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Prostate adenoma

The prostate adenoma, also called benign hyperplasia of the prostate gland (DGPZ), is an extremely common disease in men over 40 years old.With this disease, a benign growth of the glandular tissue of the prostate occurs, which can lead to compression of the urethra, impaired urinary outflow from the bladder and, as a result, unpleasant sensations during urination.Prostate adenoma can also cause serious problems with the bladder and kidneys.

Healthy prostate and adenoma

This article discusses the causes and symptoms of prostate adenoma, as well as modern methods of diagnosis and treatment of this disease.There are many effective methods of treating benign prostate hyperplasia, including not only drug therapy and open surgical intervention, but also minimally invasive methods of surgical treatment.If the first symptoms of the disease appear, you need to consult a doctor who will take into account your symptoms, the size of hyperplasia, as well as the general condition of your health and offer you the best treatment option.

Reasons

To date, it is not entirely clear what kind of reasons lead to an increase in the prostate.However, this may be due to a change in the balance of sex hormones in the male body.Throughout their lives, men produce both testosterone, male hormone, and a small amount of estrogen, female sex hormone.As the body is aging, the amount of active testosterone in the blood decreases, while the amount of estrogen remains approximately at the same level.Studies have shown that the higher estrogen fraction entering the prostate gland can increase the activity of substances that accelerate the growth of prostate cells.

prostate adenoma in a man

Another theory indicates the role of another male sex hormone - digidrotestosterone - which is important for the development and growth of a prostate at a younger age.Some studies have shown that even when the level of testosterone in the blood begins to fall, in the prostate gland there is still a high level of digidrotestosterone, which can push the prostate cells to continue to grow.

The prostate gland is located directly under the bladder.The urethra (or urethra), which removes the urine from the bladder, passes through the center of the prostate gland.It is because of such an anatomical structure that an increased prostate is able to block the flow of urine.

Risk factors for increasing the prostate gland can be:

  1. Age.In men under the age of 40, symptoms of an increase in the prostate gland are rarely observed.About 30% of men experience moderate symptoms by 60 years, and about 50% - by 80 years.
  2. The presence of a DGPZ in relatives.If your blood relatives, for example, have a father or brother, have problems with the prostate gland, then this means that you can also have increased the risk of prostate hyperplasia.
  3. Other diseases such as diabetes, cardiovascular diseases and erectile dysfunction.Studies show that diabetes, erectile dysfunction, as well as heart disease and blood vessels, can in some cases increase the risk of DGPZ.
  4. Life.Obesity increases the risk of DGPZ, and physical exercises can reduce this risk.

Nevertheless, the presence of any of the above factors is not the basis to believe that you will definitely develop a prostate adenoma.

Symptoms

The severity of symptoms in different people with prostate adenoma is different.

General signs and symptoms of DGPZh include:

  • Frequent or urgent desire to urinate.
  • Increase in urination at night (Nokturia).
  • The inability to completely empty.bladder.
  • The presence of the residual volume of urine in the bladder.
  • Weak stream of urine or periodic stops during urination.
  • The complexity of the beginning of urination.
  • Growth of urine at the end of urination.
  • Frequent urinary tract infections.
  • The complete impossibility of urination (anuria).
  • The presence of blood in the urine (hematuria).

It is worth knowing that the size of the prostate gland does not necessarily determine the seriousness of your symptoms.Some men with a slightly enlarged prostate can have serious symptoms, while other men even with extremely enlarged prostate glands can be insignificant.Almost all patients are characterized by the gradual deterioration of symptoms over time.It is extremely rare that symptoms can be stabilized or even improved over time.

Diagnostics

In case of suspicion of DGPZ, your doctor asks detailed questions about the presence of symptoms of the disease and will conduct a physical examination.This initial stage may include:

  1. A survey to identify symptoms and risk factors of the disease.
  2. Finger rectal examination.To assess the size and shape of the prostate gland, the doctor will need to insert a finger into the rectum.This study is extremely informative, allowing you to draw the primary conclusion about the state of the prostate gland.
  3. Urine analysis.An analysis of the sample of your urine can help eliminate infection or other conditions that can cause similar symptoms.
  4. Blood test.The results of blood tests may indicate the availability of kidney problems.
  5. Blood test for prostat-specific antigen (PSA).The dog is a protein that is produced only by a prostate fabric.When the prostate is healthy, very little dog is found in the blood.The test can be done in the laboratory, hospital or doctor’s office.No special training is required.The rapid increase in the level of the dog may be a sign that the rapid growth of the prostate fabric occurs.DGPZH is one of the possible causes of a high level of PSA.Inflammation of the prostate, or prostatitis, is another common cause of the high level of the dog.

