predisposition is implemented in pre-agents of men.

Benign prostate hyperplasia is rarely detected from the inhabitants of eastern countries. For example, in Japan, this disease almost does not exist.

Probabilistic causes of low morbidity are the absence of information on premature violation of the work of the prostate gland and the restraining factor in the form of nutrition of seafood and food enriched with phytoestrogens.

Once for immediate appeal to the urologist are:

• urination delay;
• sluggish jet or urination problems;
• muddy urine or detectable blood;
• symptoms of renal failure or benign prostate hyperplasia.

Sudden delay in the removal of urine jet causes a sharp pain. If this happens, all the case should be postponed and hurry to urologist or an andrologist.

Gradually accumulating, unrelated urine from the bladder overwhelms it, standing out later by a weak jet or frequent drops.

If a visit to the doctor is postponed, the urine becomes more concentrated, prone to the formation of urinary stones, reproduction of infectious pathogens.

The appearance of blood in Urine does not mean the development of prostate hyperplasia, you can assume urolithiasis, bladder cancer, renal disorders.

To prevent malignant neoplasm in the prostate, all men, it is necessary to be examined annually from the urologist, and representatives of the Negroid race and persons who have problems with the prostate gland, the urological examination is shown after 40 years.

Oncology of the prostate gland takes place until the last stage without explicit signs.

Prostate cancer should not be excluded and in men who have undergone an operation on the gland for resection or ectomy of a benign tumor.

The most frequent location for the rebirth of benign cells in malignant is localized in the outer part of the prostate, which does not ignite when the gland adenoma is transmitted.

Going to the doctor, you need to be prepared for filling the sheet with questions, the answers to which the doctor helps to pre-assume the diagnosis.

After that, the urologist is carried out by a physical examination of the prostate gland to the rectal way.

Prior to a visit to the doctor, it is better not to empty the bladder, as it will be necessary to give Urin to the analysis, as well as when urination, measure the rate of urine removal.

Diagnostic procedures.

To diagnose the prostate gland hyperplasia, several analyzes are prescribed, a number of techniques must be carried out, including instrumental:

1. Rectal study of the gland palpation, during which the degree of increase, density and pain is determined.
2. Transrectal ultrasound, allowing to detect nodal formations and calcifications of any size. The method reveals an accurate direction of increasing the gland, clear boundaries and sizes. With the help of Tui Adenoma, it is found even at the very beginning of its development.
3. Uzi pelvis.
4. Measurement of the removal rate of urin - wrophlourometry.
5. The study of the amount of urins after urination in the bladder. The amount of fluid can be accurately measured using ultrasound research.
6. Urethrocystoscopy.
7. CT scan.
8. The urine pressure on the walls of the bladder is measured by cystonanometry.

A comprehensive study of prostate contributes to the identification of an accurate clinical picture, which is the starting point when choosing a therapeutic or surgical treatment.

Careful study of the history of the disease allows differentiate obstructive and annoying symptoms.

From this point of view, the urination diary with its presence better helps to diagnose the disease than the patient's survey.

When mentioning individual symptoms of the prostate gland hyperplasia can be similar to:

• carcinoma of the bladder;
• infectious diseases of the bladder and urethra;
• stricture of urethra arising from injuries, long use of catheter, venereal diseases (gonorrhea);
• hyperglycemia, which has the consequences of frequent urges to urination and insufficient emptying of the bladder;
• infectious pathologies of the prostate gland;
• urinary bubble dysfunction associated with deficiency or absence of nerve impulses (spine damage, strokes, multiple sclerosis, Parkinson's disease, etc.).

Using the filled symptomatic scale becomes clear, whether additional studies are needed by the prostate gland or the diagnosis is clear (the scale is filled) and the choice of treatment scheme is necessary.

The scale has a maximum mark of 35 points. When filling out the scale from 20 points to the maximum, a solution is made on surgical treatment.

The interval from 8 points to 19 is a signal to the beginning of conservative treatment.

The mark below 8 points does not require medical intervention and the patient is given recommendations on the prevention of prostate diseases.

Physical inspection.

The physical examination of the patient begins with the inspection of the skin, the overall state of health, the outer palpation of the bladder to the degree of its fullness.

After this, the doctor is rectal examination of the prostate gland, for which the imagining finger has a hand to which the medical glove is being found, the surface of the prostate is investigated.

Iron is located on top of the rectum. If the area of \u200b\u200bincreasing the gland is uniform and smooth, it is concluded about the benocal nature of hyperplasia.

Prostate cancer modifies the surface of the prostate with a smooth on the barride, in which nodal formations are tested.

Fully about the degree and nature of hyperplasia are to be judged according to the size incorrectly. Not all men have the prostate gland of the same magnitude.

Men with a large iron at palpation detect an increase, but it is no symptomatic or histologically detected.

A small prostate of men with hyperplasia during palpation does not reveal deviations, although the symptoms of benign hyperplasia of the gland are obvious or obstructive phenomena in it are found.

The detectable increase in the gland is not a reason for the use of conservative treatment, but the history of the disease, symptoms and diagnostic examination of the ultrasound, with the size of the prostate, give grounds for developing a treatment regimen.

Before starting treatment, the neurological nature of the occurrence of prostate hyperplasia should be excluded.

The main direction of treatment without operational methods is the regular observation of the dynamics of reducing or increasing the size of the prostate.

The flow of the disease is not necessarily associated with the speed of developing pathology. Often the clinical picture can improve or remain at the same level without the use of therapeutic methods.

Men with a minimal manifestation of symptoms are subject to annual examination for urine removal, data collection and filling symptomatic scale, physical inspection.

When at home, a man during analyzes should abandon the reception of drugs that reduce the tone of smooth muscles (tranquilizers), drugs from sinusitis, etc. Due to the unreliability of the tests and tests obtained, as well as the strengthening of the symptomatic picture.

It is possible to independently improve the condition of the gland with a detected hyperplasia if you adhere to some rules:

• try not to take soothing agents and antidepressants that reduce the tone of smooth muscle muscles and create obstacles to the complete emptying of the bladder;
• beware of abuse of alcoholic beverages and coffee, limit the use of these drinks in the evening and night time;
• increased tone in the sphincter of the bladder is undesirable, therefore, anti-essay drugs that are medicines from colds, it is advisable to take only in extreme cases.

Recently, many ways of treating prostate hyperplasia have been developed, including phytotherapeutic. But there are also such funds that are called placebo.

The patient with the hope of recovery takes such drugs whose therapeutic effect is not credible.

One of these drugs is the extract of dwarf palm trees.

Treatment with medicines.

5-alpha reductase inhibitors.

5-alpha reductase is an enzyme accelerating the transformation of the main hormone of testosterone seeds in a dihydrotestosterone form.

There is a dependence of urine delay from dihydrotestosterone. The medicine, the inhibitory effect of the 5-alpha reductase - finasteride, the reception of which enhances the removal of urine, weakens the brightness of the signs of benign hyperplasia of the prostate and helps reduce the size of the gland.

The speed of exposure to the finasteride is small, a noticeable therapeutic effect is achieved after 6 months.

Finasteride shows less efficiency with prostate hyperplasia in men with a small source size and greater efficiency - in men with a large iron.

Definitely Finasteride has a property of improving the symptom of urination delay. For several years of drug use, the operational path of treatment of prostate can be avoided in half cases.

The use of medication is not without unpleasant adverse events: impotence is registered in each twenty-fifth patient after treatment with finasteride, a decrease in sperm volume - half of the representatives of the strong sex.

There are even individual cases of increasing the mammary glands.

Alpha blockers.

The walls of the prostate gland and the sphincter of the bladder are represented by the cells of the smooth muscles, the tone of which is provided by the sympathetic department of the vegetative nervous system.

Sympathetic branches begin with receptor formations called alpha receptors.

With the help of drugs (alpha-blockers), it is possible to reduce receptor sensitivity and, thus, reduce muscle tone in smooth muscle tissue.

The result of the use of alpha-blockers is the weakening of the symptoms of the disease and the urine jet is enhanced during the empty of the bladder.

Alpha blockers were previously known as hypotensive drugs at high systolic pressure, since alpha receptors were first discovered in the walls of blood circulation vessels.

For this reason, the reception of drugs of this group is accompanied by a decrease in blood pressure, the first symptom of which is circular heads.

Modern pharmacology has a wide range of drugs blocking alpha receptors: Polpressin, Doxaprostan, Hytrin, hyperprost, etc.

Hyperprost and its analogues are effective in the blockade of receptors located only in the prostate gland and the walls of the bladder (alpha1a receptors).

Alpha blockers are prescribed in cases of non-absolute testimony to surgical intervention, when there is no threat to the patient's life.

Medicines can be used when the volume of urins in the bladder does not exceed 0.3 liters after emptying. Urina jet under the influence of alpha blockers becomes more intense.

About half of patients with benign hyperplasia were noted after taking drugs attenuating symptoms or their disappearance.

The use of alpha blockers produces a gradual therapeutic effect that achieves the maximum peak upon expiration of 14 days. From this point on, the situation of the absence of symptoms of the disease becomes stable.

The choice of a specific preparation urologist is based on the individual perception of the medication.

In case of chronic patient hypotension, the preparations described, excluding hyperprost, further reduce blood pressure.

Approximately one of the twenty men taking hyperprost or its analogs suffer from the effects of reverse ejaculation.

Surgical methods for the treatment of prostate hyperplasia.

Every year, several thousand patients with a benign hyperplasia of the prostate gland agree to the operation, without regretting subsequently on its conduct.

With a benign nature of the increase, only part of the gland is removed, which is a prostate center.

In the presence of cancer, the ectomy is subject to all prostate.

Urination delay and other symptoms after ectomy gland will be stopped.

Men older than 80 years have age-related changes in the walls of the bladder, so problems with urination even after the complete removal of the prostate gland can be partially left.

The operation at the prostate is carried out in cases:

• untimely urination;
• the residue of urin in the bladder during emptying exceeding the volume of 300 ml;
• doubts of patients relative to conservative treatment methods;
• urolithiasis;
• residual phenomena in the treatment of infected urinary tract gaining chronic nature;
• inefficiency or impossibility of drug treatment for the patient's health;
• obstructive phenomena with renal failure.

Open prostatectomy.

An indication for open prostatectomy is the initially large iron (weight of more than 80 g), which is in a state of benign increase.

