Diagnosis 40 prostatic hyperplasia how to treat. When is BPH diagnosed? What is prostatic hyperplasia
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Main points
- Benign hyperplasia prostate gland (BPH)– non-cancerous enlargement of the prostate.
- The condition is believed to be part of the normal aging process.
- 50% of men over 60 years of age have clinically significant BPH.
- Prostate cancer and this disease are in no way connected.
- Symptoms do not necessarily progress and may change.
- Medical treatment can be very effective.
- Transurethral resection of the prostate (TURP) remains the “gold standard” in the treatment of benign prostatic hyperplasia.
Description
The prostate is a walnut-shaped gland located just under the bladder and in front of the rectum. It covers on all sides the upper part of the urethra (urethra), which is a tube that starts from the bladder and opens outward.The prostate gland produces part (±0.5 ml) of seminal fluid containing nutrients. The bladder neck and prostate form the genital sphincter, which allows antegrade ejaculation and ejaculation of seminal fluid outward rather than backward into the bladder.
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate. Its development depends on male hormones: testosterone and dihydrotestosterone. Over time, the disease affects all men to varying degrees of severity, even those whose testicles and prostates function normally.
An enlarged prostate causes a deformation of the urethra, which interferes with the flow of urine from the bladder and causes obstructive or irritating symptoms.
The size of the prostate does not directly affect the severity of symptoms. Sometimes the course of disease of very large prostate glands is asymptomatic, while damage to a small prostate is characterized by very severe symptoms.
Clinically significant BPH is present in 50% of men aged 60-69 years. Of this amount, ±50% require treatment. The risk that a man will have to undergo prostate surgery during his lifetime is 10%.
Causes
The prostate gland consists of glandular structures and stroma. The second element contains smooth muscle fibers and connective tissue. With BPH, all components of the prostate enlarge, but the stroma is still relatively larger than the rest.Male hormones (testosterone and dihydrotestosterone) are required for the growth of the gland. They are not the root cause of the appearance of benign hyperplasia, but without them its development is impossible.
Aging and male hormones are the only proven risk factors that can trigger the development of BPH. Every male with a healthy prostate and normally functioning testicles will develop this disease if he lives long enough.
The testicles produce 95% of the testosterone in the body. In the prostate gland, this hormone is converted into dihydrotestosterone, to which it is more sensitive than to testosterone. An enzyme called 5-alpha reductase is an intermediate in the chain of transformation of testosterone into its active form. It is contained exclusively in the secretion of the male sex gland. 5-alpha reductose can be controlled with medications (see “Treatment”).
Over time, dihydrotestosterone stimulates the production of growth factors in the prostate, which in turn lead to an imbalance between cell growth and programmed cell death (apoptosis).
The result of all this is a slow, progressive enlargement of the prostate gland. The vast majority of older men have this clinically significant disease, however, in itself it does not necessarily cause symptoms or lead to complications.
Symptoms may occur because BPH affects the prostate directly or the bladder outlet, causing an obstruction (see "Symptoms" below).
Symptoms
BPH may be accompanied by the absence or presence of symptoms. They arise due to mechanical compression of the urethra by an enlarged prostate, secondary changes in the bladder due to obstruction, or complications of BPH.An obstruction (blockage) of the bladder outlet can lead to various consequences, such as thickening and instability of the bladder muscles. Instability is thought to cause irritant (irritative) symptoms.
In addition, a narrowing of the lumen of the urethra can lead to insufficient contraction of the bladder muscles, or further aggravate their condition. The obvious result of this disorder is obstructive symptoms and insufficient emptying of the urinary bladder. Although the natural aging process is responsible for the appearance of these symptoms, it is the obstruction that will aggravate both signs of decline in the male body.
Obstructive symptoms:
- weak stream of urine;
- feeling of incomplete emptying of the bladder;
- intermittent stream of urine;
- difficulty starting urination (retention);
- tension during urination.
- Frequency (going to the toilet frequently);
- Urgency (a strong urge to urinate that is difficult to suppress);
- Nocturia (the need to wake up at night to empty the bladder).
- Blood in the urine (hematuria): BPH can cause blood in the urine. However, this disease cannot be considered the culprit of bleeding, unless other, more serious reasons for this have already been excluded.
- Urinary tract infection with symptoms such as a burning sensation when urinating, pain in the bladder area, fever and frequent urination.
- Urinary retention (complete inability to go to the toilet).
- Urinary incontinence (urinary leakage due to a full bladder that does not empty properly).
- Renal failure (fatigue, weight loss, increase in total blood volume (hypervolemia), etc.).
Prevalence of BPH
The first microscopic changes of hyperplasia usually appear in the prostate when men approach 35 years of age. Eventually, all members of the stronger sex will develop BPH if they live long enough.Only ±50% of men with histologically confirmed benign prostatic hyperplasia will develop symptoms. Enlargement of the male reproductive gland does not always lead to obstruction or symptoms.
The clinical syndrome (symptoms and signs) caused by prostate enlargement is known by various names including BPH, LUTS (lower urinary tract symptoms), prostatism and urinary tract obstruction.
50% of men aged 51-60 years and 90% over 80 years have histological BPH. However, only 25% of fifty-five-year-olds and 50% of seventy-five-year-old representatives of the stronger sex will be bothered by symptoms reminiscent of prostate enlargement.
Course of the disease
The natural progression of untreated BPH is variable and unpredictable. There is little reliable information on this matter in the medical literature. But what is clear is that prostatic hyperplasia is not necessarily a progressive disease.Many studies have shown that in about 30% of patients, symptoms may improve or go away completely over time. In 40% of men they remain the same, and in 30% they worsen. 10% of patients who do not seek medical help will develop urinary retention in the future. And 10-30% of patients who reject medicine will eventually need surgery for an enlarged prostate.
Risk factors
Established risk factors:- aging;
- testosterone.
Potentially possible risk factors:
- Western food;
- high blood pressure;
- overweight;
- industrialized environment;
- increased androgen receptors;
- imbalance of testosterone and estrogen levels.