After conducting an initial examination and the necessary tests, your doctor may recommend additional studies to confirm the presence of a DVGPH and exclude other conditions.These tests may include:

  1. Urodynamic examination.In this study, the patient is urinated in a container attached to a special apparatus, which measures the strength and volume of the stream during urination.The test results help track the dynamics of the development of the disease, determining whether your condition becomes better or worse.
  2. Test for the residual volume of urine.This test shows whether you can completely empty your bladder.The test can be performed using an ultrasound study or by introducing a catheter into the bladder after you are helping to measure how much urine is left in your bladder.
  3. Maintaining a 24-hour urination diary.Registration of urination and the amount of urine can be especially useful if more than one third of your daily urination occurs at night.
  4. Transrectal ultrasound.At the same time, the Uz-Zond is introduced into the rectum to measure the size and assess the state of the prostate.
  5. Study of the bladder (cystoscopy).In this study, a flexible catheter with a camera at the end (cystoscope) is inserted into the urethra, allowing the doctor to see the inner surface of the urethra and bladder.
  6. Prostate biopsy.It may be necessary to take prostate tissue samples to exclude prostate cancer.

Treatment

There are many different treatment options for prostate adenoma.You and your doctor together must decide which treatment suits you the most.Sometimes a combination of various procedures works best.Mild cases of DHCH may not need treatment.

The main types of treatment for prostate adenoma are:

  • Active observation of the disease.
  • Drug therapy.
  • Small invasive surgery.
  • Surgical interventions.
  • Active observation.

If your doctor prefers this option, then your disease will be carefully monitored without using any drugs or surgical procedures.At the same time, you will be examined annually.If your symptoms will deteriorate or new symptoms appear, your doctor may offer you an active treatment.Men with light symptoms can be good candidates for active observation.Men with moderate symptoms that do not bother them are also good candidates.

The advantage of this approach is that there are no side effects, but it is likely that then it will be more difficult to reduce the symptoms.

Medical therapy

Alpha blockers

Alpha blockers are medications that relax the muscles of the urethra, prostate and bladder.They improve the outflow of urine and reduce the symptoms of DHCH, while without affecting the size of the prostate.Alfa-blockers include alfuzososine, terazozin, doxazosin and tamsulosin.

One of the advantages of alpha blockers is that they begin to work immediately after admission.Side effects can include dizziness, fatigue and problems with ejaculation.

Men from moderate to severe DGPZ and men who are worried about their symptoms are good candidates to start therapy with alpha blockers.

5-alpha reductase inhibitors

5-alpha reductase inhibitors are drugs that block the production of dihydrotestosterone, male hormone, which can accumulate in the prostate and cause its growth.These drugs lead to a decrease in the size of the prostate and increase the outflow of urine.Such drugs include finatoride and dutasteride.

These drugs significantly reduce the risk of developing DHCH complications.They also reduce the likelihood that you will need an operation in the future.Side effects include erectile dysfunction and a decrease in libido (sex drive).At the same time, you will have to constantly continue taking tablets to prevent the repeated occurrence of the symptoms of the disease.

Combined therapy

In combined therapy, alpha blockers and inhibitors of 5-alpha reductase are used jointly.Possible combinations of drugs include finsteride and doxasosine or dutasteride and tamsulosin.Your urologist can also prescribe a combination of alpha blockers and drugs called muscarin receptor blockers if you have symptoms of the bladder hyperactivity.With a hyperactive bladder, the bladder muscles are uncontrolled and cause an increase in urination frequency, sudden desires to urgently urinary and urinary incontinence.Antimoscarin drugs are drugs that relax the muscles of the bladder.

Combined therapy significantly improves the symptoms and prevents the deterioration in the state of the DHGPH.However, it is worth remembering that each drug can cause side effects.Taking two drugs, you can have more side effects than if you took only one drug.

Alternative treatment methods

Self -medication, the use of traditional medicine or treatment using various herbs (herbal medicine) is not recommended for medical workers.Many studies show that the use of such treatment is not effective, and in some cases, irreparable harm can bring.In addition, herbs and biologically active food additives (dietary supplements) do not pass the same testing process as drugs.As a result, the quality and cleanliness of the additives sold without a recipe can vary.

Small -invasive surgical interventions

Minimally invasive interventions are carried out with minimal anesthesia and suggest faster recovery.Quite often, the procedure can be performed right in the doctor’s office or in an outpatient center.

Instant relief of the symptoms of the disease is the biggest advantage of minimally invasive surgery.In many men, after performing minimally invasive intervention, the outflow of urine and the control of the function of the bladder are improved.If you have problems with urination, obstruction of the urinary tract, stones in the bladder, blood in the urine, the presence of the residual volume of urine in the bladder after emptying or you did not notice the effect of taking drugs, then minimally invasive intervention may be the next step in the treatment of the disease.

However, it is worth knowing that any surgical interventions, including minimally invasive ones, have a risk of side effects, including:

  • Urinary tract infections.
  • Blood in the urine.
  • Burning during urination.
  • The need for more frequent emptying of the bladder.
  • Sudden urination.
  • Erectile dysfunction.