This type of operation resorts in extreme cases, since the patient transfers it worse than other types of operations.

At the bottom of the belly, the skin is made, exposing the prostate gland and the bladder. Further actions of the surgeon suggest 2 options for extracting benign content from prostate.

The first option is to delete the adenoma after opening the prostate gland.

The second version of the operation is carried out through the bladder, for which it is necessary for its regular emptying with catheters: one of them is inserted into the bubble through the urethra, the second is at the bottom of the abdomen.

Catheters are in a bubble for five days, after which the rehabilitation period begins to restore independent urination.

Although the operation may have large complications compared to other operational interventions, its effectiveness is considered the highest.

Prostate transcredia resection.

Most of the operations are carried out by this method that benefits over the rest:

• small invasion;
• small trauma;
• catheter in the bladder insert only 1 day;
• extract in 3-4 days from the hospital;
• a small risk of complications.

The operation is carried out using video-endoscopic technology having a kind of thin catheter inserted into the bladder.

From the rescuekop, the loop of a thin wire, to which the electric current is connected.

With the help of the resectoscope, a damaged part of the gland is removed, while the patient does not feel sharp pain. Can be felt a small discomfort at the bottom of the abdomen.

19 of 20 men suffering from severe symptoms of benign hyperplasia, symptomatic improvement.

The same effect is achieved after surgery in 17 of 20 men with a medium degree of severity of symptoms.

After the transteruine resection, the following complications are possible:

• impotence was found in one man out of 20;
• urinary incontinence is one of 25-30;
• reverse ejaculation - more than half of men;
• repeated resection by the transuretal method - every tenth operated;
• internal bleeding requiring blood substitute infusion or donor blood - 1 of 15-20;
• the narrowing of the urinary bubble sphincter or urethra is one of 20;
• female cases - 1 per 4000 operations.

Prostaty Transure Award (Prostomy).

The suction of the prostate gland is performed by the resectoscope, the nozzle of which is different from the electrical loop with an electrical knife.

In the gland fabric adjacent to the urethra, several cuts are produced (sometimes there is enough one) to weaken the pressure on the urinary path.

With the help of an electric knife, a part of the gland fabric is sometimes removed, but in most cases it is not required.

Prostatotomy has advantages over the partial removal of the gland with a transurethral method of less long conducting and fewer complications.

The effectiveness of prostomium with respect to small glands (less than 30 grams) is at the same level compared with resection.

Prostate TRANSURETY VAPORIZATION.

Vaporization is carried out under the action of the rescuekop, as in the previous two types of operation.

Resectocillary prostate fabric does not dissect and is not removed, and the increased part of the evaporation at high temperature achieved by the effect of electric current is deleted.

Bleedings during transcental vaporization can be avoided. Patients with catheter after surgery are used for several hours.

The patient is discharged from the hospital for the next day after the vaporization carried out.

The operation is advantageous in terms of cost compared to the rest of the operational intervention.

Although the operations have their advantages before the inhettative ways of treating the prostate, the task of medical personnel is the choice of such techniques that would leave minimal traces of interference in the body and have not been inferior in positive effects on the patient.

The ideal version of a single impact on the body is an extract immediately after exposure from the hospital, the smaller cost of impact and replacing the anesthetics of a common action to local anesthesia.

For local heating, several techniques that showed their advantages and negative points are tested for local heating of the fabric.

1. Microwave therapy by introducing a catheter through which the affected fabric of prostate is coagulated by microwaves. After the procedure, the scene of the gland can be maintained, during the course of which the catheter is installed for urination. The procedure is suitable for removing small sections of benign hyperplasia.
2. Laser vaporization. A catheter with a laser beam evaporates the cells of the central part of the prostate, which is why their destruction occurs. As in the case of the effects of microwave therapy, the procedure is advisable for small prostate adenoma.
3. Coagulation of pathological cellular material can be carried out needle ablation, for which the needles emitting radiofrequency waves are exposed from the cytoscope administered through urethra. Point radio wave destruction of cells is carried out only on tumors of small sizes with a subsequent insertion of the catheter for emptying the bladder.
4. Ultrasonic coagulation tumor little size The thermal effect of ultrasound, which focuses with high intensity through an entered tool equipped with a video camera.

Impact on increased iron with the exception of operational intervention is made by the following techniques:

Ball dilatation.

It is carried out when there is no opportunity to carry out surgery, and drug treatment does not have a proper effect.

The absurd of urethra with a cylinder is expanding, therefore the symptoms associated with urination impaired weaken. The balloon is entered with a cystoscope.

The minus of balloon dilatation refers to the impossibility of eliminating the increase in the prostate gland.

Cryodestruction.

It is carried out with the help of a cystoscope equipped with fixtures to create a low temperature in an enlarged part of the prostate and body temperature in the urethra in order to prevent the death of urethral ducts of low temperatures.

Freezing of the affected structures of the prostate gland is carried out in liquid nitrogen.

Stinting technique.

It is similar to a balloon dilatation, but the extension of the urethra stand is carried out for a longer time.

Artificial embolization of small arteries of prostate.

It is carried out in order to stop the nutrition of cells in the field of adenoma.

The procedure is carried out by introducing small pieces of medical plastic size of 100-400 μm through the femoral artery.

The probe entered into the femoral artery is promoted to the artery of the prostate gland and produce spherical fragments of plastic.

The described method got spread recently and quickly gained popularity among endovascular surgeons.

Warning of benign hyperplasia is based on a complex of events, which includes:

1. Balanced diet. It should be excluded from food fatty, fried, sharp products. Do not abuse food enriched with animal fats and cholesterol. It is better to abandon coffee and alcoholic beverages at all, if it is impossible to refuse as much as possible to resort to them. In the daily diet, it is necessary to introduce lactic acids, vegetables, fruits, legumes and low-fat meat more.
2. Moderate physical activity associated with active recreation, hypodynamine prevention not only support normal weight, but also normalizes blood circulation in the organs of a small pelvic, without allowing stagnant phenomena in the prostate.
3. Annual desired visit to the urologist, starting from 40 years and mandatory - after 50 years.

Men who have contraindications to operations are forced to use catheters on their own or with the help of persons caring for lying patients.

Under local anesthesia, the patient can also imagine stands that expand the urethra and supporting it in the open state.

Despite the only possible method of urination in laying patients, the standing is applied for a certain period, after which it is necessary to take a break.

Any violation in the urinary system needs to be diagnosed and inspected by a doctor who in a timely manner and correctly develops a treatment scheme.

The prostate hyperplasia refers to complex diseases and requires qualified treatment with good specialists.

It depends here much on the type of disease and the degree of its nestness, so at the first signs do not slow down with the appeal to the doctor.

Otherwise, the probability of operational intervention at the prostate will increase directly proportional to your ignoring the hike in the hospital.

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Basic theses

• Benign hyperplasia prostatic gland (DGPZH) - Uncindly increase prostate.
• It is believed that this disease is part of the normal aging process.
• In 50% of men who overshadowed the threshold of 60 years, there is a clinically significant DGPA.
• Prostate cancer and this ailment is not connected.
• Symptoms are not necessarily progress and can change.
• Medical treatment can be very effective.
• Transuretral prostate rescue (Turkzh) It remains the "gold standard" in the treatment of a benign prostate hyperplasia.

Description

Prostate - iron having a form walnut and located right under

bladder

and before the rectum. It covers from all sides the top

(urethra), representing a tube that starts from the bladder and opens out.

The prostate gland produces part (± 0.5 ml) of a seminal liquid containing nutrients. The neck of the bladder and prostate form a genital sphincter, providing antendic ejaculation and eruption of seed fluid to outward, and not in the opposite direction, in the bladder.

Benign prostate hyperplasia (DGPH) is an insistent increase in prostate. Its development depends on male hormones: testosterone and dihydrotestosterone. Over time, the disease of one or another severity amazes all men, even those whose testicles and prostate are functioning normally.

An increase in prostate leads to the deformation of the urethra, which is disturbed by the urine current from the bladder, and obstructive or annoying (irritative) symptoms appear.

The size of the prostate does not directly affect the severity of manifest symptoms. Sometimes the course of the disease of the prostate glands of very large sizes occurs asymptomatic, while the defeat of a small prostate is characterized by very heavy symptoms.

Clinically significant DGPA is present in 50% of men aged 60-69 years. From this number of ± 50% need treatment. The risk that throughout the life of a man will have to resort to prostate surgery, is 10%.

The prostate gland consists of ferrous structures and stroma. The second element contains smooth muscle fibers and connective tissue. With DGPA, all components of prostate increase, but the stroma, nevertheless, relatively more than others.

Men's hormones are needed for gland growth (testosterone and dihydrotestosterone). They are not the root cause of the appearance of benign hyperplasia, but without them it is impossible.

Aging and men's hormones are the only confirmed risk factors that can provoke the development of DGPH. Each representative of the male floor with a healthy prostate and normally functioning testicles arises this diseaseif he lives long enough.

The testicles produce 95% of testosterone in the body. In the prostate gland, this hormone turns into a dihydrotestosterone, to which it is more sensitive than to testosterone. An enzyme called 5-alpha reductase is an intermediate link in a testosterone transformation chain into its active form. It is contained exclusively in the selection of the genital gland men. You can manage 5-alpha reductricity with medicines (see the "treatment" item).

Over time, dihydrotestosterone stimulates the formation of an increase in the prostate, which, in turn, lead to an imbalance between the growth of cells and their programmed by death (apoptosis).

The result of all this is slow, with time progressive, increasing the prostate gland. Such a clinically pronounced disease has an overwhelming number of elderly men, however, in itself it does not necessarily cause symptoms or leads to complications.

Symptoms may arise due to the fact that the DGPA acts directly on the prostate or on the bladder outlet, as a result of which obstruction appears (read the item "Symptoms").

DGPA may be accompanied by the absence or presence of symptoms. They arise due to mechanical squeezing of the urethra of increased prostate, secondary bladder changes in obstruction, or complications of the DGPH.

The obstruction (blockage) of the weekend of the bladder can lead to different consequences, for example, thickening and instability of the muscles of the bladder. It is believed that instability causes annoying (irritative) symptoms.

In addition, the narrowing of the enlightenment of the urethra can lead to an insufficient reduction in the muscles of the bladder, or further aggravate their condition. The result of this violation on the face is obstructive symptoms and insufficient emotion of the urinary bubble. Although for the emergence of these symptoms in response the natural process of aging, but it is obstruction that will exacerbate both signs of withering the male organism.