Prostate cells are much more sensitive to dihydrotestosterone than to testosterone. An enzyme, 5-alpha reductase, found exclusively in the prostate, converts testosterone to dihydrotestosterone. Those representatives of the stronger half of humanity who were castrated in their youth or suffer from a deficiency of 5-alpha reductase do not experience BPH.
Recent research suggests that there is a likely genetic link to BPH. A man's risk of surgery increases fourfold if his immediate family member has had surgery for the disease. The genetic link is especially strong for men with a large prostate under the age of 60.
Some medical research has found that the number of male hormone receptors (androgen receptors) may be increased in BPH cells. And the role of environmental factors, as well as nutrition, excess weight and the industrialized environment, is not fully understood.
The incidence among Oriental men (especially Japanese) is low. The diet typical of their region is rich in phytoestrogens and may have a protective effect.
When to see a doctor
If you experience any of the following disorders, contact your doctor immediately:- Inability to urinate (urinary retention);
- Difficulty urinating;
- Blood in the urine;
- Urinary incontinence;
- Urinary tract infection or other complications of BPH;
- Suspicion of renal failure.
In this scenario, the bladder never empties properly, which can cause obstructive kidney failure and other complications such as infections or stones.
You should not associate the appearance of blood with an enlarged prostate until other, more serious causes (bladder cancer) are excluded.
Every man over 50 years of age should be screened annually for prostate cancer. Black men, who are at higher risk of developing this type of cancer, and men with a genetic predisposition to it, should start getting regular screenings at age 40. The purpose of annual prostate examinations is to diagnose prostate cancer at an early stage, when it can still be cured.
As a rule, at an early stage, prostate cancer is asymptomatic. If a man has ever had gonadal surgery for BPH (namely, transurethral resection or open prostatectomy), this does not mean that he is no longer at risk of developing prostate cancer.
Prostate cancer usually occurs in the outer part of the gland that is not removed during BPH surgery.
Preparing to visit the doctor
You may be asked to complete a questionnaire to assess the severity of your symptoms (prostate symptom rating scale). During the physical examination, a digital examination of the rectum will be performed.The health care provider will usually order a urine test and may ask you to urinate into a device to measure the flow rate. Shortly before visiting the doctor, it is better not to empty your bladder.
Diagnostics
The diagnosis of benign prostatic hyperplasia is made based on a medical history, physical examination, and some confirmatory tests.Disease history
Symptoms of BPH are divided into obstructive and irritant (see section “Symptoms”). It is impossible to make a diagnosis based on symptoms alone, since many diseases mimic the symptoms of BPH. A thorough medical history will help identify other conditions other than BPH that are causing your symptoms.Diseases similar to BPH:
- urethral stricture (narrowing of the lumen of the urethra in the penis);
- bladder cancer;
- bladder infection;
- prostatitis (chronic infection of the prostate gland);
- neurogenic bladder (dysfunction of this organ due to neurological disorders such as stroke, Parkinson's disease or multiple sclerosis);
- diabetes.
A possible cause of frequent voiding and insufficient emptying may be diabetes, as it affects the muscles of the bladder and the functions of the nervous system.
To assess the severity of prostate symptoms, a scoring scale is used. It helps determine whether further evaluation of the patient's condition is necessary or whether treatment should be started. The American Urological Association's Symptom Index is the most common assessment method.
Symptoms are classified according to the total score: 1-7 points - mild symptoms, 8-19 - moderate and 20-35 - severe. If the disorders are mild, then in most cases there is no need for treatment. With moderate symptoms, treatment is required, and in case of severe manifestations of the disease, surgical intervention is most often used.
Physical examination
During this examination, the doctor assesses the patient's general health and palpates the abdomen to check for a full bladder. A digital examination of the rectum is performed to determine the size, shape and consistency of the prostate gland. To do this, the doctor inserts a gloved finger into the rectum. The prostate is located next to the anterior intestinal wall and is easy to palpate in this way. This procedure is slightly unpleasant, but does not cause pain. With BPH the enlargement is smooth and uniform, but with prostate cancer it is nodular and uneven.Unfortunately, prostate size alone is poorly correlated with symptoms or obstruction. It happens that men with large prostate glands do not show any symptoms and do not experience obstruction, and conversely, small prostate hyperplasia may be characterized by severe obstruction with symptoms and/or complications.
An enlarged prostate in itself is not an indication for treatment. The size of the prostate of patients who actually need therapy may influence the choice of treatment. Neurological testing is indicated if the medical history suggests that the cause of symptoms may be neurological.
Special studies
In order to eliminate all doubts about the correctness of the diagnosis, check for other causes of symptoms, confirm or refute obstruction and look for complications associated with it, special tests are prescribed.The minimum list of examinations required to diagnose BPH:
- medical history, including symptom severity index (see above);
- physical examination including digital rectal examination (see above);
- Analysis of urine;
- urine flow rate;
- assessment of renal function (serum creatinine).
- urodynamic pressure-flow study;
- determination of the level of prostate-specific antigen (PSA) in blood serum
- ultrasound examination of the abdominal organs;
- ultrasound of the kidneys, ureter and bladder;
- transrectal ultrasound of the prostate gland.
To determine the rate of urine flow, the patient is asked to urinate into a special machine that produces a reading. Most devices measure the volume of urine, the maximum flow rate and the length of time it takes to empty the bladder. In order for the result to be accurate, you need at least 125-150 ml of urine excreted at one 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 urinary tract obstruction, it turns out that in most patients whose urine flow rate is less than 10 ml/sec, the presence of this disorder is confirmed. At the same time, those whose urine flow rate exceeds 15 ml/sec do not show signs of obstruction.
Moreover, patients with low urine flow rates measured before surgery fared better after surgery compared to those with higher urine flow measurements. It is important to understand that a low value of this parameter does not indicate whether the cause of the weak urine flow is obstruction or impaired bladder muscle function.
The level of creatinine is determined in the serum of a blood sample taken. The result gives an idea of how the kidneys function. Creatinine is one of the waste products excreted by the kidneys. If the level of this substance is elevated due to urinary tract obstruction, it is better to drain the bladder with a catheter, which will allow the kidneys to recover before prostate surgery.