Methods of minimally invasive surgery include:

  1. The elevation of a prostatic urethra (or PUL methodology) - with this procedure, a special device is used to install tiny implants in the prostate gland.These implants are raised above and hold an enlarged prostate in this position, while the pressure on the urethra decreases and the outflow of urine improves.In this case, the destruction or removal of the tissue of the prostate gland does not occur.Pul can be made with both local and general anesthesia.Most patients notice an improvement in symptoms within 2 weeks.In some cases, pain or burning can occur when urinating, blood in the urine or a constant strong desire to urinate.Usually these side effects take place within two to four weeks.Good candidates to perform an elevation of prostatic urethra can be patients who have a history of other health problems or patients for whom surgical intervention has a high risk.
  2. Transurethral microwave thermotherapy (or TUMT method) - microwaves are used in this procedure to destroy prostate tissue.First, the doctor introduces a catheter through the urethra to the prostate gland, and then sends microwaves built into the catheter to heating the selected sections of the prostate.High temperature destroys an excess of prostate fabric.With this procedure, anesthesia is usually not required, the risk of side effects is minimal.
  3. The method of treating prostate pathologies using convection ablation by water steam (Rezum therapy) - this procedure uses thermal energy to destroy the excess of prostate tissue.In this case, sterile water inside a special portable device heats up to a temperature just above the boiling point when it turns into steam.This hot steam then causes the rapid death of cells.Treatment can be carried out in the doctor’s office under local anesthesia.After the procedure, you may have an admixture of blood in the urine for some time, you will also need to use a catheter for several days.Painful or frequent urination after the procedure should pass after about 3 weeks.Sexual side effects, such as erectile dysfunction, are unlikely.

Traditional surgical operations

Surgical interventions with the removal of part of the prostate tissue are performed with the ineffectiveness of other methods of therapy, with extremely expressed symptoms (for example, with complete impossibility of urination).These include:

  • Transuretral prostate resection (Turp)

    TURP is one of the most common operations in DHC.During this operation, after performing anesthesia, the surgeon introduces a special thin tool through the head of the penis into the urethra.Using this tool, the doctor removes the excessive tissue of the prostate gland.After the procedure, it is usually necessary to use a catheter for 1-2 days.The effect of such treatment usually lasts 15 years or more.Like any other operation, the turp has side effects and anesthesia used in intervention, is associated with a certain risk.Side effects of Turp can include retrograde ejaculation, erectile dysfunction, urinary tract infection after surgery and urinary incontinence.Full recovery takes from 4 to 6 weeks.

  • Laser Enucleation of Prostate

    With this intervention, the surgeon puts a thin tool through the penis in the urethra.The laser inserted into the tool destroys an excess of prostate fabric.At the same time, as with transurethral resection of the prostate, no cuts need to be made.Recovery after laser enucleation is very fast, but after that for several days you may have an admixture of blood in the urine and frequent or painful urination.With this procedure, anesthesia is also required, which is associated with certain risks.

  • Prostate removal operations

    Currently, operations to remove prostate during DGPZ in men are extremely rare with the ineffectiveness of all other methods of therapy.Such operations are associated with significant risks and side effects, including urination, violations of erectile function and serious complications during the operation itself.

Complications

The absence of timely medical care in the DGPG can lead to the development of serious complications, which include:

  • Sudden and complete inability to urinate (delayed urine, anuria).In this state, it may be necessary to enter a catheter into the bladder to provide an outflow of urine from a crowded bladder.In some cases, surgery may also be required to reduce urinary retention.
  • Urinary tract infections.The inability to completely empty the bladder can increase the risk of infections in the urinary tract.
  • The stones of the bladder.Stones in the bladder are also formed due to the impossibility of completely emptying the bladder.Stones can cause the development of infections, irritation of the bladder, impurities of blood in the urine and further difficulties in the outflow of urine.
  • Damage to the bladder.With incomplete emptying, the bladder can be stretched, which over time leads to a weakening of its muscle wall.As a result, the bladder becomes unable to compress properly, which becomes the cause of further difficulties in its emptying.
  • Kidney damage.Urine delay can cause an increase in pressure in the bladder and the reverse outflow of urine to the kidneys, which can lead to their direct damage or increase the risk of infectious diseases.Such complications are extremely serious and can remain for life.

In most men with increased prostate gland, these complications develop extremely rarely, however, it must be remembered that many complications, including acute urinary retention or kidney damage, may pose a serious threat to your health and life.If any symptoms of the disease occur, consult a doctor immediately.

Diet and prevention of development of prostate adenoma

Unfortunately, there is no reliable way to prevent the development of prostate adenoma, but the rate of increase in prostate can lose weight loss and proper nutrition with a high content of fruits and vegetables in the diet.This may be due to the fact that the excess amount of adipose tissue in the body can increase the level of hormones and other blood factors and stimulate the growth of prostate cells.Constant physical activity also helps to control the weight and level of hormones, thereby reducing the risk of developing prostate adenoma.