Obstructive symptoms:

• weak urine jet;
• feeling of incomplete devastation of the bladder;
• intermittent urin jet;
• difficult to start urination (his delay);
• voltage during urine emission.

Irritative (irritative) symptoms:

• Frequency (frequent walking in the toilet);
• Emergency (strong urination to urine, which is difficult to suppress);
• Nocturia (the need for awakening at night to empty urinous bubble).

Symptoms indicating complications:

• Blood in the urine (hematuria): DGPA may be the cause of blood appearance in the urine. However, this disease cannot be considered a culprit of bleeding, except for those cases when other, more serious reasons for this are already excluded.
• Urinary tract infection with such symptoms as burning during urine emission, bladder pain, heat and frequent uinilities.
• Urine delay (complete inability to go to the toilet).
• Urinary incontinence (its allocation due to overflow of the bladder, which does not deviate properly).
• Renal failure (fatigue, weight loss, increasing the total blood volume (hypervolemia), etc.).

Only ± 50% of men with a histologically confirmed diagnosis of benign prostatic hyperplasia will be shown symptoms. It is not always an increase in the male sex glare leads to obstruction or the emergence of symptoms.

Clinical syndrome (symptoms and signs), due to an increase in prostate, is known under various names, including DGPA, SNMP (symptoms from the lower urinary tract), prostatism and obstruction of urinary tract.

50% of men aged 51-60 years and 90% for 80 years have histological DGPA. However, only 25% of fifty-year-old and 50% of seventy-year-old representatives of strong sex will disturb the symptoms resembling an increase in prostate.

The natural course of development of DGPA, the treatment of which was not engaged, was poured and unpredictable. In the medical literature, there are few reliable information on this. But it is clear that prostate hyperplasia is not necessarily a progressive disease.

Many studies have shown that about 30% of patients with symptoms can improve or go through time. In 40% of men, they remain the same, and in 30% deteriorate. In 10% of patients who did not resort to medical care, urine delay will appear in the future. And 10-30% patients who rejected medicine will eventually need a surgical operation on an increased prostate.

Potentially possible risk factors:

• western food;
• increased blood pressure;
• diabetes;
• overweight;
• industrialized environment;
• enlarged androgen receptors;
• imbalance of testosterone and estrogen levels.

Any healthy man who lived long enough will become a victim of prostate hyperplasia. Time and men's hormones (dihydrotestosterone and testosterone) are the only risk factors whose influence on the development of DGPA was established.

Prostate gland cells are much more sensitive to dihydrotestosterone than to testosterone. The enzyme, 5-alpha reductase inherent exceptionally prostate, turns testosterone into dihydrotestosterone. The representatives of the strong half of humanity, which were neutered in youth or suffer from a lack of 5-alpha reductase, do not face BPH.

Recent studies show that there is a probable genetic connection with DGPA. The risk of surgery for a man increases four times, if his closest relative was operated on in connection with this disease. Genetic communication is particularly strong for men with a large prostate under the age of 60.

Some medical surveys found that in DGPF cells, the number of male hormone receptors (androgen receptors) can be increased. And the role of the environmental factor, as well as nutrition, overweight and industrialized environment, is not fully clarified.

The frequency of morbidity among the eastern men (especially the Japanese) is low. Nutrition, characteristic of their region, is rich in phytoestrogens and, possibly, has a protective effect.

With this scenario, the bladder is never emptied properly, which can cause obstructive renal failure and other complications, such as infections or stones.

Neither should bind blood appearance with an increase in prostate until other, more serious causes (bladder cancer) will not be excluded.

Each man who overshadowed the threshold of 50 years should be inspected annually for the presence of prostate cancer. Black representatives, subject to higher risk of developing this type of cancer, and men with genetic predisposition to it, it is worth starting to regularly undergo surveys at the age of 40. The purpose of the annual inspections of the prostate is to diagnose the malignant prostate tumor at an early stage, when it can still be cured.

As a rule, at an early stage, prostate cancer prohibitively. If once a man did a surgical operation of the sexual gland due to the DGPA (namely, transuretral resection or open prostatectomy), this does not mean that it is no longer at risk of developing prostate cancer.

Prostate cancer usually occurs in the outer part of the gland, which is not deleted during the operation about the DGPF.

You may be asked to fill out a questionnaire, which will help to evaluate the severity of symptoms (on the scale of estimating symptoms of diseases of the prostate in points). During the physical inspection, a finger study of the rectum will be held.

Medical employee, as a rule, assigns urine analysis and can ask you to let the urine in the device to measure the flow rate. Shortly before the visit to the doctor is better not to empty the bladder.

Disease history

Symptoms of DGPG are divided into obstructive and annoying (see the item "Symptoms"). To diagnose, proceeding only from some symptoms it is impossible, since many diseases imitate the symptoms of DGPA. Careful study of the history of the disease will help to identify others other than the DGPH diseases that caused the appearance of symptoms.

Diseases similar to DGPH:

• stricture of urethra (narrowing of the surveillance of the urethra in the penis);
• bladder cancer;
• urinous bubble infection;
• prostatitis (chronic prostate infection);
• neurogenic bladder (dysfunction of this organ, due to neurological disorders, such as stroke, Parkinson's disease or multiple sclerosis);
• diabetes.

Stricture of urethra may occur as a result of the previous injuries, the use of technical means in treatment (meaning catheter) or infections (gonorrhea). Blood in the urine can talk about the presence of a bladder cancer. The burning and pain when urination may indicate infections or stones.

The possible cause of frequent walks in small need and insufficient devastation can be diabetes, as it affects the muscles of the urinary bubble and the function of the nervous system.

To assess the severity of prostatic symptoms, use the score of the scores in points. It helps to determine whether further evaluation of the patient's condition is needed or treatment should begin. The symptom index developed by the American Urological Association is the most common assessment method.

Symptoms are classified in accordance with the total amount of points: 1-7 points - light symptoms, 8-19 - moderate and 20-35 - heavy. If there is a light violation, then in most cases there is no need for treatment. With moderate signs, treatment is required, and in the case of severe manifestations, the disease most often resort to surgery.

In the course of such an inspection, the doctor assesses general state Patient health and feeling the abdominal cavity for the presence of a complete bladder. The finger study of the rectum is carried out in order to determine the size, shape and consistency of the prostate gland. To do this, the doctor introduces his finger, dressed in a glove, in the rectum. Prostate is located next to the anterior intestinal wall, and it is easy to palpate in this way. Such a procedure is slightly unpleasant, but the pain does not cause. With DGPA, an increase in smooth, homogeneous, and with prostate cancer it is noded and uneven.

Unfortunately, only the size of the prostate is weakly relate to symptoms or obstruction. It happens that no symptom has no symptom in men and obstruction does not appear, and on the contrary, the hyperplasia of the prostate of small size can be characterized by severe obstruction with symptoms and / or complications.

Increased prostate in itself is not an indication for treatment. The size of the prostate of patients who really need therapy may affect the choice of the treatment method. The neurological study is shown if from the history of the disease it is assumed that the cause of symptoms may be neurological.

In order to exclude all doubts about the correctness of the diagnosis, check other reasons for symptoms, confirm or refute the obstruction and find complications associated with it are prescribed special research.

Minimum list of surveys required for diagnosing DGPH:

• the history of illness, including the expression index of symptoms (see above);
• physical examination, including a finger rectal study (see above);
• analysis of urine;
• urine flow rate;
• evaluation of renal function (Creatine in blood serum).

Additional tests:

• urodynamic study "Pressure-flow";
• determination of the level of prostatospecific antigen (PSA) in serum
• ultrasound examination of the abdominal organs;
• ultrasound kidneys, ureter and bladder;
• transrectal ultrasound of the prostate gland.

A simple urine test can be done in the office using an indicator strip. If it indicates the presence of a possible infection, urine sowing is taken. If blood discovered in Urin, it is necessary to conduct a further examination to exclude other reasons for this symptom.

To determine the flow rate of urine, the patient is asked to persist in a special apparatus, which gives an indicator. Most instruments measure urine volume, the maximum flow rate and the time interval for which the bladder was devastated. In order for the result to be accurate, it is necessary at least 125-150 ml of urine allocated at a time.

The most useful parameter is the maximum urine flow rate (Q MAX), measured in milliliters per second. Despite the fact that the mentioned parameter is an indirect sign of the urinary tract obstruction, it turns out that most patients whose urine flow less than 10 ml / s is confirmed by the presence of this disorder. At the same time, those whose streaming rate of urine exceeds 15 ml / s, do not detect the signs of obstruction.

Moreover, patients with low indicators measured before passing the operation, feel better after it, compared to those who have the results of measuring the flow rate of urine were higher. It should be understood that the low value of this parameter does not indicate that it is precisely the cause of a weak stream of urine - obstruction or disturbed function of the muscles of the bladder.

Creatinine level is determined in serum taken blood sample. The result obtained gives an idea of \u200b\u200bhow the kidneys functions. Creatine is one of the waste products allocated by the kidneys. If the level of this substance is raised due to the obstruction of the urinary tract, it is better to drain the bladder catheter, which will allow the kidney to recover before the start of the operation at the prostate.

Urodynamic study "Pressure-flow" is the most accurate method that allows you to determine the presence of urinary tract obstruction. At the same time, the pressure in the bladder and the urine flow pressure is measured. Obstruction is characterized high pressure and a weak stream. This is an invasive analysis, for the implementation of which the sensors in the bladder and the rectum are introduced. Many scientists do not recommend this procedure to patients with severe prostate symptoms. At the same time, such a study is indispensable if there are doubts about the diagnosis.

Indications for the Urodynamic Research:

• any neurological disorder, for example, the attack, Parkinson's disease and multiple sclerosis;
• acute symptoms, but normal urine velocity (\u003e 15 ml / s);
• long-term diabetes;
• earlier transferred unsuccessful operation at the prostate.

The level of the prostatospecific antigen (PSA) in the blood serum increases in the presence of DGPF. There are contradictions associated with the use of this analysis to identify prostate cancer. The American Urological Association, like most urologists, recommends that every year check the level of PSA in the serum of patients over 50 years, whose estimated life expectancy is 10 years.

