Good-quality giperplaziya of a prostate gland
Good-quality giperplaziya of a prostate gland — the growth of ferruterous fabric and a stroma of a transitional zone of a prostate leading to increase in body. Adenoma of a prostate can cause urination violations: weak stream of urine, feeling of incomplete depletion of a bladder, frequent or night desires, paradoxical ishuriya. The diagnosis is established according to the DOG level, TRUZI, an urofloumetriya and a questionnaire of assessment of symptoms of IPSS. Treatment correlates with gland volume, age, the accompanying pathology and expressiveness of symptoms: apply expectation tactics, medicamentous therapy, surgeries, including low-invasive techniques.
Good-quality giperplaziya of a prostate gland
The good-quality giperplaziya of a prostate gland (adenoma of a prostate, DGPZh, DGP) — the common world problem which one third of men faces is more senior than 50 years and 90% of the patients who lived up to 85 years. Statistically, about 30 million men have the urinogenital dysfunction connected with DGPZh, and this figure increases every year. Pathology meets at the Afro-Americans with initially higher level of testosterone, activity 5 more often - alpha reductases, growth factors and an expression of receptors of androgens (population feature). At residents of east countries adenoma of a prostate is registered less often that, apparently, is connected with consumption of a large number of the products containing fitosterola (rice, soy and its derivatives).
It is obvious that prostate adenoma - a multifactorial disease. A major factor — the change of a hormonal background connected with natural aging at normal functioning of testicles. There is a set of the hypotheses explaining mechanisms of development of pathology (the theory of stromalno-epitelialny relationship, stem cells, inflammations and so forth), however most of researchers as fundamental consider the hormonal theory. It is supposed that age prevalence of dihydrotestosterone and an estradiol stimulate specific receptors in iron which start a giperplaziya of cages. Carry to additional background risk factors:
- Excess weight / obesity. Accumulation of fatty tissue, especially in a stomach, is one of the indirect reasons of increase in a prostate. It is connected with the lowered testosterone level at the men having obesity. Besides, at a gipoandrogeniye the amount of estrogen increases that increases activity of dihydrotestosterone promoting a giperplaziya.
- Diabetes. High level of glucose and insulin resistance accelerate progressing of DGP. Glucose level at SD is higher not only in blood, but also in all cells of a prostate that stimulates their growth. Besides, diabetes leads to injury of blood vessels, including, a prostate gland, the increased prostate can become result of what. A number of researches show that among men with diabetes and the increased level of lipoproteins of low density of DGPZh comes to light 4 times more often.
- Features of food. The use of food with the high content of fats increases probability of a giperplaziya of a prostate for 31%, and daily inclusion in a diet of red meat - for 38%. The exact role of greasy food in emergence of hyper plastic processes is unknown, presumably, it promotes the hormonal imbalance connected with DGP.
- Heredity. Genetic predisposition has a certain value: if prostate adenoma with the expressed symptoms was early diagnosed for male relatives of the first line, the risk of its development in the subsequent generation of men increases.
Testosterone in an organism of the man contains in various concentration: in blood its level is more, in a prostate — it is less. Age men have a decrease in level of testosterone, but the level of dihydrotestosterone remains high. The significant role belongs to enzyme 5, specific to a prostate, alphareductase thanks to which testosterone passes in 5 - alpha dihydrotestosterone. Androgenic receptors and DNA of kernels of cells of a prostate which stimulate synthesis of factors of growth are most sensitive to its action and brake apoptosis (violation of programmable processes of natural dying off). As a result old cages live longer, and new actively share, causing proliferation of fabric and growth of adenoma.
The increased prostate promotes difficulty of an urination against the background of narrowing of a pro-static part of an urethra (especially if growth of adenoma is directed in a bladder) and to increase in a tone of gladkomyshechny fibers of a stroma. At an initial stage of pathology the state is compensated for the account of the strengthened work of a detruzor which straining, allows urine to be evacuated completely. In process of progressing morphological changes of a wall of a bladder appear: a part of muscle fibers is replaced with soyedinitelnotkanny. Capacity of body gradually increases, and walls become thinner. The mucous membrane also undergoes changes: hyperaemia, a trabekulyarny hypertrophy and diverticulums, erosive ulcerations and a necrosis are typical. At accession of a secondary infection cystitis develops. The good-quality giperplaziya of a prostate and stagnation of urine lead to the return current of urine, a tsistolitiaz, hydronephrotic transformation of kidneys and HPN.