Urodynamic pressure-flow testing is the most accurate method to determine the presence of urinary tract obstruction. Bladder pressure and urine flow pressure are measured at the same time. Obstruction is characterized by high pressure and low flow. This is an invasive test that involves inserting sensors into the bladder and rectum. Many scientists do not recommend this procedure for patients with severe prostate symptoms. At the same time, such a study is indispensable if there are doubts about the diagnosis.
Indications for urodynamic examination:
- any neurological disorder, such as seizure, Parkinson's disease and multiple sclerosis;
- acute symptoms, but normal urine flow rate (>15 ml/sec);
- long-term diabetes;
- Previous unsuccessful prostate surgery.
Representatives of the Negroid race and men with a genetic predisposition to prostate cancer should undergo such a study starting at age 40. PSA levels rise before prostate cancer becomes clinically evident. Thanks to this, it is possible to establish a diagnosis at an early stage and begin timely treatment.
An abdominal ultrasound can help identify renal hydronephrosis (enlarged kidneys) and determine the amount of urine that remains in the bladder after the patient has relieved himself. This indicator does not directly explain the appearance of other symptoms and signs of prostatism, and the outcome of surgery cannot be predicted on its basis.
It is also unknown whether a large residual urine volume indicates impending bladder or kidney problems. Most experts believe that it is necessary to more carefully monitor patients with a high value of this indicator if they prefer non-surgical therapy.
Renal failure due to obstruction occurs as a result of increasing dilation of the kidneys (hydronephrosis). Ultrasound examination of patients with elevated serum creatinine levels can determine whether the deficiency is due to obstruction or other factors.
Transrectal ultrasound of the prostate is not always performed in patients with benign hyperplasia. But still, during this examination you can very accurately measure the volume (size) of the prostate. The main function is to help perform a biopsy of the gland in case of suspected cancer of this organ.
Treatment
Dynamic observation, drug therapy and surgery are the main treatment options. For patients who are not suitable for surgery and have not received positive results from drug treatment, indwelling catheters are placed, intermittent (periodic) self-catheterization is performed, or an internal urethral stent is installed (read more). Complications arising from BPH are usually an indication for surgery. Therefore, patients with complications are not treated with follow-up or medications.Home treatment
Dynamic observation is a non-emergency treatment strategy that involves medical monitoring of the patient’s health at regular intervals. The course of benign prostatic hyperplasia is not necessarily progressive. For many patients, symptoms are stable or may even improve. Dynamic observation is suitable for men with a minimal arsenal of symptoms and not experiencing any complications. Patients may be screened annually, have their symptoms scored, have a physical examination, and have their urine flow rate measured. If the patient is receiving this treatment at home, they should not take tranquilizers, over-the-counter medications, or sinus medications, which can worsen symptoms and cause urinary retention.To improve the symptoms of BPH, consider these recommendations. Drink alcohol and caffeinated drinks in moderation, especially in the late evening before going to bed. Tranquilizers and antidepressants weaken the bladder muscles and prevent complete emptying. Cold and flu medications typically contain decongestants, which increase smooth muscle tone in the bladder neck and prostate, causing symptoms to worsen.
Herbal medicine is the use of plant extracts for medical purposes. Recently, this method of treating BPH symptoms has received attention in the press. The most popular is the extract of dwarf palm (also known as saw palmetto). The mechanism of action of herbal medicine is unknown, and its effectiveness has not been proven. The extract of this plant is believed to have an anti-inflammatory effect that reduces prostate swelling and inhibits hormones that control 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.
Drug treatment
There are two groups of drugs that have shown their effectiveness in the treatment of benign prostate hyperplasia. These are alpha blockers and 5-alpha reductase inhibitors.Alpha blockers
The prostate gland and bladder neck contain large numbers of smooth muscle cells. Their tone is under the control of the sympathetic (involuntary) nervous system. Alpha receptors are called receptors on nerve endings. Alpha blockers are medications that block alpha receptors, thereby reducing muscle tone in the prostate and bladder neck. As a result, the flow rate of urine increases and the symptoms of prostate disease improve. Alpha receptors are also found in other parts of the body, particularly in blood vessels. Alpha blockers were originally developed to treat high blood pressure. Not surprisingly, the most common side effect of these medications is orthostatic hypotension (dizziness caused by a drop in blood pressure).
Commonly used alpha blockers include:
- prazosin;
- doxazosin;
- terazosin;
- tamsulosin.
Alpha blockers are effective in treating patients with residual urine volume less than 300 ml and no absolute (vital) indication for surgery. Most studies have found that these medications reduced symptoms by 30-60% and moderately increased urine flow. All of the above alpha blockers, taken in therapeutic dosages, have the desired effect. The maximum result is achieved within two weeks and lasts for a long time. 90% of patients tolerate treatment well. The main reasons for stopping treatment are dizziness due to hypotension and lack of effectiveness. Direct studies comparing different alpha blockers with each other have not been conducted. Therefore, claims that any one of them is better than the others are not justified. As a rule, treatment must be continued throughout life. A less common side effect is abnormal or retrograde ejaculation, which is experienced by 6% of patients taking tamsulosin.
5-alpha reductase inhibitors
The enzyme 5-alpha reductase converts testosterone into its active form, dihydrotestosterone, in the prostate gland. Finasteride prevents this transformation from happening. Taking this drug relieves the symptoms of BPH, increases urine flow, and reduces the size of the prostate. However, such improvements can be called no more than modest, and they are achieved within a period of up to six months. Recent studies have shown that finasteride may be more effective for men with large prostates, and less effective in treating patients with small prostates. The medicine in question actually reduces the incidence of urinary retention. Thanks to it, the need for prostate surgery is reduced by 50% in four years. Side effects include: breast enlargement (0.4%), impotence (3-4%), decreased ejaculate volume and a 50% drop in PSA levels.