Representatives of the Negroid race and men with genetic predisposition to prostate cancer are worth a study, starting from 40 years. The PSA level increases before the prostate cancer becomes clinically pronounced. Due to this, you can make a diagnosis at an early stage, and start timely treatment.

Ultrasound of the abdominal cavity can assist in identifying the hydronephrosis of the kidneys (their expansion) and determining the volume of urine, which remains in the bladder after the patient has ordered. This indicator does not directly explain the emergence of other symptoms and signs of prostatism, and on its basis it is impossible to predict the outcome of surgery.

It is also unknown, whether the large residual volume of urine indicates the upcoming disorders of the bladder or kidney. Most of the specialists believe that it is necessary to follow the patients with a high meaning of this indicator more carefully if they preferred non-functioning therapy.

Renal failure in obstruction occurs as a result of the growing expansion of the kidneys (hydronephrosis). Ultrasound examination of patients with elevated levels of creatinine in blood serum can determine what caused insufficiency - obstruction or other factors.

The transrectal ultrasound of the prostate gland does not always make patients with the presence of a benign hyperplasia. But still, during this examination, you can very accurately measure the volume (size) of the prostate. The main function is to help make the biopsy of the gland in the case of suspicion of the presence of cancer of this body.

Dynamic observation, medication therapy and surgery are the main treatment options. Patients who are not suitable for operation and not received positive results of drug treatment are permanent catheters, conduct intermittent (periodic) self-saming or an internal urethral stent (read further). Complications arising from DGPG usually serve as an indication of a surgical operation. Therefore, patients with complications are not treated by dynamic observation or medical preparations.

To improve the symptoms of DGPA, consider recommendations. Drink alcohol and caffery-containing drinks in moderate quantities, especially late in the evening, before going to bed. Tranquilizers and antidepressants weaken the work of the muscles of the bladder and prevent complete emptying. Medicines for cold and flu, as a rule, contain anti-reflective substances that increase the tone of smooth muscles in the neck of the bladder and prostate, which leads to the deterioration of symptoms.

Fitotherapy - the use of plant extracts for medical purposes. Recently, such a method of treating symptoms of DGPH attracted the attention of the press. The greatest popularity was obtained by the extract of a dwarf palm tree (also known as "Palma Serena"). The mechanism of action of phytotherapy is unknown, and its effectiveness has not been proven. It is assumed that the extract of this plant has an anti-inflammatory effect that reduces the erection of prostate, and oppresses hormones controlling the growth of prostate cells. It is possible that the positive results obtained from the use of plants are only a consequence of the placebo effect.

Two groups of drugs, which showed their effectiveness in the treatment of a benign prostate hyperplasia. These are alpha blockers and 5-alpha reductase inhibitors.

Alpha blockers In the prostate gland and the neck of the bladder contains a large number of smooth muscle cells. Their tone is under the control of the sympathetic (involuntary) nervous system. Alpha receptors are the receptors of nerve endings. Alpha blockers are medicationswhich block alpha receptors, thereby lowering the tone of the muscles of the prostate and the neck of the bladder. As a result, the rate of stream of urine increases and symptoms of prostate disease are improved. Alpha receptors are in other parts of the body, in particular, in the blood vessels. Initially alpha blockers were designed to treat high blood pressure. It is not surprising that the most common side effect of such drugs is ortostatic hypotension (dizziness caused by a drop in pressure).

The list of widespread alpha blockers includes:

• prazozin;
• doxazozin;
• terasozin;
• tamsulosin.

The last medicine is the electoral blocker α1A-adrenoreceptors, designed specifically to oppress the subtype of alpha receptors located preferably in the bladder and prostate.

Alpha blockers are effective for the treatment of patients with residual urine volume less than 300 ml, and non-absolute (vital) indications for surgical operation. Most studies have shown that as a result of the reception of these drugs, the symptoms decreased by 30-60%, and the rate of urine flow moderately increased. All of the above alpha blockers adopted in therapeutic dosages have a proper action. The maximum result is achieved within two weeks, and is preserved for a long time. 90% of patients are well tolerated treatment. The main reasons for which the treatment has to be discontinued is dizziness due to hypotension and insufficient effectiveness. Direct studies, the subject of which was the comparison of various alpha-blockers among themselves, were not conducted. Therefore, the statements that any of them are better than others are not justified. As a rule, treatment needs to be held throughout life. Anomalous or retrograde (reverse) ejaculation, which is experiencing 6% of patients taking Tamsulosin, is less common than the existed side effect.

5-alpha reductase inhibitors The 5-alpha reductase enzyme turns testosterone into its active form, namely dihydrotestosterone, in the prostate gland. Finasteride does not give this transformation. Reception of this drug facilitates the symptoms of DGPA, increases the flow rate of urine and reduces the size of the prostate. However, such improvements can be called no more than modest, but they are achieved in the period up to six months. Recent studies have shown that the finasteride may be more effective for men with large sizes of prostate, and less effective in the treatment of patients with small size sizes. The medicine, which is in question, really reduces the number of cases of urine delay. Thanks to him, the need for an operation at the prostate decreases by 50% in four years. Side effects include: breast an increase (0.4%), impotence (3-4%), a decrease in the volume of ejaculate and the drop in the PSA level by 50%.

This is the most common urological procedure. Only in the United States of America annually make 200,000 operations. Prostatectomy DGPA is to remove only the inner part of the prostate. Such an operation differs from radical prostatectomy of cancer, during which all the tissue of the prostate gland is removed. Prostatectomy is the best and fast way Improve symptoms of benign prostate hyperplasia. However, it may not soften all the irritative symptoms of the bladder. Unfortunately, this is more applied to the elderly men over 80, when the bladder instability is considered the cause of most of the symptoms.

Indications for Prostatectomy:

• urine delay;
• renal failure against the background of obstruction;
• recurrent urinary tract infections;
• stones in the bladder;
• large residual amount of urine (relative reading);
• unsuccessful drug therapy (turned out to be ineffective or accompanied by severe side effects);
• patients who are not delighted with the prospects to undergo medication therapy.

Transuretral resection of the prostate gland (Turplezh) This operation is still considered the "gold standard" in the DGPH healing, which is equal to all other treatment options. Turmps are performed using a resectoscope that is injected through the urethra in the bladder. Wire loop conductive electric current cut out prostate fabric. The catheter is left for one or two days. The stay in the hospital is usually three days. Turku is practically painless, or causes a small discomfort. On the third week after surgery, the patient fully recovers.

Significant improvements after this operation are observed in 93% of men with severe symptoms, and 80% with moderate disorders.

Complications associated with the turples may be such:

• mortality rate is less than 0.25%;
• bleeding requiring transfusion - 7%;
• stricking (narrowing) of urethra or bladder neck - 5%;
• erectile dysfunction - 5%;
• incontinence - 2-4%;
• retrograde ejaculation (with ejaculation, seed fluid enters the bladder) - 65%;
• the need to carry out another transurethral resection - 10% for five years.

There are several varieties of Turku:

Transuretral prostate glare / prostatotomy / incision of the bladder neck. As with the tourism, the tool is injected into the bladder. Instead of hinges, an electric knife is used, which is made by one or more pristigules of the prostate to remove the pressure on the urethra. Firebird fabric is not deleted, and if removed, then a very small piece. Results achieved using the prostatotomy of a small prostate (

Transuretral vaporization of prostate This type of resection is carried out using a resectoscope introduced through urethra. However, in this case, the fabric is not cut off, and exposed to powerful electrical energy. As a result, the fabric is evaporated with minimal blood loss. Possible advantages of electric surveys include a smaller period of wearing a catheter, a shorter stay in the hospital and less cost, compared with the Turkger or laser prostatectomy.

Open prostatectomy The prostate glands of large sizes are less suitable for the turple, because, due to the longer time of the resection process, complications often occur. Open prostatectomy is the preferred method of treatment if the prostate is greater than 70-80. To expose the bladder and the prostate, make a cross incision at the bottom of the abdominal cavity. Sex heating capsule dissect, and a benign hyperplasia is caused. A variant of the removal of the bladder and deserted prostate through it is possible. For this, one catheter is put in the bladder through the urethra, and the second through the lower part of the abdomen. Catheters are left for four to five days. Such an operation gives good results, but it is heavier than the turple. Stay in the hospital and the period of rehabilitation lasts longer, and complications are slightly worse. But at the same time, open prostatectomy is considered a very effective way to remove FLG fabric. And only a slightly small number of patients subsequently emerge difficulties with normal emptying of the bladder.

Despite the successful holding of Turkgers, scientists are in constant search for less invasive, safer and less expensive procedures that can be performed in one day under the local

anesthesia

Without leaving a person at the night in the hospital. The diversity of energy sources for point heating of prostate tissue and its destruction was tested. On this principle are based

laser

Microwave thermotherapy, therapy with high-intensity focused ultrasound, radio frequency therapy and transurethral needle

prostate gland (TUIA). All these types of manipulations lead to a smaller number of complications during therapy, but are characterized by smaller efficiency and large postoperative troubles. Stay in the walls of the hospital in short, than when carrying out the turple, but the wearing time of the catheter longer. As a result, many patients need a re-treatment, which, as a rule, is carried out with the help of Turkge. Various laser methods are also used to treat prostate gland. The newest and promising invention is the therapy of the Golmia laser, similar to the turple, is that the fabric of the prostate is actually deleted. According to research, blood loss with this therapy is significantly less than during transurethral resection.

There are patients who are contraindicated by any kind of surgical intervention. To help such a patient, in the prostate part of the male urethra put intraetral stents that support it in the open position. Due to this, the patient can normally emit urine. Steets can be inserted under the action of local anesthesia. In the short term, this method gives good results. Due to offset and other complications in 14-33% of cases, these devices are removed. Of course, it is better not to wear a standing catheter all the time. But they are the only salvation for people of patients, weakened or chained to bed. Alternatively offer

intermittent (periodic) self-saming, which is a patient, or a person who caregoes him can do himself.

Unfortunately, it is impossible to prevent the development of benign hyperplasia of the prostate gland. It is not known whether long-term treatment of finasteride has significantly affected, which began to clinical manifestations of the disease, on the pathological process of the DGPH.

Among the urological diseases of men, one of the most common is a benign prostatic hyperplasia (or DGPA). This name has become applied since 1998 according to the new international classification of diseases instead of the "Prostaty Adenoma".

