BPH: treatment, symptoms, causes, surgery
Among all the diseases of the male reproductive system BPH, perhaps the most common. Foci of hyperplasia of the gland tissue appear at the end of the thirties of life, at age 50 every man has the signs of adenomas, and 70-year-old age incidence of pathology reaches 80%.
The term «adenoma» is used in the case of benign prostatic hyperplasia (BPH) is very conditional, just pointing out a tumor-like growth pattern and the quality of the process, but in fact a tumor of this adenoma is not. Hyperplasia is an increase in the volume of the parenchyma of the prostate, which like the tumor pushes to the periphery the healthy tissue of the gland compresses the urethra and over time becomes a connective tissue capsule. Education has not metastasized and not prone to malignancy. It is believed that prostate cancer arises by itself, although a combination with BPH in older men is possible.
The prostate gland is very important organ of the reproductive system in men. It is located in the pelvis, under the urinary bladder and covers the outside of the urethra. The normal functioning of the prostate provide adequate sexual function, her secret part of the sperm, and iron itself closes the lumen of the urethra during erection.
In the pathology of this organ is disturbed the flow of urine, there is a stagnation in the urinary tract, eventually joins the inflammatory process, decreased libido and an erection occurs impotence that creates a significant sexual and psychological disorders in patients. In severe cases may develop renal failure and acute urinary retention, when you may need emergency medical care.
From time to time prostate cancer does not cause obvious symptoms, so the man may not even be aware that active cell proliferation and the formation of microshells has already begun. Moreover, if the urethra was outside of the prostate, any evidence of pathology would not be at all. With increasing mass of the prostate gland, it starts to narrowing of the urethra on the outside, contributing to the obstruction of the normal passage of urine, when there are the first symptoms of the disease. Diagnosis and treatment of diseases of the prostate deals with the urologist, to which you immediately have to go the man at the first sign of an adenoma.
Causes of benign prostatic hyperplasia
Causes of benign prostatic hyperplasia is still unknown, however, predisposing to this disease factors as follows:
- Older age, especially while maintaining a high function of the testicles that produces testosterone;
- Increase metabolism of male sex hormones in the cells of the prostate gland on the background of the age-related increase in the number of female hormones in older individuals;
- Genetic predisposition;
- Diet (craze in animal fats, especially in the decreased proportion of vegetables and fruits);
- A sedentary lifestyle, contributing to the stagnation of blood in the pelvis and blood circulation in the organs.
It is noted that men engaged in mental work, a long time conducting in a sitting position and neglecting going to the gym suffer from BPH often. Obesity, especially abdominal type, where fat accumulates in the abdomen, leads to the accumulation of female sex hormones in adipose tissue, thus reducing the concentration of testosterone, difficult sexual activity and prostate displayed foci of hyperplasia. Excessive beer consumption can lead to similar consequences. The citizens of Europe and the United States who eat a lot of animal fats and alcohol, suffer from BPH at times more often than men in Asian countries who eat enough vegetables (tomatoes, beans, etc.).
Accurate communication of risk of adenoma with sexual activity is not established, but the refusal of a regular sex life can contribute to stagnation of blood in the pelvis and violation of the adequate excretion of prostate secretion, which may contribute to inflammatory changes and hyperplasia.
Symptoms of BPH
The prostate gland grows to a clinically significant level, so in the initial stages of the disease symptoms may not be at all. The first appearance of some difficulty in emptying the bladder the man may be blamed on other problems, but ideally this is the best time for visiting the doctor.
Increasing giperplazirovannah prostate is narrowing the urethra, therefore the main symptoms of the adenoma due to a violation of the promotion of urine through the urethra:
At the initial stage of BPH troubling the patient, frequent and difficulty urinating, getting up during the night to 5-8 times, with residual urine in the bladder was not because his arm is tense and more able to push the increased volume of content through a narrowed part of the urethra.
As disease progression occurs not only obstruction of the urethra, and irritation alpha-adrenergic receptors of the muscular wall of the bladder and its sphincter, resulting in increased tone of the body, which further prevents complete emptying. In the second stage, in addition to the above symptoms of disorders of urination, there is an accumulation of residual urine. First the quantity is small, about 50-100 ml. Gradually compensatory ability of the bladder are depleted, the muscle wall becomes thin and flabby, and the volume of residual urine may reach liters or more.
The third stage of the disease, decompensation, peculiar to such symptoms as: significant violation of the excretion of urine due to the progressive atony of the bladder, the delay content in the bladder, the ureters, the addition of a secondary inflammation of the urinary organs, disruption of the functioning of the kidneys. In the third stage, the patient is extremely difficult to empty the bladder, sometimes a strong straining and tension of the muscles of the abdominal wall lead to the need to rest in the process of urination. Simultaneously with the difficulty of outflow of urine it is a constant «leakage» drop by drop, day and night. The patient becomes irritable, complains of nausea, dry mouth, weakness, which are associated with renal involvement in the pathological process.
