Prostate gland adenoma
Prostate gland adenoma – the growth of ferruterous tissue of prostate leading to violation of outflow of urine from a bladder. The speeded-up and complicated urination, including night, weakening of a stream of urine, involuntary release of urine, pressure in a bladder is characteristic. Subsequently the full delay of urine, an inflammation and formation of stones in a bladder and kidneys can develop. The chronic delay of urine leads to intoxication, development of a renal failure. Diagnosis of adenoma of a prostate gland includes ultrasonography of a prostate, a research of its secret, if necessary - a biopsy. Treatment, as a rule, surgical. Conservative treatment is effective at early stages.
Prostate gland adenoma
Prostate adenoma – a good-quality new growth of the paraurethral glands which are settling down around an urethra in its pro-static department. The main symptom of adenoma of a prostate - violation of an urination owing to a gradual sdavleniye of an urethra one or several growing small knots. The good-quality current is characteristic of adenoma of a prostate.
Prevalence of adenoma of a prostate
Only small part of the patients having prostate adenoma asks for medical care, however, detailed inspection allows to find disease symptoms in every fourth man at the age of 40-50 years and in a half of men from 50 to 60 years. Adenoma of a prostate comes to light at 65% of men at the age of 60-70 years, 80% of men at the age of 70-80 years and more than 90% of men are aged more senior than 80 years. Expressiveness of symptomatology can significantly differ. The researches conducted in the field of urology say that problems at an urination arise approximately at 40% of men with prostate adenoma, but only every fifth patient from this group asks for medical care.
Prostate adenoma reasons
The mechanism of development of adenoma of a prostate so far is up to the end not defined. Despite the popular belief connecting prostate adenoma with chronic prostatitis there are no data which would confirm communication of these two diseases. Researchers did not reveal any communication between development of adenoma of a prostate and alcohol intake and tobacco, the sexual orientation, sexual activity postponed venereal and inflammatory diseases.
The expressed dependence of frequency of developing of adenoma of a prostate on age of the patient is noted. Scientists believe that adenoma of a prostate develops owing to violations of a hormonal background at men at approach of an andropauza (a men's climax). This theory is confirmed by the fact that the men castrated before puberty and, extremely seldom – the men castrated after its approach never suffer from prostate adenoma.
Prostate adenoma symptoms
There are two groups of symptoms of adenoma of a prostate: irritativny and obstructive. Increase of an urination, persistent (imperative) desires on an urination, a nikturiya, an urine incontience concerns to the first group of symptoms at adenoma of a prostate. In group of the obstructive symptoms characteristic of prostate adenoma, include difficulties at an urination, a delay of the beginning and increase in time of an urination, feeling of incomplete depletion, an urination a faltering sluggish stream, need of a natuzhivaniye.
Three stages of adenoma of a prostate are allocated:
- The compensated prostate adenoma stage (the I stage)
Dynamics of the act of an urination changes. It becomes more frequent, less intensive and less free. There is a need 1-2 times to urinate at night. As a rule, the nikturiya at the I stage of adenoma of a prostate does not cause concern in the patient who connects constant night awakenings with development of an age insomniya.
In the afternoon normal rate of an urination can be kept, however patients with the I stage of adenoma of a prostate note the expectation period which is especially expressed after a night dream. Then the frequency of day urinations increases, and the volume of the urine emitted for a single urination decreases. There are imperative desires. The stream of urine which formed a parabolic curve earlier is allocated inertly and falls almost vertically.
At the I stage of adenoma of a prostate the hypertrophy of muscles of a bladder thanks to which efficiency of its depletion remains develops. There is no residual urine in a bladder at this stage or practically not. The functional condition of kidneys and top urinary tract is kept.
- The subcompensated prostate adenoma stage (the II stage)
The bladder increases by the II stages of adenoma of a prostate in volume, in its walls dystrophic changes develop. The amount of residual urine reaches 100-200 ml and continues to increase. Throughout the act of an urination of the patient it is forced to strain intensively muscles of an abdominal tension and a diaphragm that leads to a bigger increase in vnutripuzyrny pressure. The act of an urination becomes multiphase, faltering, wavy.
The urine passage on the top urinary tract is gradually broken. Muscular structures lose elasticity, uric ways extend. Function of kidneys is broken. Patients are disturbed by thirst, a polyuria and other symptoms of the progressing chronic renal failure. At failure of mechanisms of compensation there comes the third stage.
- Dekompensirovanny stage of adenoma of a prostate (III stage)
The bladder at the III stage of adenoma of a prostate is stretched, crowded with urine, easily is defined palpatorno and visually. The upper edge of a bladder can reach navel level above. Depletion is impossible even at an intensive tension of muscles of an abdominal tension. Desire to empty a bladder becomes continuous. Severe pains in the bottom of a stomach are possible. Urine is emitted often, drops or very small portions. Further pains and desires to an urination gradually weaken. The paradoxical delay of urine, characteristic of prostate adenoma develops (the bladder is crowded, urine is constantly emitted on drops).