Pathology is predominantly in patients of elderly and senile age. Since in recent decades there is a tendency to increase the life expectancy in men, the number of patients with the prostate DGPA has increased markedly. In connection with the increase in the relevance of the problem, there is always a search for new, more efficient and gentle treatments.

Causes of disease development

The main cause of the metabolism failure of ferrous cells is a violation of a hormonal balance in the process of age restructuring of the body. At the age of 50-55, men decreases the production of male sex hormones. At the same time, there is an increase in the concentration of some female sex hormones, which give an impetus to change the metabolic rate in prostate cells.

The older man, the higher the risk of pathology. Thus, among men, 55-60 years old, the DGPG is revealed from almost 50%, among representatives of the strong sex of the older age group (75-80 years), this figure is already 80-90%. Related factors capable of increasing the likelihood of pathology detection include overweight and hereditary predisposition.

Despite the general moments in the mechanism of the development of pathology, the process of the growth of tissues can occur differently. The diagnosis is taken into account, the structure of the neoplasm, its location and direction of growth is taken into account.

Depending on these characteristics, in each individual case, a slightly different from the standard clinical picture may be observed. There is also a generally accepted division into three stages of the development of the disease, each of which has a certain list of symptoms.

Localization is distinguished by three types of pathology: intravenous, preposter and sub-menu. The most vividly pronounced symptomatology has an intravenous hyperplasia. The growth of the neoplasm in this case occurs towards the bladder. At first, the prostate gland supports the bottom of the bubble, and then hesitates into it, causing a significant deformation of the neck and the top of the urethra. Followed by tumor growth increases outside pressure On the urethra, which leads to a gradual narrowing of his lumen. For this type of pathology, violations of urination are characteristic: the participation of the urges, the embankment of urine. If you do not start treatment at an early stage, severe renal failure can become one of the complications.

When the fabric expansion of the fabrics, the lateral shares of the prostate increase first. Such a tumor does not lead to significant changes in the bubble shape and its neck. The disease does not have pronounced symptoms, so a man may not guess his existence for a long time.

The subwoofer hyperplasia is called tumor formation, localized in the back of the prostate adjacent to the wall of the rectum. This type of pathology does not lead to violations of the process of urine outflow, but it may affect the functioning of the upper urinary ducts and kidneys. For the sub-tumor, the feeling of discomfort during defecation is characterized.

According to the type of tissue growth, two forms of adenoma are distinguished:

• in diffuse growth, the prostate gland increases in size evenly;
• in a nodule form, single or multiple nodules are formed in ferruginous tissues.

The prostate gland consists of several types of cells: muscle, ferruginous (generating a secret) and stromal (connecting tissue is formed). The structure of the neoplasm depends on which tissues it began to form. It is possible to establish the type of DGPA by cytological analysis of tissue samples. The material fence is produced by conducting a biopsy of the prostate.

After the laboratory study is performed, one of the following types of adenoma is determined:

Ironisto-stromal	In the structure of the tumor, cells secreting prostatic juice, and connective tissue cells are presented. The growth of tissues in this case will occur evenly.
Fermented	It is noted an increase in the amount of gland cells. This type of prostate hyperplasia can also be established at an elevated level of prostate-specific antigen (PSA). In most men, the iron adenoma is multiple nodules that are gradually increasing in size. Characteristic feature This pathology is a slow growth of the neoplasms. Due to the lack of symptoms, many patients do not realize the presence of the disease. It is possible to identify it in the early stages in most cases by chance during preventive inspections or in the survey process about other diseases.
Fibrous	Difference of fibrous DGPH is the separation of nodules and seals with a protective capsule from the connective tissue. The growth of formations occurs from stromal and glandular cells. When the fibrous adenoma detects, men needed constant control over the state of tumors due to the high probability of their rebirth and misstatement.
Muscular hyperplasia (adenomyoma)	Such a growing tissue is rarely diagnosed.

There are three degrees of prostate increasing: compensated, subcompensated and decompensated. In determining the stage of the disease, the condition of the patient is taken into account, the presence of characteristic symptoms, as well as structural and functional changes in the organs of the urogenital system.

The compensated stage begins with minor urination disorders. Initially, men appear the need to visit the toilet much more often. The emptying of the bladder requires additional effort. To speed up the outflow of urine, it is necessary to strain the muscles of the pelvis and abdominal wall. The jet at the same time becomes sluggish and may even interrupt for a few seconds. Despite the difficulties with urination, at this stage, during the visit to the toilet, it is possible to empty the bladder completely.

During the examination of the patient, the abnormal structure of the kidney and urinary tract is missing. Upon timely appeal for medical care, the treatment of PCPH prostate at the compensated stage is carried out by conservative methods. The duration of the first stage can be very different: some men continue this period for 3-4 years, others have from 10 years and longer.

The subcompensated stage begins from the moment when the bladder cannot fully perform its function. This means that as a result of the regular stress of the muscles, the pelvis when urinating the wall of the bladder lost elasticity and cannot completely push the accumulated urine. Initially, the volumes of liquid remaining after urination do not exceed 20-50 ml. With further progression of the disease, its quantity can reach up to 500 ml. At this stage, the first renal disorders are noted. Conservative treatment of men with a subcompensated stage of the prostate DGPA, as a rule, does not give the expected therapeutic effect. In most cases, patients recommended surgical intervention using a minimally invasive endoscopic tool.

A benign prostate gland hyperplasia in the decompensated stage is manifested by an increase in the volume of residual urine to 800 ml and more, while many men have its spontaneous allocation. Regular urine delay leads to the development of such complications as a urolithiasis, severe renal failure, intoxication of the body with nitrogen exchange products. If the patient had such symptoms as a complete loss of appetite, nausea, weakness, tangible smell of acetone, this means that immediate medical care is needed. Lack of treatment can lead to a fatal outcome.

Since the benign prostate gland hyperplasia in its manifestations is similar to some other urological diseases, at the initial stage of the survey, a differential diagnosis is carried out to exclude the inflammation of the bladder, neurological disorders, diabetes and others. In suspected adenoma, a rectal finger survey is carried out to establish the form of the gland, the presence of seals and nodes, pain.

After putting the primary diagnosis, the examination is carried out according to the following scheme:

• a questionnaire is filled to assess the disease over the IPSS system;
• the quality of life of the patient is evaluated;
• the following are carried out laboratory research: general clinical analyzes urine and blood, blood test for determining the concentration of urea, PSA;
• ultrasound examination of the prostate and urinary system organs;
• it is also recommended such a study as a urophloumometry (determining the speed of urine outflow).

Before starting treatment, a biopsy can be prescribed to the patient to eliminate the malignant nature of the neoplasms.

The treatment of DGPH includes dynamic observation, conservative therapy and surgical intervention. With small size of the adenoma, its slow growth and the absence of symptoms associated with urination disorders, such treatment is used as a dynamic observation. The patient is recommended to change the lifestyle, excluding all factors from it provoking the intensive growth of the tumor. Special attention is paid to properly balanced nutrition and drinking regime.

The patient should carry out hiking, do physical exercises that prevent congestive phenomena in the field of small pelvis. Conservative treatment of DGPH is shown to those patients who have no complications and structural changes in the urinary system organs.

The therapeutic scheme includes drugs for removing acute symptoms, normalization of urination and stopping adenoma:

Alpha adrenoblocators

They act on muscle fibers of the bladder neck and prostate gland, reducing their tone and alleviating the outflow of urine. The first positive changes are marked after 10-14 days. In cases where the effect of the use of drugs did not occur after 4 weeks, the treatment is considered unproductive.

5-alpha reductase inhibitors

This dosage group oppresses the production of 5-alpha dihydrotestosterone, which provokes the development of neoplasms. Recently, a newly developed synthetic drug finasteride is applied in connection with a smaller number of side effects and contraindications. As clinical trials proved, with long-term use of the drug (from 1 to 2 years), it is possible to achieve not only the cessation of the growth of DGPA, A and reduce its size.

Operational treatment is used in the involvement of the upper urinary tract or in the absence of an effect from the reception of drugs. Indications for urgent surgery are urolithiasis, acute urine delay, severe renal failure, recurrence of inflammatory processes in the organs of the urinary system.

The main goal of any surgical intervention is to reduce the pressure on the upper urethra department and an increase in its lumen to normalize urine outflows. If the disease is not launched and there are no serious complications, in most cases, only the part of the gland is removed, which squeezes the urethra.

Surgical treatment can be carried out by one of the following methods:

Open operation	It is used if it is necessary to completely remove noticeably enlarged in the size of the prostate gland. Adenomectomy is carried out through a cut in the abdominal cavity. Duration postoperative period ranges from 10 to 14 days. Rehabilitation after applying this method of treatment lasts from 1.5 to 2 months.
Endoscopic operation	For manipulations, a special tool is used, which is introduced into the abdominal cavity through small punctures. Next, using an electric current or laser, the removal of the part of the gland, which squeezes the urethra is carried out. Such surgical intervention requires a significantly smaller rehabilitation period.
Minimally invasive operations	If a elderly age The patient and the presence of background pathologies do not allow using one of the above methods, it is necessary to apply less traumatic methods: microwave therapy and needle ablation. The effect of their implementation is somewhat lower, however, the likelihood of the development of postoperative complications is minimal.

If the patient's condition does not allow for operational treatment, one of the following ways to normalize urine outflows are used.

Prostround adenoma (benign hyperplasia, DGPA) is diagnosed in men of middle and older. After 50 years, this neoplasm is detected from each sixth. Due to the increased gland, the process of urination is hampered, inflammatory diseases of the urogenital system are developing. Until a certain degree, the growth can be restrained, but as a result, most men are still forced to resort to surgical interference.

Prostate adenoma is a pathological increase in its cells. As a result of the iron loses functional tissues and increases in size.

The adenoma itself is called a single (monocentric) tumor, which occurs in the glandy epithelium. Hyperplasia is, as a rule, multiple nodule formations of various sizes. Most people and specialists identify these concepts.

Prostate by 70% consists of iron tissue (parenchyma). The rest is the urethral part and fibrous muscular stroma (a kind of organ frame), represented by loose connective and smooth muscle tissue. It forms a layer inside the prostate body. Depending on which region, the process of hyperplasia began and which cells are involved in it, isolated adenomatous (ferruginous), fibrous (from connective tissue), myomatous (from smooth muscle tissue) and stromal-iron form. Pure stromal prostate gland hyperplasia is rare.