In andrology several classifications of DGPZh are accepted. Depending on gland volume (it is defined by ultrasonography and measure in cubic centimeters) allocate small (up to 25 cm ³), average (26-80 cm ³), large (more than 80 cm ³) and huge adenoma (over 250 cm ³). Gyuyon's classification allocates three clinical stages of DGPZh:
- Compensation. The Dizurichesky phenomena are absent or are expressed slightly, there is no residual urine. A bladder, kidneys without visible symptoms of pathology.
- Subcompensation. The clinical phenomena are expressed more brightly that is caused by progressing of a disease. Residual urine is defined. The top uric ways change that is shown by violation of functional ability of kidneys.
- Decompensation. Functions of a bladder are broken, the paradoxical ishuriya, heavy degree, accession of HPN takes place.
Symptoms depend on extent of obstruction of an urethra. If the increased prostate squeezes an urethra, complaints to the speeded-up urination in the small portions, especially, at night, a sluggish stream, feeling of incomplete depletion, irrespective of urination frequency appear. In process of growth of adenomatozny knots the innervation therefore there are urgentny desires — uncontrollable desire to urinate with the subsequent not deduction of urine changes.
At an advanced stage the paradoxical ishuriya — impossibility to urinate completely with simultaneous dribble of urine on drops that is connected with an atoniya of walls of a bladder, and also with a detruzorno-sfinkterny dyssynergia — lack of synchronous work between the muscle responsible for urine exile, and relaxation of a sphincter of an urethra develops. To empty a bladder, some men are forced to urinate on female type ‒ sitting. Clinical manifestations of a good-quality giperplaziya of a prostate gland of a nepatognomonichna can also accompany any obstruction, including an urethra striktura, a diverticulum, a tumor and so forth therefore only on the basis of assessment of symptoms it is impossible to establish the diagnosis.
Complications of a giperplazirovanny prostate can include a number of states. Against the background of DGP in 35% the sharp delay of an urination is shown. Residual urine has property to crystallize, in this case in a bladder concrements with a secondary inflammation are formed. The increased vnutripuzyrny pressure promotes formation of puzyrno-mochetochnikovy refluxes, a gidronefroza and HPN. If to consider complications of therapy of adenoma of a prostate gland, then there is a probability of development urethras after a transurethral resection (5-7%), an urine incontience (1-2%), erectile dysfunction (9-14%), a retrograde ejaculation (74-87%), a cervical sclerosis of a bladder (2-4%).
The diagnosis is established by the urologist or the andrologist. Rectal survey is informative only on condition of an achievable arrangement of a tumor. At manual inspection the prostate is increased, uniform, painless, its consistence is elastic, the median groove is maleficiated. The biopsy of a prostate gland is not a routine way and is shown only at suspicion of a prostate cancer. Consultation of the nephrologist is necessary for the patient with suspicion on dysfunction of kidneys.
There is a special questionnaire developed for assessment of degree of expressiveness of symptoms of obstruction of the lower urinary tract. The questionnaire consists of 7 questions connected with common symptoms of a good-quality giperplaziya of a prostate gland. Frequency of each symptom is estimated on a scale from 1 to 5. At summation receive the general assessment which influences further tactics of treatment (dynamic observation, conservative therapy or operation): from 0-7 — poorly expressed symptomatology, 8-19 — average, 20-35 ‒ a serious problem with an urination. Tool and laboratory diagnostics at DGPZh includes:
- Ultrasonography. TRUZI and transabdominal ultrasonography of a prostate and bladder — complementary ways of visualization. Ultrasonography is carried out twice — with the filled bladder and after the act of an urination that allows to define amount of residual urine. Asymmetry, density, heterogeneity of structure, the strengthened blood supply of a prostate indicate adenoma.
- X-ray analysis. At radiological diagnostics (excretory urography, a tsistografiya) it is possible not only to determine the prostate sizes, but also to estimate function of kidneys, anomalies of development, to diagnose pathologies of a bladder, an urethra. The research means intravenous administration of contrast substance.