Surgery (prostatectomy)
This is the most common urological procedure. In the United States alone, 200,000 surgeries are performed annually. BPH prostatectomy involves removing only the inner part of the prostate. This surgery is different from a radical prostatectomy for cancer, which involves removing all of the prostate tissue. Prostatectomy is the best and fastest way to improve the symptoms of benign prostatic hyperplasia. However, it may not relieve all irritative bladder symptoms. Unfortunately, this is more the case in older men over 80 years of age, where bladder instability is thought to be the cause of most symptoms.Indications for prostatectomy:
- urinary retention;
- renal failure due to obstruction;
- recurrent urinary tract infections;
- large residual urine volume (relative indication);
- unsuccessful drug therapy (proved to be ineffective or accompanied by severe side effects);
- patients who are not enthusiastic about the prospect of undergoing drug therapy.
This operation is still considered the “gold standard” in the treatment of BPH, to which all other treatment options are equal. TURP is performed using a resectoscope, which is inserted through the urethra into the bladder. A wire loop that conducts electrical current is used to cut out prostate tissue. The catheter is left in place for one to two days. The hospital stay is usually three days. TURP is virtually painless or causes little discomfort. By the third week after surgery, the patient has fully recovered.
Significant improvements after this operation are observed in 93% of men with severe symptoms, and in 80% of those with moderate symptoms.
Complications associated with TURP may include:
- mortality rate less than 0.25%;
- bleeding requiring transfusion - 7%;
- stricture (narrowing) of the urethra or bladder neck - 5%;
- erectile dysfunction - 5%;
- incontinence – 2-4%;
- retrograde ejaculation (during ejaculation, seminal fluid enters the bladder) - 65%;
- the need for another transurethral resection – 10% within five years.
Transurethral incision of the prostate/prostatotomy/incision of the bladder neck.
As with TURP, the instrument is inserted into the bladder. Instead of a loop, an electric knife is used to make one or more cuts in the prostate to relieve pressure on the urethra. The gonad tissue is not removed, and if it is removed, it is only a very small piece. Results achieved with prostatotomy of a small prostate (
Transurethral vaporization of the prostate
This type of resection is performed using a resectoscope inserted through the urethra. However, in this case, the tissue is not cut off, but is exposed to powerful electrical energy. As a result, the tissue is evaporated with minimal blood loss. Possible advantages of electrovaporization include shorter catheter wear, shorter hospital stay, and lower cost compared with TURP or laser prostatectomy.
Open prostatectomy
Larger prostates are less suitable for TURP because complications are common due to the longer resection process. Open prostatectomy is the preferred treatment method if the prostate is larger than 70-80g. To expose the bladder and prostate, a transverse incision is made in the lower abdomen. The gonad capsule is incised and the benign hyperplasia is exfoliated. It is possible to open the bladder and remove the prostate through it. To do this, one catheter is placed into the bladder through the urethra, and the second through the lower abdomen. The catheters are left in place for four to five days. This operation gives good results, but it is more severe than TURP. The hospital stay and recovery period is longer, and the complications are slightly worse. However, open prostatectomy is considered a very effective way to remove BPH tissue. And only a very small number of patients subsequently have difficulty emptying their bladder normally.
Minimally invasive methods for treating BPH
Despite the success of TURP, scientists are constantly searching for less invasive, safer and less expensive procedures that can be performed in one day under local anesthesia without leaving the person in the hospital overnight. A variety of energy sources have been tested to specifically heat prostate tissue and destroy it. Laser, microwave thermotherapy, high-intensity focused ultrasound therapy, radiofrequency therapy and transurethral needle ablation of the prostate (TUIA) are based on this principle. All these types of manipulations lead to fewer complications during therapy, but are characterized by less efficiency and greater postoperative troubles. The hospital stay is shorter than with TURP, but the catheter wear time is longer. As a result, many patients require retreatment, which is usually done with TURP. Various laser methods are also used to treat the prostate gland. The newest and most promising invention is holmium laser therapy, which is similar to TURP in that the prostate tissue is actually removed. According to studies, blood loss with this therapy is significantly less than with transurethral resection.Fighting obstruction
There are patients for whom any type of surgical intervention is contraindicated. To help such patients, intraurethral stents are placed in the prostatic part of the male urethra to support it in an open position. Thanks to this, the patient can pass urine normally. Stents can be inserted under local anesthesia. In the short term, this method gives good results. Due to displacement and other complications, in 14-33% of cases these devices are removed. Of course, it is better not to wear an indwelling catheter all the time. But they are the only salvation for people who are sick, weakened or bedridden. As an alternative they suggestintermittent (periodic) self-catheterization, which the patient or the person caring for him can do himself.
Disease Prevention
Unfortunately, the development of benign prostatic hyperplasia cannot be prevented. It is unknown whether long-term treatment with finasteride, starting before clinical manifestations of the disease, significantly affects the pathological process of BPH. Before use, you should consult a specialist.Today, many men, especially after 50 years, have problems with urination, which is a consequence of certain diseases. Most often, BPH appears at this age; this diagnosis is made only after an appropriate examination. The disease is accompanied by the appearance of a benign formation in the prostate area, i.e. non-cancerous is observed. Treatment is effective; transurethral resection is most often performed.
Obstructive and irritative symptoms
BPH is usually diagnosed when characteristic symptoms are observed. But there are a number of cases when the course of the disease is asymptomatic or they are specific. All symptoms can be divided into several groups; if they occur, you must immediately contact the hospital.
Minimally invasive methods
Today, specialists are constantly looking for ways to provide more effective and safe treatment. Benign prostatic hyperplasia can be treated in a hospital for only 1 day. For this purpose, gentle local anesthesia is used. The patient spends one night in the hospital. Such methods include laser therapy, microwave, high-intensity focused ultrasound, radiofrequency and special needle transurethral ablation.
This treatment is distinguished by the fact that the number of complications with it is minimal, and the duration of therapy is also the same. But the patient may need a repeat procedure, in which case TURP is used.
Fighting obstruction
It also happens that it is impossible to fight BPH through surgery. Then a special intraurethral stent is placed in the urethra. This allows you to keep the channel open. The patient is able to urinate normally without experiencing much discomfort. Such stents are inserted only under local anesthesia, since without it this procedure is impossible.