Zonal anatomy of prostate in transverse sections on three levels

Hyperplastic processes arise mainly in iron fabric and pass in their development several stages. The focus of the generation of adenoma is two or three firmly adjacent glands, in which the process of pathological division of cells begins (a proliferative center is formed). The neoplasm surrounds the stromal tissues, over time they become more fibrous and dense.

In the second stage, active breeding of cells is already occurring, as a result of which the nodules are formed. The connecting tissue around them is even more compacted, creating the visibility of the capsule.

At the third stage, other cell proliferation foci (subsidiaries) are formed.

Due to the permanent growth of the cells, squeezing the gland ducts begins, the outflow of the secret is violated. As a result, the walls of the ducts are expanded, cysts are formed - this is the 4th stage of the development of adenoma.

On the fifth terminal stage of the development of adenoma cysts grow, surrounding their ferrous cells atrophy.

According to the above scenario, 90% of prostate hyperplasia is developing, the rest are called atypical. Of the recent most common form is basal cell.

Definition of structure benign education Prostates are very important to choose treatment tactics. The true adenoma develops from one hearth (focal form), does not cause diffuse gland damage (many foci) and does not recur by removal. The hyperplasia on the contrary - is distinguished by a pronounced ability to resume growth, strongly depends on the hormonal background.

Another important point: after removing hyperplasia, the prostate function will not be restored, and after removal of the adenoma it is possible. It grows from parauretral glands, located next to the urethra, expands and gradually presses the parenchyma of the prostate to the outer shell. As a result, the so-called surgical capsule is formed. An attached parenchyma after removing the tumor is able to "turn out" and recover in 6-7 months. True adenoma (adenomatous hyperplasia) occurs infrequently. Typically remove a mixed form - adenofibromy (includes ferrous, coupling and muscle tissue).

Three types of tumors are distinguished in size:

• Small - up to 30 g;
• Average - up to 70 g;
• Big - up to 250 g

Adenoma more than 250 g is already considered a gigantic.

Differences from cancer

With hyperplasia or true adenome, there is no malignant rebirth of cells, therefore the neoplasms of this class are called benign. The fabric grows up, but does not surround itself with an additional vascular network for food, does not have toxic effects on the body with products of its metabolism.

Other distinctions of adenoma from cancer:

• Grows within the prostate capsule, stretches it;
• Does not germinate into the surrounding authorities, but can squeeze them;
• Does not metastasizes;
• Favorable treatment prediction.

However, it should not relax a doctor nor the patient, because against the background of hyperplasia, foci of the prejudice, prone to subsequent oncological reincarnation, may well appear.

Causes of occurrence

The exact cause of the development of the adenoma is still not named. The main provoking factor of the doctors consider the age reduction of testosterone levels. It has been proven that the parauretral glands of the prostate react to female estrogen by growing. With age, the level of men's hormones decreases, women begin to prevail, which becomes one of the reasons for adenoma. The extensive form of testosterone - dihydrotestosterone can be a provocative of the growing gland.

According to adenoma statistics, it is less common in the residents of the countryside, as well as the Chinese and Africans. What can conclude that the development of pathology provokes not only the age change of the hormonal background, but also lifelong lifestyle, abundant use of oily and refined food, atherosclerosis. Moving men eating mainly vegetable food, adenoma rarely suffer.

Prostround Adenome Development Risk Factors

Favorable soil for the development of hyperplasia is also the wear of prostate tissues due to both other diseases, the consequences of which are manifested with age.

Stages of the disease

From the point of view of the clinical picture, the following stages of adenoma are distinguished:

1. Compensated. The name is due to the fact that urination problems are still compensated by the voltage of the muscles (deloader) and hypertrophy of the muscles of the bladder walls. Adenoma increases in a volume of up to 30-50 ml, starts to put pressure on the urethra, but the bladder still manages completely empty. The urges become frequent, the pressure of the jet decreases. After night sleep, urination begins with a delay. The residual urine is not yet, the kidneys work normally.
2. Subcompensated. There is a further reduction of adenoma to 60 cm 3, and therefore the difficult urination is compensated only in part. A residual urine appears, the volume of which can reach 400 ml, the bladder walls are stretched, their ability to the normal reduction is reduced. Urination becomes intermittent, requires the tension of the abdominal press. The expansion of ureters leading to the kidneys occurs, which contributes to their infection due to urine cast.
3. Decompensated. The volume of adenoma can reach 100-120 cm 3. Urination is impaired so much that the bladder is constantly overflowing (up to 1 l of urine), they will break, characterized by pain in the stomach and drip separation of urine. With the exhaustion of nerve receptors, pain weakens, urinary urination, too, urine continues to podcap the (paradoxical ichuria).

In the absence of medical care on the background of the adenoma, chronic renal failure will develop, the acute urine delay is possible inflammation of the testicles and appendages.

The process of the development of a benign hyperplasia of prostate gland:

Symptoms of prostate adenoma

The time of the appearance of symptoms and their severity depends on the direction of the growth of the adenoma. Perhaps several options:

• Sub-menu. Adenoma grows towards the rectum, without affecting the urethra. Symptoms may not be even when reacing a substantial volume.
• Intravenous. Adenoma gradually begins to sign the neck of the bladder, changing his shape. At the bottom of the abdomen feels constant discomfort.
• Retrotrigonal. The tumor presses on the prostatic part of the urethra, difficult urination is manifested even with small expansion volumes.

About how the symptoms show adenoma Prostata tells the doctor urologist-Andrologist of Livis Alexey Viktorovich

Most often, the adenoma grows immediately in several directions. The first symptoms: the increase in urination (especially at night), the weakening of the head of the urine jet.

Next, as the bladder walls are stretched, abdominal pain is added. Adenoma is often accompanied by inflammation of prostate tissues, which can go to the testicles, then pain in the scrotum will arise. Cystitis and urethritis often develops. Urination becomes painful.

In the development of renal failure, the temperature rises, pain in the lower back, the patient is fevering.

Diagnostics

With the appearance of suspicious symptoms, you need to contact the urologist. Before a visit to the doctor, you can fill out a questionnaire, which will help to evaluate the severity of symptoms in urination disorders.

Install the diagnosis of adenoma is not enough. The doctor needs to find out the stage of its development, the direction of growth, to identify complications.

Basic methods of diagnosis of adenoma:

1. Rectal palpation of prostate. Apply in the absence of acute inflammation.
2. Blood and urine tests for identifying complications from the urinary system, determining the immune status of the patient.
3. Ultrasound, cubizhes.

PSA levels taking into account age and reasons for increasing total PSA

1. Cistoscopy is an internal inspection of the bladder. The indication is the appearance of blood in the urine, an unclear picture with an ultrasound.
2. Radionuclide urophloummetry to assess the nature of urine jet.
3. Radiography of urinary tract and kidneys.
4. CT, MRI small pelvis.

To exclude prostate cancer and assess the structure of the tumor, if necessary, perform. After the procedure, the prostate cannot be operated, it is necessary to wait 1-2 months. If the state is sharp, then this time is not.

How to treat adenate prostate

As mentioned above, it is important to determine the nature of the structure of the neoplasia for the selection of adenoma treatment tactics. For this, a morphological study of the tissue sample (bioptate) is produced. If there are proliferative centers of 2.3 levels, then 5-alpha reductase blockers will be effective as conservative therapy. Transuretral resection in this case is not a radical method of getting rid of hyperplasia, which is especially important for young men (repeated operations will be required). When atypical foci of laser and electrosurgical removal methods are excluded, since it is already about the optional prejudice.

Urologist Kamaletdinov Rinase Enesovich talks about the diagnosis and treatment of prostate adenoma

If proliferative centers of 4 and 5 levels are found in the samples of the tissues, then conservative therapy is already meaningless. Atrophic processes are strongly pronounced, so there is a reason to hope for the randomy outcome of the operation. Electrorescation will contribute to a decrease in the size of the prostate due to the excision of the tensile cysts.

The complexity of the treatment of adenoma is also the fact that in 96% of cases it is accompanied by inflammation, and in acute form.

Medications

It is impossible to cure conservative methods to adenomose. Medicines and physiotherapy are advisable to apply in the absence of residual urine or in the presence of contraindications to surgical intervention. As part of drug therapy with adenoma, drugs are used to reduce the volume of glands, painkillers ("Nurofen", "ibuprofen"), antibiotics for the relief of inflammation (Levuary, Mepooderitsin, Iperrofan), immunomodulatory funds.

Hormonal therapy

Since prostate tissue receptors respond to hormones, the following groups of drugs are used for adenoma therapy:

• Containing the combination of androgens and estrogen (testobromerester).
• Influencing the metabolism of androgens in the testicles and prostate (oxyprogesterone capronate, pregnin, depostat).
• The inhibiting activity of the 5-alpha reductase enzyme for the subsequent decrease in the activity of dihydrotestosterone (finasteride). The effect can be expected no earlier than six months after the start of use.

The substantial minus of hormonal treatment of adenoma consists in the formation of fibrous changes in the surgical capsule, and this significantly makes it difficult for subsequent surgical intervention. Some patients even detect necrosis foci. In addition, there is a danger of endocrine imbalance in the body due to excess female hormones.

Natural 5-alpha reductase inhibitors

In addition to chemical inhibitors of 5-alpha reductases, there are both natural, most popular of which are "Permikson" based on the palm trees extract. The drug has a pronounced anti-edema effect, increases depronor tone. Alternative to him is "Prostasen".

The drug Permikson is a vegetable antandrogenic agent, which is used to treat a benign prostate hyperplasia (BPH) and chronic prostatitis. Price from 748 rubles.

Taenan also applies to natural means on an African plum extract. The drug brakes the growth of fibroplastic cells of stroma, relieves inflammation and swelling. The volume of residual urine decreases by 35%. A course of reception at least 6 weeks.

Alpha-1-adrenoblays

Another direction of exposure to adenoma are alpha-adrenoreceptors, which are located in the rear urethra, stroma and prostate capsule. They lead to a tone smooth muscles, they will spy them, which makes it difficult to urinate. The severity of adenoma symptoms is largely determined by the functionality of these receptors. If they are blocked, the bladder spasms are eliminated, the irritation of its neck and walls.