When you attach a secondary infection that occurs quite often with stagnation in the urinary tract, may cause back pain, fever, burning sensation and pain in the urethra and the bladder.
In the third stage of BPH often experience various complications – renal failure, infection, acute urinary retention as the result of atony of the bladder, bleeding, formation of stones in the background of the concentration of the contents in the lumen of the bladder and the accession of the inflammatory process. In severe cases, patients require immediate medical care in hospital. At the same time will be considered the surgical treatment of the adenoma.
Often patients with BPH can be diagnosed and the prostate, which is not directly associated with the tumor, but to provoke an inflammation of the prostate may be a blockage, particularly with infection of the ways to rochevilaine, poor blood circulation in the prostate against the background of increasing its mass. The presence of prostatitis, in addition to difficulties with urination, pain in the pelvic area and perineum and violation of sexual activity men.
The effects of growth of the adenoma can become such a major change, such as:
- Acute retention of urine, when its amount is 2-3 litres, and the aggravating factors are errors in diet, use of alcohol, hypothermia, exhaustion; it may occur at any stage of the adenoma;
- Chronic cystitis, pyelonephritis;
- Chronic renal failure;
- Stone formation in the bladder;
- Intense bleeding.
How to detect adenoma?
Even the seemingly most insignificant signs of violation of urination should lead man to the doctor. The specialist will ask about the nature of the complaints, will make the inspection, palpation of the prostate and prescribe additional tests:
To the use of instrumental methods of diagnosis, the urologist will conduct a digital rectal examination of the prostate and seminal vesicles, which gives quite a large amount of information about the size, consistency, tenderness of the prostate, the mobility of the rectal mucosa palpation of the gland. After such a feeling on the doctor can formulate a preliminary diagnosis and even suspect cancer.
Of course, the procedure is unpleasant, but many men simply are too embarrassed to go to the urologist with their delicate problem, but any delay with the visit to a specialist leads to the progression of the adenoma, aggravation of symptoms and the necessity of using more complex methods of treatment until surgery.
Treatment of BPH
Treatment of benign prostatic hyperplasia you need to do as soon as there are signs of the disease. The first thing you should address to the urologist, because the symptoms will not disappear, and the progression of hyperplasia requiring surgical intervention. In the early stages of the disease enough drug treatment, which has become effective through the development of modern drugs. When significant changes of the gland tissue and the dysfunction of organs mochevyvodjashie without surgery is not enough. The sooner a patient seeks help, the better will be therapy that will allow to avoid surgical intervention.
Conservative therapy involves the use of drugs that must be prescribed by a doctor. Do not self medicate under any circumstances. The effectiveness of modern tools allows in 80% of cases to do without surgery, the treatment can be performed even for life, and the effects on the body as a whole and the likelihood of side effects is minimal. Today is very effective are:
- Blockers 5-alphareductase;
The combination of drugs from these groups is the most modern scheme of medical treatment, which allows to achieve good results even in complicated patients.
Alpha-blockers (alfuzosin, tamsulosin) contribute to the relaxation of the muscular fibers of the bladder neck and prostate, improve blood flow and contractile function bodies, greatly facilitating the process of urination and eliminating the stagnation of urine. The effect of taking it is developing quite rapidly, and among the possible side effects of hypotension and reflux of semen into the bladder, which happens rarely.
Inhibitors of 5-alphareductase (finasteride) prevent further prostate enlargement and multiplication of its cells by blocking the conversion of testosterone to its active form. The use of these tools is able for many years to slow down the progression of hyperplasia and even reduce the size of cancer, especially when large volumes of the body. To achieve a lasting effect from the use of this group of drugs must be taken for at least six months, and among the side effects most frequently reported decreased libido, erection problems and retrograde reflux of ejaculate.
M-anticholinergics help relax tense muscles of the bladder, thereby disappear frequent urination and incontinence.
A good result shows the appointment of herbal preparations that can affect a variety of metabolic processes, inhibiting the growth factors of the tumor, to exert anti-edematous and anti-inflammatory effect. Such treatment substantially relieves the symptoms of urinary retention and urination disorders, particularly in patients for whom surgery may be dangerous or even contraindicated.
Modern development was a preparation composed of antibodies to the prostate specific antigen, which acts purposefully only on the affected organ, improves metabolic processes and blood flow in the prostate, has anti-inflammatory and anti-edematous properties, able to eliminate the violation of urination due to the normalization of tone of ways to rochevilaine, without systemic side effects. Indications for this kind of treatment is prostatic hyperplasia of I-II stage, a variety of dysuric disorders, including those accompanied by prostatitis.