This method gives excellent results, but only in the short term. But in 14-33% of cases, stents are removed, this is due to the fact that they are displaced from their position. Constantly wearing such devices is not allowed, as the catheter begins to cause severe inconvenience, causes irritation, and can cause an inflammatory process. Such treatment is prescribed when the patient is constantly bedridden or severely weakened. Self-catheterization, which is periodic in nature, is proposed as an alternative method. In this case, the patient can do everything himself or the person caring for him can help him.
How to prevent the disease?
Contrary to popular belief, the development of BPH cannot be prevented. Some advise long-term treatment with a drug such as finasteride. This remedy begins to be used even before the clinical manifestations of the disease, but today there is no comprehensive data that could indicate the effectiveness and efficiency of the drug.
BPH, or benign adenoma that occurs in the prostate gland, is a disease that affects more than half of the male population. The disease is usually detected when the patient has complaints. During even the simplest examination, changes can be detected. Treatment is prescribed in full accordance with the stage of the disease; self-medication is not only useless, but also dangerous; a preliminary examination in a hospital is necessary.
In modern medicine, abbreviations are often used that are not entirely clear to the average person without medical knowledge. education. One of these confusing acronyms is BPH. What it is? Speaking in the language of doctors, this is benign. But people call it more simply - prostate adenoma (the option “prostate adenoma” is possible). BPH is often confused with a disease such as prostatitis. BPH is a benign formation, and it grows not without the participation of the stromal component of the prostate (in other words, the glandular epithelium), and prostatitis is nothing more than inflammation of the prostate gland. Don't confuse them.
BPH. What it is? Statistics
As mentioned above, BPH is a benign neoplasm. With it, small nodules are formed in the prostate (the abbreviated name for the prostate), which, as they grow, compress the urethra more and more.
Because of this, a man develops urinary problems. This disease has a benign growth, and this is what distinguishes BPH from cancer.
BPH is one of the most common diseases in urology today. According to statistics, it appears in almost 80 percent of men in old age. In 20 percent of cases, instead of BPH, atrophy of the gland or its enlargement is observed.
BPH most often develops in men over 45 years of age.
More than half of men aged 40 to 50 consult a specialist with this disease, and only in rare cases can the disease overtake young people.
Causes of BPH
Today, it is impossible to indicate the exact causes of the development of BPH of the prostate gland, since they are simply not fully understood. It is believed that the disease is one of the signs of menopause in men.
The only risk factors are the level of androgens in the blood and the person's age.
Typically, as a man ages, the balance between estrogens and androgens is gradually disrupted, which causes a loss of control over the growth and function of gland cells.
It is known that there is no connection between BPH of the prostate gland and a person’s sexual activity, orientation, bad habits, venereal and inflammatory sexually transmitted diseases, and none of the above in any way affects the occurrence of the disease.
Pathogenesis
BPH of the prostate gland most often appears in its central part, but sometimes it can also affect the lateral lobes. The growth of benign hyperplasia depends on adenomatous proliferation (tumor) of the paraurethral glands. As a result, the gland’s own tissue shifts outward, and a capsule, as it were, forms around the growing adenoma.
Hyperplastic (that is, tumor-affected) cells of the prostate tissue also tend to grow both towards the rectum and towards the bladder, and this causes upward displacement of the internal opening of the bladder and lengthening of the posterior part of the urethra.
There are several forms of hyperplasia based on the type of its growth:
Quite often, several forms of BPH can be seen in one person at the same time. This happens when the tumor grows in several directions at once.
BPH: symptoms
The signs of this disease directly depend on the location of the tumor, its growth rate and size, as well as the degree of dysfunction of the bladder.
Prostate BPH can be divided into three stages:
Diagnosis of the disease
The basis for diagnosis is the characteristic complaints of men, for whom a special scale for assessing the symptoms of prostate adenoma (in English I-PSS) has been created. Basically, the diagnosis of BPH is made after a clinical examination of the patient, as well as the following research methods:
- Palpation (finger) rectal method for examining the prostate gland. Thanks to it, doctors have an idea of the consistency and size of the gland, the presence of a beard between its lobes, as well as the degree of pain of palpation.
- Laboratory tests for BPH. What it is? First of all, this is a familiar general urine test. A biochemical blood test is also performed, which is used to determine the level of PSA (stands for prostate specific antigen).
- Instrumental methods. Most often this is cystoscopy and ureteroscopy. With their help, you can check the patency of the urethra, the condition of the lobes of the gland, and using these procedures you can determine the volume of residual urine.
- Ultrasonography. This is also one of the types of instrumental methods that allows you to see the size of each lobe of the gland, its condition (presence of stones, nodules). In addition to conventional ultrasound, it is also used
- X-ray research methods. Excretory urography (with contrast) and plain radiography (without contrast) can help determine the presence of complications of BPH, for which treatment has been started. Using X-rays, stones are found in the bladder and kidneys.
Treatment of BPH
At the moment, there are many ways to treat the disease, each of which is highly effective at different stages of BPH. Treatment for this disease can be divided into three parts:
- Drug treatment
- Surgical method of treatment
- Other non-operative treatments
Typically used at the first sign of BPH.
In the first stages of prostate BPH, treatment is aimed at reducing the growth rate of hyperplastic prostate tissue, improving blood circulation in nearby organs, reducing inflammation of the prostate gland and bladder, eliminating stagnation of urine, eliminating constipation, and facilitating urination.
It is also worth reducing your fluid intake in the afternoon, especially before bed.
If there are clinical and laboratory signs of androgen deficiency, androgen replacement therapy is also prescribed.
Often, in parallel with the treatment of hyperplasia, treatment of its complications - cystitis, prostatitis or pyelonephritis - is carried out.
Sometimes (due to hypothermia or alcohol consumption) the patient may develop. In this case, the patient must be urgently hospitalized and undergo catheterization of the bladder.
Let's take a closer look at each type of treatment.
Drug treatment
Most often, two types of medications are used to treat BPH:
- Alpha-1 blockers (eg tamsulosin, doxazosin or terazosin). Their action is aimed at relaxing the smooth muscles of the prostate and bladder neck, which leads to easier passage of urine. The effect of these drugs can be prolonged or short.