The preparations of the Alpha-1-adrenerobators group are helped solve the problem. Unlike 5-alpha reductase inhibitors, they begin to act quickly. Prostate decreases in the amount of 2-2.5 times due to the removal of spasm and edema.

The most secure from the point of view of the side effects of Tsamulosin ("Omnik"). It is favorably different from other alpha-adrenobloclars (alfuzosine, therazosine, prazosin) by the fact that it does not cause a significant pressure reduction. In the first days of reception, the flow rate of urine increases by 16%. The maximum effect can be felt in a month. Libido and erection remain preserved, some patients occur. An alternative preparation is doxazozin ("Cardura").

Omnik - Blocator α1-adrenoreceptors; Means for the symptomatic treatment of benign prostatic hyperplasia. Price from 330 rubles.

To improve blood circulation and removal of spasms, the adenoma is also prescribed Tadalafil (FDE-5 inhibitor) of 5 mg daily. The study conducted in 2012, the results of which were published in the Europen Urology journal showed that Sialis is more effective for removing the symptoms of adenoma than Tsamulosin.

Preparations for improving the functional state of the prostate

At the initial stage of the adenoma, preparations based on peptides extracted from the extract of prostate of bulls are effective: "Prostatylene", "Robaveron", "Prostar". They improve blood microcirculation in the prostate, improve the venous outflow.

Candles "Longidase" also possess anti-eash and immunomodulatory property, and the drugs "Indica" (based on Palm Sabal extract) and "Indica Plus". However, many doctors consider them useless in the treatment of adenomas, since there are no reliable evidence of their effectiveness.

"Indica Plus" - biologically active additive Food (BAA), an additional source of epigalocatechin-3-gamut, fatty acids and indole-3-carbinol. Price from 2255 rub.

As an immunostimulating agent, you can try Todikovp dietary supplements (walnut extract and petroleum products). According to reviews, it helps reduce the volume of prostate when applied in the form of compresses to the crotch area and lower back, as well as in the form of microclism in a mixture with linseed oil.

At home

The success of conservative therapy adenoma largely depends on the responsibility of the patient himself. Avoid exacerbation of the situation will help the observance of the diet: the rejection of alcohol, acute, carriage, excess caffeine.

With adenoma, regular physical activity is important: squats, exercises for the press, pumping the pelvic muscles. Sexual excesses are prohibited because too frequent reductions of prostate can provoke inflammation and swelling.

Proper technique of squatting

Adrenal folk remedies are not treated, but can act as auxiliary therapy for removing swelling and inflammation. Popular funds:

• Propolis, bees submor, honey;
• Kora Osin, Ivan-Tea, Lukovaya husk;
• Pumpkin seeds;
• Castoreum;
• Cinnamon, turmeric.

On the Internet, there is a lot of information about the observing of the body by the method of nonsense. According to it, the regular intake of soda has an antitumor effect, including adenoma. The technique is dubious, scientifically not recognized.

Physiotherapy

Physiotherapeutic methods for adenoma are aimed at removing the edema by improving the blood flow and stimulation of protective cellular mechanisms. To do this, use magneto, laser and indentoraterature. At home, you can use portable devices "Almag", "Vitafon", Kuznetsov Applicator. Although most men say that the effect of them is no compared to procedures in physicate.

Video review of the vibroacoustic apparatus "Vitafon"

There are also specific physiotherapy methods aimed at partial destruction of adenoma tissues. These include:

1. Cryotherapy.
2. Transuretral needle ablation.
3. Transurethral microwave therapy.
4. Thermabulation.

Their use causes damage and subsequent degradation of adenoma tissues. They are compressed, the volume of the gland decreases.

Surgical removal

Surgical methods of adenoma treatments:

1. Electrorescape. It is performed through urethra with an endoscope with electric fetters at the end.
2. Open adenomectomy. A long-distance operation to remove the prostate adenoma (inadequate and integrated) implies the mechanical desertion of the tumor through a cut above the pubic or for the testicles. It is used for large volumes of neoplasms.

1. Laser techniques. Measure the transurethral removal of the adenoma laser beam. 2 fundamentally different directions are isolated: Vaporization (laser ablation, tissue evaporation) and enucleation (excision of adenomatous units blocks).
2. Plasma methods (bipolar ablation). Adenoy is removed using a plasma arc resulting between the electrodes.
3. Transuretral resection (tour) - excision of adenoma tissue transurethral access.

The head of the surgical direction of the Hospital "Garvis" Robert Molchanov will tell about how the operation of the tour of the prostate is held

The choice of the method depends on the volume of adenoma and the associated pathologies.

Clinics and prices:

• Vaporization in the Central Bank of the Russian Academy of Sciences (Moscow) - 33 thousand rubles, in the Alexandrovsk Hospital (SPB) - 75 thousand rubles;
• Tour in the clinic of urology them. FRONSTENA (Moscow) - 36 thousand rubles, laser enucleation - 55 thousand rubles. without consumables;
• Robot-assisted prostatectomy in the clinic of urology and robotic surgery (SPB) - 168 thousand rubles.

You can remove adenoma for free on the policy of the OMS.

What is dangerous adenoma for men: complications and consequences

The adenoma interferes with complete emptying of the bladder, as a result of which urine is constantly stared in it. It multiplies pathogens, and the pressure being created provokes the expansion of the ureters. As a result, pathogenic microorganisms rise to the kidneys and descend into the testicles, which leads to complications:

1. Cystitis.
2. Urethritis.
3. Urinary bubble atrophy.
4. Inflammation of eggs and appendages.
5. Renal failure.

The penetration of bacteria in the bloodstream can cause a fatal outcome.

Frequently asked questions about prostate adenoma

1. Is it possible to cure adrenal prostate without surgery? - It is impossible. In the first stage, it is possible to restrain its growth of drugs, to remove symptoms and reduce the volume by removing the edema and spasm of smooth muscles.
2. Can adenoma resolve? - Not. The formed nodes themselves from the prostate capsule will not disappear, the cells will not dissolve. The only thing that can happen is their seal and transformation into focus focus.
3. How many people live with adenoma? - With adequate treatment, the adenoma's life expectancy does not affect, but if it comes out, for example, the renal failure is possible. The growth of adenoma in the direction of the rectum can be at all asymptomatic throughout life.
4. How does the prostate adenoma affect the potency? - It all depends on the stage and severity of symptoms.
5. Is it possible to ride a bike, do the exercise bike? - It is possible, but this should be exactly walking, and not many hours of marathons, and preferably a special saddle with a crotch cut.

1. Is it possible to have sex with prostate adenoma? - sex with adenoma is not rebeling and even welcome, because congestive processes in the area of \u200b\u200bthe small pelvis aggravate the symptoms.
2. Is it possible to make a prostate massage during the adenoma. - A direct prostate massage with adenoma is dangerous, since mechanical irritation can cause the movement of stones (if any), provoke the growth of tissues. It is better to massage the crushes.
3. Can I go to the bath? - With a small controlled tumor, it is possible, but infrequently and do not abuse overheating, otherwise prostate tissue edema.
4. Is it possible to drink alcohol? - When adenoma it is better to completely exclude. Even 20-30 g of alcohol provoke a tide in the area of \u200b\u200ba small pelvis, in particular, into the sublipal part of the urethra, which can lead to an acute urine delay.

Prevention

Specific prophylaxis of adenoma does not exist. One can only minimize the impact of provoking its development of factors. Basic measures:

• Regular physical activity, sex;
• Balanced diet;
• Rejection of smoking, minimum alcohol;
• Maintaining normal weight;
• Regular surrender analyzes for sex infections.

Researcher in the Research Institute of Urology Votko Dmitry Alekseevich will give 10 tips to help preserve and strengthen the health of the prostate gland

Prostate hyperplasia (prostate adenoma) is a common urological disease in which proliferation of prostate cell elements occurs, which is the reason for squeezing the urethra and, as a result, urination disorders. The neoplasm develops from a stromal component or from a glandular epithelium.

Source: Radikal.ru.

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men older than 50 years have symptoms of prostate hyperplasia, in 65 years the disease is found in 50% of male persons, and at an older age - about 85% of men.

With timely correctly selected treatment, the prognosis is favorable.

Diagnostics

The diagnosis of prostate hyperplasia is based on the data collection of complaints and anamnesis (including family), examination of the patient, as well as a number of instrumental and laboratory studies.

During the urological inspection, the state of external genital organs is estimated. The finger study allows determining the condition of the prostate gland: its contour, soreness, the presence of a groove between the proportions of the prostate gland (is normal), sealing sections.

A general and biochemical blood tests are prescribed (the content of electrolytes, urea, creatinine), general urinary analysis (the presence of leukocytes, erythrocytes, protein, microorganisms, glucose) is prescribed. The concentration in the blood of the prostatecific antigen (PSA) is determined, the content of which increases with the hyperplasia of the prostate gland. It may be necessary to carry out the bacteriological sowing of urine in order to eliminate infectious pathology.

The main instrumental methods are:

• a transrectal ultrasound study (determination of the size of the prostate gland, the bladder, the degree of hydronephrosis in its presence);
• wrooflometry (determination of the volumetric rate of urination);
• overview and excretory urography; and etc.

Most often, the disease is diagnosed in 40-50 years. According to statistics, up to 25% of men over 50 have symptoms of prostate gland hyperplasia.

If necessary, differential diagnosis with bladder cancer or urolithiasis are resorted to cystoscopy. This method is also shown if there is a history of sexually transmitted diseases, long-term catheterization, injuries.

Treatment of prostate hyperplasia

The main objectives of the treatment of prostate hyperplasia are the elimination of urination violations and preventing the further development of the disease, which causes severe complications from the bladder and kidney.

In some cases, limited to dynamic observation of the patient. Dynamic observation implies regular inspections (with an interval of half a year old) by a physician without any therapy. The expectant tactic is justified in the absence of pronounced clinical manifestations of the disease with the lack of absolute indications for surgery.

Indications for medication therapy:

• the presence of signs of the disease that deliver anxiety to the patient and reduce the quality of his life;
• the presence of risk factors for the progression of the pathological process;
• preparation of the patient for surgical intervention (in order to reduce the risk of early postoperative complications).

In the composition of drug therapy of prostate hyperplasia can be assigned:

• selective α 1 -adrenoblockers (effective in the case of an acute urine delay, including postoperative genesis, at which it is impossible to empty the overcrowded bladder for 6-10 hours after surgery; improve cardiac activity with accompanying ischemic heart disease);
• 5-alpha reductase inhibitors (reduce the size of the prostate gland, eliminate macrohematuria);
• preparations based on vegetable extracts (decrease in the severity of symptoms).