- Urodinamichesky researches. Urofloumetriya — the simple test for urine stream assessment, graphically shows, the speed of release of a bladder and extent of obstruction. The research is carried out for definition of indications to expeditious treatment and by trackings of dynamics against the background of performing conservative therapy.
- Research DOG. The Prostatspetsifichesky anti-gene is developed by cages of the capsule of body and periuretralny glands. At patients from a good-quality giperplaziy prostate and prostatitis the DOG level is increased. The result is influenced by a set of factors therefore according to one analysis the diagnosis cannot be established.
- Analyses of urine. With prostate adenoma often diagnose the accompanying inflammation of a bladder, kidneys therefore in OAM pay attention to inflammation signs — a leykotsituriya, a proteinuria, a bakteriuriya for men. Blood in urine can demonstrate varicose changes of vessels of a neck of a bladder, their gap at a natuzhivaniye. At changes urine is sowed on nutrient mediums for specification of structure of microbic flora and sensitivity to antibiotics.
Differential diagnostics is carried out with tumoral process of a bladder or prostate, tsistolitiazy, a trauma, interstitsialny and post-radiation cystitis, a neurogenetic bladder, a striktury urethra, a prostate sclerosis, meatostenozy, urethra valves, fimozy, prostatitis.
Treatment of DGPZh
Therapy of adenoma of a prostate correlates with degree of expressiveness of obstructive symptoms and complications, the choice of tactics of treatment is influenced by age of the patient and the accompanying pathology. All existing ways of treatment are directed to restoration of an adequate derivation of urine. Options of therapy include:
- Vigilant expectation. This tactics is applied at men with easy symptoms ≤7 on a scale of IPSS and at patients with IPSS ≤8 assessment, presence of symptoms at whom is not considered as the breaking quality of life in the absence of complications. Once a year such patients pass TRUZI, the analysis on the DOG, manual survey. Medicamentous therapy is not shown as does not lead to improvement of health and has big risks which can affect considerably quality of life (for example, erectile dysfunction against the background of treatment alpha ).
- Medicinal therapy. With the advent of an alpha adrenoblokatorov many patients from a giperplaziy prostate gland had an opportunity to avoid operation. Medicines relax muscles in a prostate, an urethra and in a bladder neck because of what force of a stream of urine increases. Medicamentous therapy is carried out at patients with the expressed, moderate and heavy violations of urination from 8 points and above. Inhibitors 5 of alphareductase are appointed for prevention of progressing of symptoms of obstruction at urination. According to indications the combined therapy is possible. Inclusion in the scheme of inhibitors of a 5-fosfodiesteraza improves an otkhozhdeniye of urine and positively influences erectile function.
- Expeditious treatment. There are several options of surgeries: an adenomektomiya which belongs to radical operations (it can be carried out by both open access, and laparoscopic) and a transurethral resection of a prostate gland. Each operation has the indications, advantages and shortcomings. At the heavy accompanying pathology when the probability of a failure is high, as a palliative measure carry out an epitsistostomiya. After normalization of a state the solution of a question of removal of a drainage and restoration of an independent urination is possible.
- Low-invasive therapy. There is a number of the techniques allowing to avoid the adverse effects connected with TURP and an adenomektomiya. Refer laser destruction (vaporization, coagulation) to those in the contact or contactless way, a needle ablation, an elektrointsiziya, transurethral microwave therapy (Microwave energy), radio-frequency water thermotherapy and so forth. The large volume of a prostate gland — a contraindication to low-invasive methods of treatment.
Forecast and prevention
The forecast for life favorable, to most of patients of rather long (lifelong) reception of modern medicines for normalization of function of an urination. Need for operation arises only at 15-20% of men. After an adenomektomiya the recurrence of a disease does not exceed 5%, malonivazivny techniques do not give 100% of a guarantee of healing and can repeatedly be carried out. Improvement of the forecast was promoted by introduction of low-invasive methods of treatment in the last decade that allows to minimize complications, life-endangering patients. Consultation of the andrologist-sexologist is necessary for normalization of erectile function. Data of researches on prevention of a prostate cancer show that the diet with the low content of animal fat and red meat and high content of protein and vegetables can reduce risk of symptomatic DGPZh. Physical activity at least 1 hour a week reduces probability of a nokturiya by 34%.