- Inhibitors (permixon, dutasteride or finasteride). These medications prevent dihydrotestosterone (the biologically active form of testosterone) from being produced in the body of a sick person, causing the prostate gland to shrink.
Surgical method of treatment
In especially severe cases, drug treatment alone is not enough, and, as a rule, it is necessary to resort to surgical intervention. This may be excision of hyperplastic tissue (adenomectomy) or total resection of the prostate gland (prostatectomy).
There are two types of surgical intervention:
- Open operations (transvesical adenomectomy). With this intervention, access to the gland tissue is gained through the wall of the bladder. This type is the most traumatic and is used only in advanced cases. Open surgery provides complete cure for BPH.
- Minimally invasive surgeries(in which there is practically no surgical intervention). They are performed using modern video endoscopic technology, without an incision. Access to the prostate through the urethra.
There is another type of surgical intervention that cannot be compared with those described above. Prostate artery embolization is an operation that is performed by endovascular surgeons (the above described are performed by urologists) and consists of blocking the prostate arteries with small particles of a special medical polymer (through the femoral artery). Hospitalization is not required, the operation is performed under local anesthesia and is not traumatic.
After any type of surgery there is a small risk of complications, such as impotence or urethral stricture.
Non-operative treatment methods
Non-operative treatment methods include the following:
Cryodestruction;
Transurethral needle ablation;
Treatment using high intensity focused ultrasound;
Method of microwave coagulation of the prostate or thermotherapy;
Introduction of prostatic stents into the area of narrowing;
Prostate.
Postoperative period
Unfortunately, at some stages of the disease surgery is simply necessary. BPH is a serious disease, and even after surgery you need to follow some rules in order to finally get rid of the disease and not provoke a recurrence. The three main points that you must follow after surgery are proper diet, a healthy lifestyle and regular visits to the doctor.
Diet during the postoperative period is extremely important for the patient, as it can significantly contribute to a faster recovery. The diet after surgery completely excludes fatty foods, spices, salty and spicy foods and, of course, alcohol. It is recommended to eat low-fat foods rich in fiber.
As for work, if your profession does not involve frequent physical activity, then you can return to the workplace a couple of weeks after the operation. When working sedentarily, it is recommended to do a warm-up every half hour. A sedentary lifestyle can contribute to stagnation of blood in the organs, which only worsens the disease. For the first few days after surgery, don't even think about lifting anything heavy!
Stop smoking at least in the postoperative period (two weeks after surgery), if you cannot quit the bad habit completely. Nicotine damages the walls of blood vessels, and this affects the blood circulation of the prostate, which can result in an inflammatory process.
Many people think that after removal of BPH they should forget about sexual activity forever. This opinion is wrong, and a man’s sexual function is completely restored after some time. However, you should resume sexual relations no earlier than 4 weeks after the operation.
Another piece of advice that is worth paying attention to: you can drive a car no earlier than a month after BPH removal.
In general, the postoperative period lasts about a month, after which the patient can return to normal life. However, experts strongly recommend leading a healthy lifestyle to prevent the recurrence of the disease.
Urination after surgery
Almost immediately after the operation, the urine stream becomes stronger, and emptying the bladder becomes easier. After removing the catheter, pain may occur when urinating for some time, the reason for this is the passage of urine through the surgical wound.
Experts do not exclude the occurrence of urinary incontinence or urgent urge to urinate in the postoperative period; these phenomena are completely normal. The more your symptoms bothered you during your illness, the longer your recovery period will be. Over time, all problems will disappear and you will return to a normal rhythm of life.
There may be blood clots in the urine for some time after the intervention. This phenomenon is associated with wound healing. It is recommended to drink as much fluid as possible to properly flush your bladder. But if there is severe bleeding, you should immediately contact a specialist.
Forecasts
Prolonged urinary retention (if prostate adenoma is not treated) can ultimately lead to urolithiasis, in which stones form in the bladder, and later, infection. In this case, the most serious complication that a patient can expect without proper treatment is pyelonephritis. This disease further aggravates kidney failure.
In addition, prostate adenoma can give rise to malignant growth - prostate cancer.
The prognosis for adequate and timely treatment of the disease is very favorable.
Disease Prevention
The best prevention of BPH is regular monitoring by specialists and timely treatment of prostatitis.
You should also eat right (reduce the amount of fried, salty, hot, spicy and smoked foods), stop smoking and alcoholic beverages. In general, a healthy lifestyle significantly reduces the risk of BPH.
So now you know what BPH is. The signs of this disease, treatment, postoperative period and even prevention are described in detail above.
In any case, this knowledge will be useful to you. Be healthy!
Benign prostatic hyperplasia is an increase in the size of the organ that does not correspond to the norms of physiology and anatomy. Most experts are inclined to believe that gradual enlargement of the prostate is a completely natural mechanism of aging of the gland. Half of the male population over 65 years of age has hypertrophy, expressed to one degree or another.
In men over 40 years of age, this pathology is less common. An increase in the size of the gland indicates a clear imbalance in the male body.
Organ anatomy and basic aspects of physiology
The prostate is a small organ with secretory functions located near the bladder and rectum. The prostate gland partially covers a fragment of the urethra. The glandular organ produces a secretion that enters the seminal fluid.
Prostate hyperplasia in men over 40 years of age is a noncancerous enlargement of the prostate that develops under the influence of male hormonal substances. Gradual enlargement of the organ threatens even men with excellent health. Pathological enlargement of the prostate gland, due to its anatomical features, leads to deformation of urethral fragments. The flow of urine is impaired. Patients begin to be plagued by irritative and obstructive symptoms.
The size of the organ itself does not affect the clinical picture. Sometimes even very large hyperplastic phenomena do not cause symptoms, and very minor deviations from the norm lead to unpleasant consequences. It all depends on how quickly the pathology develops, whether it affects the organ completely or partially.
In the vast majority of cases, men over 60 years of age who do not experience any particular discomfort do not need radical treatment. However, all patients aged 40–55 years require adequate therapy.