In the case of an acute urine delay, the patient with the prostate hyperplasia shows hospitalization with the coating of bladder catheterization.

Replacement androgen therapy is carried out in the presence of laboratory and clinical signs of the age deficit of androgen.

There were assumptions about the possible malignancy of the prostate gland hyperplasia (i.e., reborn in cancer), but they were not proved.

Absolute indications for surgical treatment of prostate hyperplasia are:

• recurrences of acute urine delay after the removal of the catheter;
• lack of a positive effect of conservative therapy;
• formation of a diverticule or stones of the bladder of large sizes;
• chronic infectious processes of the urogenital tract.

Surgical interference over the prostate hyperplasia is two species:

• adenomectomy - excision of hyperplasted tissue;
• prostatectomy - resection of the prostate gland.

The operation can be carried out by traditional or minimally invasive methods.

To transvisical adenomectomy with access via the bladder wall, they are usually resorted in the case of an intractional growth of the neoplasm. This method is somewhat traumatized compared to minimally invasive interventions, however, with a large share of probability provides complete cure.

Transurethral resection of the prostate gland is characterized by high efficiency and low trauma. This endoscopic method involves the absence of the need to disseminate healthy tissues when approaching the affected area, makes it possible to achieve reliable hemostasis control, and can also be performed in elderly and senile patients with concomitant pathology.

The transurethral needle ablation of the prostate gland is to be introduced into the hyperplasned tissue of the prostate gland of needle electrodes, followed by the destruction of pathological tissues using radio frequency effects.

Transuretral vaporization of the prostate is carried out by means of a roller electrode (electrical position) or laser (laser vaporization). The method is to evaporate the hyperplasned tissue of the prostate gland with its simultaneous drying and coagulation. Also, for the treatment of prostate hyperplasia, the method of cryodestruction (treatment with liquid nitrogen) can be used.

The embolization of the prostate arteries refers to endovascular operations and lies in the blockage of arteries with medical polymers that feed the prostate gland, which leads to its decrease. The operation is carried out under local anesthesia access through the femoral artery.

In order to reduce the risk of developing prostate hyperplasia, timely appeal for medical help at the first signs of urination disorder, as well as annual preventive inspections with a urologist upon reaching 40 years have been reached.

Endoscopic golm laser enucleation of the prostate gland hyperplasia is carried out using a 60-100 W 50-100 W Holmium laser. In the course of the operation, the hyperplazed fabric of the prostate into the urinary bubble cavity is caused, after which the adenomatous nodes are subject to removal by an endomocel. The effectiveness of this method is approaching such with adenomectomy open. The advantages are the lower chance of developing complications in comparison with other methods and a shorter rehabilitation period.

Possible complications and consequences

Against the background of prostate hyperplasia, serious urinary tract pathologies can develop: urolithiasis, pyelonephritis, cystitis, urethritis, chronic and acute renal failure, urinary bubble diverticulus. In addition, the consequence of the launched hyperplasia may become orchoepididimitis, prostatitis, bleeding from the prostate gland, erectile dysfunction. There were assumptions about possible malignancy (i.e., reborn in cancer), but they were not proved.

Forecast

With timely correctly selected treatment, the prognosis is favorable.

Prevention

In order to reduce the risk of developing prostate hyperplasia, recommended:

• upon reaching 40 years - annual preventive inspections with a urologist;
• timely appeal to medical care at the first signs of urination disorder;
• rejection of bad habits;
• avoiding supercooling;
• regular sexual life with a regular partner;
• sufficient physical activity.

Video from YouTube on the subject of Articles:

), previously known as prostate adenoma, requires a responsible and integrated approach to therapy. Methods that are elected by the doctor in many ways depend on the stage of the pathological process. The four-stage classification of the pathological process is generally recognized. For armament of doctors there are a number of drugs and surgical methods. How do hyperplasia treat in different cases?

Distinguish 4 stages of benign prostatic hyperplosion

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Symptoms. At the first stage, symptomatics is absent or extremely poorly lets itself felt. However, with due subside of attention to its own body, pathological signs can be noticed. There are rapid urges for emptying the bladder, weak laundering pains in the lower abdomen, giving in anal hole, penis. Especially attentive should be men of the older age group (40+). Hyperplasia is extremely rarely striking young people.

At this stage of the development of the disease, the dimensions of the adenomatous node do not exceed 10-20 mm in diameter. In the latent form, the disease occurs over 2-5 years.

Treatment. When it comes to the first stage of benign hyperplasia of the prostate gland, doctors most often elect the tactics of dynamic observation. Treatment as such is not required. In extreme cases are prescribed. These drugs allow you to stabilize the size of the tumor-shaped structure. Preference is given to therapeutic physical education and diet. Indications for surgical intervention as such are not. The question is solved at the discretion of the patient.

The diet involves eating a large number of vitamined products. It should be abandoned with strong tea, coffee, spicy and sharp, salted.

There is a simple complex that allows you to normalize the function of the prostate and brake the growth of the adenoma. It is possible to perform it, including at home.

• Lie on the back. The body maximize relax. Feet dispersed, hands lie along the body. According to "Once" both hands raise and pull up. According to the "two" return to the initial posture.
• The initial position is identical. Bend feet in the knees. In the account of times the sliding movement break the lower limbs. Do it need it without a rush. In the same way, bend the legs back.
• Lying on the back to do the exercise "Bike".
• The initial position is the same. It is necessary to rhythmically compress and relax the buttocks.
• Bend feet in the knees. Breed the legs and compress them in the hips.
• In any position. Strain the muscles located in the prostate area. To understand what the sensations should be, it is recommended to interrupt the process of urination 2-3 times.

Himself has proven walking, running in place, swimming. Physical activity normalizes the blood circulation of a small pelvic, helps to prepare for the main therapy of the disease, as well as to recover after surgery.

Prostate Adenoma 2 Stages

Symptoms. It is still considered the initial stage of the course of the disease. Symptoms manifests itself sufficiently becomes a noticeable patient. Do not identify pathology difficult.

Treatment. At this stage, conservative comprehensive treatment with the use of drugs of the following groups is shown:

• . Contribute to relaxing the smooth muscles of the urinary tract and the normal evacuation of urine. You can call the following names: Omnik, Cardura, Kornam, etc.
• Inhibitors 5 alpha reductase (see). Stabilize the size of the tumor, not allowing the process to develop further. First of all, this is finasteride and its analogues.
• Preparations of plant origin. For the most part, they have a spasmolytic effect. Specific names are selected by the doctor.

At this stage, the tumor sizes do not exceed 30-40 mm. Strictly contraindicated reception of diuretic agents.

Despite the fact that the tactics of the therapy of the second stage implies conservative methods, in some cases the early stages are difficult. For such clinical situations, urologists have developed informal criteria for which the need for surgery is determined:

One of the manifestations of prostate adenoma in the second stage can be concrections (stones) in the bladder

• Acute urine delay.
• The formation of concrections in the bladder.
• Reducing the intensity of urin current is below 10 ml / s.
• Hematuria.
• Significant volume of residual urine (over 80-100 ml).

In the absence of contraindications, the use of minimally invasive instrumental treatment techniques is allowed (which is not considered operational in their nature): vaporization, cryodestruction, electrocoagulation, etc.

Adenoma Prostate 3 Stages

Symptoms. This is already a launched stage of the formation of pathology. There are pronounced symptoms, including:

• incomplete emptying of the bladder;
• pollakiuria;
• intense pains;
• frequent night awakening.

The sizes of the tumor range from 55 to 80 mm. These are large formations that violate the normal functioning of the entire excretory system.

Treatment. Therapy in this case is combined. Showing gentle operational intervention transurethral access (surgical instruments are introduced through the urethra to access the prostate gland). At the end of the operation, the fabric is mandatory sent to the laboratory for the histological and morphological research. If the patient first came to the doctor at this stage of increasing the prostate and the successiveist there are suspicions regarding the nature of the current process, the open extensive operation (For example, if there are grounds to assume a malignant process). Before appointment of treatment, careful diagnosis is required.

The postoperative period shows the reception of specialized drugs. Transuretral resection is good because it does not leave postoperative scars and implies a small period of rehabilitation period. After 1-2 weeks after the implementation of the intervention, it is necessary to start engage in medical gymnastics. For the entire period of therapy, the gentle mode of physical activity and a vitaminized diet with a minimum content of animal fats are recommended.

Prostate Adenoma 4 Stages

The most severe form of the disease, fraught with the development of severe complications. If a lot of probability is in a timely manner in a timely manner with a vast share of likelihood. Alternative to surgical intervention in this case is simply not. Urgently, the patient is hospitalized in an ultrasound hospital and carry out surgery.

Significant dimensions of the adenomatous node (and in the case of the fourth stage, these are huge tumors exceeding 80 mm in diameter) do not allow interventions with a transurethral method. Showing open adenomectomy. This is highly eluamatic and solved by complications operation, which, however, allows you to solve the problem once and for all. Access is carried out through the front wall of the abdominal cavity and the incision in the bladder.

The postoperative period lasts about a month. A significant part of the patient's time is carried out in the hospital. The consequences in the form of intense urethral bleeding, the obstruction of the urethra canal with blood clots, infection, the stenosis of the urethral canal. However, others effective ways There is no treatment yet.

About folk treatments

The psychology of the average patient-aless from the CIS countries is arranged in such a way that in the event of health problems, a person is not drawn to a doctor, but on the Internet. This is an extremely dangerous practice. Sources concentrated on the network are recommended to be treated with folk methods.

Sex system, especially prostate iron - fragile structure. Many recipes that can be found on sites are at best useless. It's a waste of time. Others are frankly dangerous. So, attempts to receive diuretic phytotherapeutic agents with a large share of the likelihood will lead to an acute urine delay and breaking the bubble, which is fraught with a fatal outcome. Folk remedies are categorically prohibited.

Benign prostate hyperplasia is treated with complex. Exceptionally operational technique is shown only at the running stages of pathology. It is important to keep in mind: no self-treatment can go about any self-treatment. At the most favorable case, this will lead to the hospital. At worst - you can say goodbye to life. Therapy should be carried out only under the control of the urologist or urologist-Andrologist.

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