Medical treatment of BPH should be administered only by a physician and performed under his control after a thorough investigation and eliminate the possibility of malignant transformation of cells of the gland.
In each case, the technician selects the medications and a combination of individually based on the age, condition of the patient, the degree of hyperplasia of prostate and nature of the violations of rochevilaine. To maintain the effect of conservative treatment the patient should regularly visit the urologist and undergo repeated courses of therapy. For years, the man can take medication without thinking about the operation in principle, but in cases of failure of conservative treatment, development of serious complications, often related to severe BPH, surgery becomes inevitable.
Nice effect on the background of drug therapy provides prostate massage, which is recommended to be performed regularly, about once every six months all susceptible individuals. The aim of the massage is to improve blood flow in the body and obtaining its secret. This procedure must exercise well-trained specialist who knows the proper technique of manipulation, in which the likelihood of damage to the prostate and rectum is minimized. The woman may not have such skills, so the common opinion about such a prevention is better to sweep aside, to discard the shame and embarrassment and come to the doctor.
Often patients fear a trip to the urologist, prefer treatment of folk remedies. Any scientific justification for this approach is not received. Moreover, it was proven the futility and even danger associated with the progression of hyperplasia and exacerbation of dysuric disorders, and the development of inflammatory changes.
If you still do not to refrain from the use of medicinal herbs, it is necessary to notify about their reception of the attending physician, and preference should be given to a harmless and non-toxic (pharmacy chamomile, for example). Diuretic teas to get involved is not worth it, because they can create the extra volume of urine in the already crowded bladder, which can lead to a significant deterioration of the patient.
For advanced forms of hyperplasia, the absence of effect of medical treatment and high risk of complications of BPH, the only way is surgery, which is forced to conduct almost all patients with the third stage of the disease.
When choosing a specific method of removing giperplazirovannah prostate tissue, the doctor will be based on the gland size, degree of urinary disorders, the patient’s age and presence of comorbidities that may complicate anesthesia with the intervention.
Indications for surgical removal of the prostate are:
Many men can seem to get rid of even a small increase in cancer is easier to surgically, once and for all eliminating the unpleasant symptoms of the disease, but it is not. First, any operation carries a risk of complications associated with the need for anesthesia, bleeding and dysfunction of other vital organs in aged patients with concomitant pathology of heart, lungs, blood vessels. Second, approximately one third of patients after surgery has the same complaints as before her, and they may join the of erectile dysfunction associated with damage to nerve endings in the intervention.
The most common types of surgical operations for BPH consider:
- Adenomektomii measured in the bladder.
- Transurethral resection of the.
Transurethral resection involves the removal of the adenoma (but not the entire gland!) with the help of a cystoscope inserted into the urethra. This is a relatively gentle method of treatment that does not require penetration into the pelvic cavity through the abdominal wall or the perineum. After removal of tumor tissue urine flow is restored, kidney function improves and in most cases take and erectile dysfunction and sexual function, but a relapse is not excluded.
Transvesical adenomectomy is a more radical method of treatment leading to permanent cure. It consists in the removal of the tumor through the abdominal incision and the bladder. The indications for this intervention was the considerable size of the prostate gland, disturbance of outflow of urine with the development of chronic renal failure, the presence of stones in the bladder and bleeding.
Any surgery is always a trauma for the patient, so modern medicine is committed to the use of gentle and minimally invasive ways to combat tumors. Those with prostate adenoma are:
- Transurethral microwave and electrotherapy therapy;
- Transurethral laser treatment (ablation of tumor tissue).
With such treatment options, the impact of physical factors (laser, electric current, heat) occurs through the urethra, so the need for incisions of tissue disappears.
To treat BPH by minimally invasive methods is possible only at early stages of the disease when there are severe complications with the authorities rochevilaine, and prostate has not reached a critical size, so patients who do not wish to be on the table from the surgeon, so it is important to come to the urologist at the first signs of pathology.
In addition to medical and surgical treatment, it is important that the way of life of the patient. It is no secret that disease men are more vulnerable mental work, leading a sedentary lifestyle and fat face, so a good physical activity, normalization of weight, an adequate sex life to a large extent contribute to the prevention of BPH.
Nutrition patients with BPH involves increasing the amount of fresh vegetables and fruits in the diet, which share shall be not less than 60%. Should abandon the sweet and starchy foods, foods with animal fats, fried, salty foods and alcohol. If there are no violations functions cardiovascular system and kidney, it is not necessary to limit fluid intake, valid and phytotherapy facilitating the flow of urine and making urination easier and painless.
Prevention of prostate diseases it is better to start at a young age, when signs of organ yet. A healthy lifestyle is the best way to avoid the adenoma, with all its adverse effects and operations in the future.