Main risk factors
The structure of the prostate is formed by glandular elements and stroma. With hyperplasia, it is the muscle fibers and connective tissue that increase most.
Male sex hormones have a positive effect on the development of pathology. They are not the main cause of the development of the disease, however, without these biologically active substances, further growth of the gland is impossible.
In youth and adulthood, high levels of testosterone have a beneficial effect on the functioning of the prostate. However, after 40 years, excess amounts of male hormones have a dual effect. Old age and hormonal levels are a specific “foundation” for the development of hyperplastic phenomena.
Symptoms
Pathological growths compress the urethra and have a detrimental effect on the functional characteristics of the bladder.
Progressive obstruction causes the following symptoms:
- the urine stream is rather weak;
- the bladder can never be completely emptied;
- the beginning of the process of urination itself is difficult.
In addition to obstructive phenomena, patients are worried about irritative symptoms:
- constant irritation of the urethral tissue provokes a constant urge to go to the toilet with unproductive urination;
- the urge to go to the toilet is almost impossible to suppress, while the bladder itself is rarely full;
- frequent urges at night.
If the enlargement of the prostate gland occurs quite quickly, and pathological changes negatively affect the general health of a man, the following clinical manifestations are observed:
- traces of blood in the urine;
- burning during urination;
- tendency to infections and constant inflammatory processes;
- urinary incontinence;
- blood quality deteriorates;
- general fatigue, weakness;
- the appearance of bladder diverticula;
- hydronephrosis;
- kidney pathologies.
How does prostatic hyperplasia occur?
There is very little information in documentary sources on medicine about which course of the disease is considered the most common and natural. It is not known for certain in which cases the proliferation of prostate tissue occurs rapidly and cannot be controlled, and in which situations the disease does not threaten any special complications.
Statistics show that in 45% of patients, minor hyperplasia remains at the initial level for quite a long time and does not threaten serious consequences. However, 10-25% of all cases require adequate therapy and surgery.
Risk factors
It has already been stipulated that hyperplasia occurs in men over 65 years of age with high testosterone levels.
However, there are a number of factors that can provoke further tissue growth:
- genetic predisposition;
- unbalanced diet;
- pathological type hypertension;
- diabetes;
- excess weight;
- bad ecology;
- hypertrophied androgen receptors;
- hormonal imbalance.
When you can't do without a doctor's help
Any conditions associated with urinary incontinence or the inability to fully release urine for a long time should be treatable. It is worth contacting a specialist at the first appearance of blood in the urine. Also, you cannot do without medical help if the hypertrophied prostate gland becomes inflamed and turns into a source of pathogenic microflora.
If urine retention is accompanied by severe pain, the body most likely develops obstructive renal failure. This is an extremely serious pathological condition, which can only be cured by qualified specialists in a modern hospital.
Diagnostic measures
Benign prostatic hyperplasia is relatively easy to diagnose. To do this, the doctor collects a complete medical history, conducts a full examination and prescribes a number of laboratory and, if necessary, instrumental tests.
It is important to carefully study the clinical picture in order to exclude other possible pathologies.
At the first stages of diagnosis, prostatic hyperplasia may be confused with the following diseases:
- structural phenomena in the urethra;
- bladder cancer;
- infections;
- atypical prostatitis;
- disorders in the urinary system from neurological disorders that appear due to strokes, sclerotic processes or Parkinson's disease;
- diabetes mellitus with an atypical course.
Special studies: subtleties of diagnosis
After performing a digital rectal examination, the doctor can already determine the approximate size of the prostate and the degree of hyperplasia. The patient needs to undergo a general urine test, undergo studies that will help calculate the rate of urine flow, as well as a number of measures to study renal function.
Depending on the data obtained during the initial examination, the diagnostician may prescribe a number of auxiliary diagnostic procedures:
- urodynamic study according to the flow/pressure type;
- identification of PSA in the blood;
- Ultrasound of the abdominal organs;
- ISI of the kidneys and bladder;
- transrectal ultrasound.
Key aspects of therapy
Prostatic hyperplasia requires constant monitoring by doctors. Drug therapy and surgical intervention are encouraged.
Drugs are often used to eliminate swelling and inflammation. Alpha blockers and 5 alpha reductase inhibitors are widely used. Prostatectomy and transurethral resection of the gland are acceptable if the patient suffers from pain, excretory dysfunction and urethral obstruction.
(Prostatic hyperplasia, Prostate adenoma)Health disorder related to the group of diseases of the male genital organs
Fill out the form to select a doctor
Form submitted
×
We will contact you as soon as we find a suitable specialist
The diagnosis of prostatic hyperplasia is made only for men
4 658 227
Men are diagnosed with Prostatic hyperplasia. For 18,858 of them, this diagnosis is fatal.
0.4 %
mortality in men with prostatic hyperplasia
95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0
0
women are diagnosed with Prostatic hyperplasia. No deaths were identified.
0 %
mortality in women with prostatic hyperplasia
Risk group for the disease Prostatic hyperplasia men aged 70-74
The disease most often occurs in men aged 70-74
In men, the disease is least common at the ages of 1-4, 15-19
In women, the disease is least common at age 0+
No cases of prostatic hyperplasia have been identified in women.
Features of the disease Prostatic hyperplasia
Absence or low individual and social danger
Short description
A benign neoplasm in the form of a nodule, developing from the cells of the glandular epithelium of the organ, which grows and subsequently causes compression of the urethra. As a result of this compression, urination problems occur. Adenoma has benign growth, that is, it does not metastasize. The pathology is so common that many researchers talk about the inevitability of this condition in men. By the age of 80, 80% of men suffer from this disease.
Etiology
The reasons for the development of prostate adenoma are not fully understood today. It is believed that the development of this pathology is one of the manifestations of male menopause. The only risk factors include age and the level of male sex hormones (androgens) in the blood. As a man ages, the physiological balance between male and female sex hormones is disrupted, which leads to disruption of control over the growth and function of prostate cells. There was no significant connection between the occurrence of BPH and sexual activity, sexual orientation, tobacco and alcohol consumption, or previous inflammatory and sexually transmitted diseases of the genital organs.
