Adenoma of the prostate: symptoms, causes, treatment, operation

What is it - benign hyperplasia, or adenoma of the prostate gland - urological pathology that develops as a result of the proliferation of epithelial cells of the paraurethral glands, which inevitably leads to compression of the urethra and a violation of the outflow of urine.

This disease of men belonging to the age category over 40 years is considered the most famous urological problem. According to statistics with signs of hyperplasia, every second man comes to the specialist.

Causes of adenoma

The causes of prostatic adenoma are not completely revealed. Various factors can influence, but to date, the appearance of the disease is associated with a decrease in testosterone levels, which, as a rule, is a consequence of age-related changes in the body.

Presumably increase the risk of developing adenoma can:

• heredity;
  
• heavy weight;
  
• is an unhealthy diet.

Such harmful habits as smoking or drinking alcohol, as well as the transmitted infections do not affect the course of the disease.

See also, symptoms of prostatitis.

Symptoms of prostatic adenoma

Prostate adenoma, the clinical symptoms of which are determined by the size and growth rate of the neoplasm, its location and the degree of disturbance of the contractile activity of the bladder.

In some men the proliferation of adenomatous tissue in the prostate does not cause any subjective sensations, while others overlap the urethra and problems with urinary outflow begin.

For adenoma of the prostate gland is characterized by the presence of several stages of development, the symptoms of which we will consider in more detail.

1. 1) Compensated stage .The urinary bladder empties to the fullest, but gradually urination becomes difficult. The urine stream becomes sluggish, in parallel there are frequent night desires. In the afternoon, the emptying act can be ordinary, but the process does not start immediately, but after some waiting. The condition remains unchanged for several years, which is explained by the reserve potential of the bladder and kidneys.
   
2. 2) Subcompensated stage .It is characterized by thickening of the walls of the excretory organ, its incomplete emptying and the appearance of residual urine in a volume exceeding 100 ml. Symptoms that occur in the previous stage, as the compression of the urethra develops, intensify. Urination is uneven, with respites, which can reach several minutes. Increases intravesical pressure, and an additional provoking factor is that the patient has to strain the abdominal muscles, pushing during the act of urination. The mouth of the ureter is squashed by bundles of stretched muscles and nodes of the adenoma, which leads to interruptions in the intake of urine in the upper urinary tract and an increase in the decrease in kidney function.
   
3. 3) Decompensated stage .Due to stagnation of urine, the bladder after a while increases in size and can be fixed by palpation or visually. Its upper part sometimes reaches the height of the navel, producing in this case a sensation of a tumor. The ability to expel urine is lost, as the bladder stops contracting. In contrast, the patient feels a constant desire to empty it, painful sensations in the lower abdomen are possible. The phenomenon of paradoxical ishuria develops when urine from the filled bladder reflexively leaves in droplets or small portions, often. There are irreversible changes in the urinary tract and kidneys, kidney failure progresses.

Symptoms are also present: thirst, dryness in the oral cavity and a characteristic odor of urine in the exhaled air, lack of appetite, nausea or vomiting. All this is accompanied by anxiety and depression, loss of interest in the environment.

Without receiving medical treatment, the patient dies as a result of high content of nitrogenous metabolic products in the blood, disturbance of the water-electrolyte balance.

Treatment of prostatic adenoma

Treatment of prostate adenoma can be conservative and operative. Drug treatment has an effect at the first signs of the disease, in cases where the patient still has the ability to completely remove urine from the bladder. Existing drugs in our time not only greatly facilitate the course of the disease, but reduce the volume of the gland and resist the obstruction of the urethra.

This can be achieved with the use of two types of drugs:

• 5-alpha-reductase inhibitors, preventing the formation of a biologically active form of testosterone.
  
• alpha-1-adrenoblockers, relaxing the muscles of the neck of the bladder and prostate.

The first group of drugs include finasteride, dutasteride, to the second - terazosin, alfuzozin, doxazosin. Long-term remission allows to achieve also the use of antibacterial drugs and biological products( permixon, prostomol uno).Conservative methods can not completely cure this pathology, therefore, it is impossible to do without surgical intervention. But it is resorted to in severe cases.

Depending on the neglect of the process, surgical treatment of prostatic adenoma is performed. For this, operations of various kinds are used, for example:

1. 1) Transurethral resection of the prostate. The essence of the method is in the removal of adenoma through the urethral canal in the first stage of the disease. The least traumatic method of treatment.
   
2. 2) Transgender adenomectomy. It guarantees a cure for the disease, although the operation is more traumatic than the previous one. It is performed with renal failure and when reaching an adenoma of a large size.
   
3. 3) Transurethral dissection of the prostate gland. It is shown at a young age with the patient's interest in maintaining sexual activity. This procedure can delay the need for removal of the gland for several years.
   
4. 4) Laser vaporization is a gentle technique, which is the replacement of transurethral resection. Performed under general anesthesia through the urethral canal through the use of endoscopic instruments. There is an evaporation of adenomatous tissues with a laser whose penetration depth is no more than 1 mm, so there is no risk of affecting the underlying layers.
   
5. 5) X-ray endovascular embolization of the arteries of the prostate. By introducing a special embolus through the femoral artery, the flow of blood to the vessels is blocked, which is supplied to the gland. The blocking is selective, in time it allows to reduce the sizes of benign hyperplasia and normalize urination without violating the functions of the prostate and circulation. Improvement is observed only a week after discharge. Hospitalization is shown for no more than a day.

Diagnosis is based on the characteristic complaints associated with urination and clinical examination of the patient in which the doctor is required to perform a rectal finger examination of the prostate.

Other diagnostic methods:

• total blood and urine analysis;
  
• biochemical blood test;
  
• ultrasound of the prostate and kidney;
  
• cystography;
  
• transrectal ultrasound;
  
• uroflowmetry( measurement of urine stream characteristics);
  
• cystomanometry( determination of pressure inside the bladder);
  
• MRI and CT.

From instrumental methods, the most simple is the catheterization of the bladder, which allows you to determine the amount of residual urine after urination.

With prostate adenoma, the prognosis for life is mainly favorable due to the timely detection and surgical treatment of pathology.

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