At this stage of adenoma of a prostate the top urinary tract are expanded, functions of a kidney parenchyma are broken owing to the continuous obstruction of uric ways leading to increase in pressure in a cup lokhanochnoy to system. The clinic of a chronic renal failure accrues. If medical care is not provided, patients perish from the progressing HPN.
Prostate adenoma complications
If medical events are not held, at the patient with adenoma of a prostate development of a chronic renal failure is possible. At prostate adenoma the sharp delay of urine sometimes develops. The patient cannot urinate at the crowded bladder, despite intensive desire. For elimination of a delay of urine the bladder kateterization at men, sometimes – the emergency operation or a puncture of a bladder is carried out.
One more complication of adenoma of a prostate – a gematuriya. At a number of patients the mikrogematuriya is noted, but also intensive bleedings from adenoma fabric (are frequent at a trauma as a result of manipulation) or a varicosity in a bladder neck. At formation of clots development of a tamponada of a bladder at which the emergency operation is necessary is possible. It becomes frequent the bleeding reason at prostate adenoma a diagnostic or medical kateterization.
Stones in a bladder at adenoma of a prostate can appear as a result of stagnation of urine or migrate from kidneys and urinary tract. At a tsistolitiaza the clinical picture of adenoma of a prostate is supplemented with the increase of an urination and pains irradiating in a penis head. In a standing position, during the walking and the movements the symptomatology becomes more expressed, in a prone position – decreases. The symptom of "an urine stream mortgaging" (despite incomplete depletion of a bladder, the urine stream suddenly is interrupted and renews only at change of position of a body) is characteristic. Quite often at adenoma of a prostate infectious diseases develop (epididimoorkhit, the epididymite, vezikulit, adenomit, prostatitis, uretrit, sharp and chronic pyelonephritis).
Diagnosis of adenoma of a prostate
The doctor conducts a manual research of a prostate. To estimate expressiveness of symptoms of adenoma of a prostate, to the patient suggest to fill in the diary of urinations. Carry out a research of a secret of a prostate and dabs from an urethra for an exception of infectious complications. Carry out ultrasonography of a prostate during which determine prostate gland volume, reveal stones and sites with developments of stagnation, estimate amount of residual urine, a condition of kidneys and urinary tract.
It is reliable allows to judge urine delay degree at prostate adenoma an urofloumetriya (time of an urination and speed of a stream of urine is defined by the special device). For an exception of a prostate cancer it is necessary to estimate the DOG level (a prostatospetsifichesky anti-gene) which size normal should not exceed 4ng/ml. In disputable cases the prostate biopsy is carried out.
Tsistografiya and excretory urography at prostate adenoma are carried out less often in connection with emergence of new, less invasive and safer methods of a research (ultrasonography) in recent years. Sometimes for an exception of diseases with similar symptomatology or by preparation for expeditious treatment of adenoma of a prostate carry out a tsistoskopiya.
Treatment of adenoma of a prostate
Criterion of the choice of tactics of treatment at prostate adenoma for the urologist is the scale of symptoms of I-PSS reflecting degree of expressiveness of violations of an urination. According to this scale if score less than 8, therapy is not required. At 9-18 points conservative treatment is carried out. If score more than 18 - is necessary operation.
- Conservative therapy of adenoma of a prostate
Conservative therapy is carried out at early stages and in the presence of absolute contraindications to operation. Apply inhibitors 5 to reduction of expressiveness of symptoms of a disease a reductase alpha (, ), alpha (, , , ), phytogenesis medicines (extract of bark of the African plum or fruits ).
For fight against an infection, often joining at prostate adenoma, appoint antibiotics (gentamycin, tsefalosporina). Upon termination of a course of antibiotic treatment apply the probiotics restoring normal intestinal microflora. Carry out immunity correction (alpha 2b interferon, pirogenat). The atherosclerotic changes of vessels developing at most of elderly patients with prostate adenoma interfere with intake of medical medicines in a prostate gland therefore for normalization of blood circulation appoint trentat.
- Expeditious treatment of adenoma of a prostate
There are following surgical techniques of treatment of adenoma of a prostate:
- adenomektomiya. More than 40 g are carried out in the presence of complications, residual urine in number of more than 150 ml, the mass of adenoma;
- TOUR (transurethral resection). Low-invasive technique. Operation is carried out through an urethra. It is carried out at amount of residual urine no more than 150 ml, the mass of adenoma no more than 60 g. It is not applied at a renal failure;
- laser ablyation, laser destruction, TOUR vaporization of a prostate. The sparing methods. The minimum blood loss allows to perform operations weighing tumor more than 60 g. The listed interventions are operations of the choice for young patients with prostate adenoma as allow to keep sexual function.
There is a number of absolute contraindications to expeditious treatment of adenoma of a prostate (dekompensirovanny diseases of respiratory and cardiovascular system etc.). If surgical treatment at adenoma of a prostate is impossible, the kateterization of a bladder or palliative surgery – a tsistostomiya is carried out. It is necessary to consider that palliative methods of treatment reduce quality of life of the patient.