Another important factor is heredity, or genetic predisposition to such diseases. It has been revealed that those representatives of the stronger sex whose previous generation was affected by this pathology are at risk.
Development of the disease - pathogenesis
In 80-90% of men, prostatic hyperplasia is subject to progressive growth, and only in 10-20% it remains in a stable state. The progression of the disease gradually leads to the appearance of symptoms. Their occurrence is due to both the development of the pathological process and the addition of various complications.
Most often, benign hyperplasia develops in the central part of the gland, affecting its lateral lobes. This leads to a displacement of the gland’s own tissue outward and the formation of a capsule on the growing tumor. Because the urethra passes through the center of the prostate, and prostate tissue grows inside the prostate gland, there is a possibility that the urethra may be completely or partially obstructed, causing complaints related to urination. In most cases, prostatic hyperplasia is a constantly progressive and by no means harmless disease, which can lead to the development of severe complications and even death of the patient. Timely diagnosis and provision of adequate treatment can prevent their occurrence.
Clinical picture
Clinical manifestations depend on the location of the tumor, its size and growth rate, and the degree of impairment of the contractile function of the bladder.
There are 3 stages of the disease
Stage 1 - compensated - is manifested by a delay in the onset of urination. The urine stream is sluggish, with frequent urges and frequent urination, there is a need to urinate 1-2 times at night. During the day, normal frequency of urination can be maintained, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after a night's sleep. Then the frequency of daytime urination increases, and the volume of urine released per urination decreases. Imperative urges arise. The first stage lasts 1-3 years.
Stage 2 - subcompensated - as compression of the urethra develops, the bladder is no longer able to function adequately and completely expel urine - residual urine appears, incomplete emptying of the bladder is felt, the walls of the bladder thicken significantly; patients urinate in small portions; throughout the act of urination, the patient is forced to intensively strain the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure. The act of urination becomes multiphase, intermittent, and wave-like. Then urine begins to be released involuntarily due to the overflow of the bladder (paradoxical ischuria); sometimes the urine is cloudy or mixed with blood, acute urinary retention is observed, and symptoms of chronic renal failure are added.
Stage 3 - decompensated - due to the large amount of residual urine, the bladder is greatly stretched, emptying is impossible even with intense tension of the abdominal muscles. The desire to empty the bladder becomes continuous. Severe pain in the lower abdomen is possible. Urine is released frequently, in drops or in very small portions. In the future, pain and the urge to urinate gradually weaken. Paradoxical urinary retention, characteristic of prostate adenoma, develops (the bladder is full, urine is constantly released in drops), urine is released in drops, it is cloudy or mixed with blood.
Deterioration of the outflow of urine from the kidneys leads to impaired renal function (renal failure); Common symptoms include weakness, weight loss, dry mouth, smell of urine in the exhaled air, poor appetite, anemia, and constipation.
Main symptoms
Diagnostics
1 standard has been established for diagnosing the disease Prostatic hyperplasia
Based on the characteristic complaints of a man, a clinical examination of the patient and research methods such as:
Digital rectal examination of the prostate gland The method gives an idea of the size and consistency of the prostate gland, pain, the presence of a groove between the lobes of the prostate (normally there should be one).
Laboratory tests Include a general urine test, a biochemical blood test, and determination of the level of PSA (prostate specific antigen) in the blood to exclude prostate cancer. In controversial cases, a prostate biopsy is performed.
Instrumental research methods
Ultrasonography. Allows you to give an idea of the size of each lobe of the prostate gland, the condition of its parenchyma (presence of nodules, stones), and the presence of residual urine. A modification of prostate ultrasound is transrectal ultrasound (TRUS). Uroflowmetry Objectively evaluates the speed and time of urination.
X-ray research methods Plain radiography (without contrast) and excretory urography (using contrast) make it possible to determine the presence of complications of prostate adenoma: stones in the kidneys and bladder, expansion of the renal collecting system and the formation of diverticula.
Medical services to determine the diagnosis Prostatic hyperplasia
Treatment
44 medical procedures intended for the treatment of prostatic hyperplasia
There are a large number of treatments for benign prostatic hyperplasia. They are diverse and highly effective. These methods can be divided into three groups:
- Drug treatment
- Surgical treatment methods
- Non-operative methods
At the first symptoms of prostate adenoma, drug treatment is used.
Treatment is aimed at improving blood circulation in the pelvic organs, inhibiting the growth of hyperplastic prostate tissue, reducing concomitant inflammation of the prostate tissue and surrounding tissues (bladder), eliminating constipation, reducing or eliminating stagnation of urine, facilitating urination and eliminating secondary urinary tract infections.
The patient is recommended to have an active lifestyle and reduce fluid intake before bedtime. The patient is also prohibited from drinking alcohol, smoking, and eating spicy foods. Replacement therapy with male sex hormones is prescribed only in the presence of clear laboratory and clinical signs of age-related androgen deficiency. At the same time, treatment of complications is prescribed - pyelonephritis, prostatitis and cystitis.
In case of acute urinary retention, the patient is urgently hospitalized for bladder catheterization.
Drug treatment
Basically, two types of drugs are used to treat prostate adenoma:
- Alpha-1 adrenergic blockers. These drugs relax the smooth muscle of the prostate and bladder neck, preventing urethral obstruction and facilitating the passage of urine. Their action can be short or prolonged.
- 5-alpha reductase blockers. Medicines in this group prevent the formation of dihydrotestosterone (the biologically active form of testosterone), which helps to reduce the size of the prostate gland and counteracts urethral obstruction.
Surgical treatment methods
In severe cases, when drug therapy is ineffective, surgical intervention is resorted to. It consists of excision of hyperplastic tissue - adenomectomy, or total resection of the prostate gland - prostatectomy. In this case, there are two types of operations: 1. Open (transvesical adenomectomy) - with access through the wall of the bladder. They are used in advanced cases, they are more traumatic, but provide a complete cure for the disease. 2. Minimally invasive operations (with a minimal amount of surgical intervention) - without an incision, through the urethra, using modern video endoscopic technology.