Treatment of benign prostatic hyperplasia

With age, prostate tissue, under the influence of certain sex hormones, begins to increase in size. This condition is commonly called prostatic hyperplasia (formerly adenoma).

Despite the fact that pathology does not relate to oncological diseases, it can threaten the patient’s life.

Let us consider what means modern medicine has for the treatment of hyperplasia and list the names of some drugs.

What is prostate hyperplasia

Even if a man has not had problems with the genitourinary system in old age, irreversible changes begin. Under the influence of testosterone and dihydrotestosterone, the glandular tissue of the prostate grows and takes the form of a nodule.

Increasing in size, it compresses the prostatic urethra, which causes dysuric disorders. In this case, the symptoms will depend precisely on the size of this benign neoplasm - if it is small, the man may not be aware of the problem for a long time and live his usual life.

Several decades ago, BPH was considered incurable, but now doctors' opinions have changed. According to recent reports, the following statements apply to the disease:

1. Occurs more often in older men.
2. It is in no way associated with prostate cancer and is not a precancerous condition.
3. Signs may change gradually, including waxing, waning, and disappearing.
4. Conservative therapy can give positive results.
5. The optimal treatment option for men beyond reproductive age is transurethral resection.

Half of men over 60 years of age have benign prostatic hyperplasia, and one in ten will require surgical treatment. Without medical help, acute urinary retention develops, then acute renal failure, which often ends in death.

Modern treatment methods and their possibilities

As of the first decade of this century, there are three methods of medical care for benign prostatic hyperplasia - monitoring changes in dynamics, treatment with drugs and surgery. There are also alternative methods that are recognized by some doctors. Each of them has its own characteristics, including regarding the appropriateness of use.

Dynamic observation

The essence of the method is systematic monitoring of the patient’s health status, which is comparable to medical examination.

If the area of ​​hyperplastic tissue does not increase in size and does not threaten organ dysfunction, no treatment is prescribed.

This is due to the fact that in some cases, prostate hyperplasia may be reversible - over time, the symptoms will go away on their own.

Dynamic observation is characterized by:

• annual examination of the patient;
• assessment of the condition on a special scale in points;
• control of the rate of urine outflow within the time limits established by the doctor.

Most often, hospitalization is not necessary for observation. A man can live a normal life, work, go about his business and only visit a doctor on designated days.

However, you should not take any medications without his knowledge, especially for the treatment of sinusitis or prostatitis. Some medications may interfere with urination, leading to increased symptoms of hyperplasia.

The same applies to tranquilizers and antidepressants.

Treatment with herbal extracts

Easy access to various information has led to a surge in the popularity of treating benign prostatic hyperplasia with herbs. Men brew teas and infusions, buy dietary supplements, put candles with sea buckthorn extracts and wait for a positive result.

Meanwhile, the effect of such actions is unpredictable. Some products, especially those based on saw palmetto (saw palmetto) extract, have not been studied. Neither doctors nor pharmacists can predict what mechanism of action these drugs have, whether they can be trusted and whether there will be any complications.

Modern medicine does not recognize herbal medicine. However, if benign hyperplasia is complicated by chronic prostatitis, rectal suppositories may be prescribed. These include Prostatilen, suppositories with propolis or sea buckthorn oil. These medications should be selected by a doctor; self-medication is unacceptable here.

Treatment of hyperplasia with drugs

At the initial stage of glandular tissue proliferation, alpha-blockers and 5-alpha reductase inhibitors are especially effective. They affect various receptors and affect urination, but can also affect other organs, affecting their functionality.

Alpha blockers act on alpha receptors that control the smooth muscle of the bladder and prostate gland. Already after the first dose of drugs, the tone of these muscles decreases, which leads to an increase in the rate of urine outflow.

The most popular tablets of this group are:

• Tamsulosin;
• Doxazosin;
• Terazosin.

The drugs are prescribed in case of progression of symptoms of hyperplasia, with residual urine in a volume of 300 ml and in the absence of indications for surgical intervention. After a course of treatment, the intensity of symptoms decreases by 30-60 percent, and men feel significantly better.

However, the side effects can be dangerous: 10% of men experience a sharp drop in blood pressure and dizziness.

5-alpha reductase inhibitors prevent the conversion of testosterone to dihydrotestosterone. As a result, the volume of the prostate gland decreases and urination is gradually restored. However, the effect is observed only after six months, in addition, there are risks of complications:

• growth of glands in the chest area;
• erectile disfunction;
• decrease in sperm volume.

Most often, men are prescribed Finasteride, but its use is advisable only in cases where the test results clearly show the transition of testosterone to dihydrotestosterone, and according to the results of ultrasound or MRI there is reason to fear further growth of the prostate.

Partial prostatectomy

If the enlarged gland completely blocks the lumen of the prostatic urethra and threatens the development of acute urinary retention, a prostatectomy may be performed. During surgery, part of the glandular tissue of the prostate will be removed, which will lead to improved health.

Indications for surgery are:

• renal failure due to impaired urine flow;
• absent urination;
• ineffective drug therapy;
• detection of stones in the bladder;
• increased residual urine value.

This method of surgical treatment of prostatic hyperplasia does not always give the desired result, therefore another technique is considered the gold standard.

Transurethral resection of the prostate

During the operation, a special device – a resectoscope – is inserted into the patient through the urethra. Under visual control, an electrode will be inserted into the prostate, to which an electric current of certain parameters is supplied. As a result, the hyperplastic tissue of the organ is burned out, and the blood vessels are cauterized.

It has been found that 93% of men feel better after this technique. After the operation, the patient is in the hospital, in the general ward. Three days later he is discharged.

TURP (abbreviation for surgery) may cause minor discomfort, but there is usually no pain.

A type of TURP is laser vaporization. In this case, areas with benign hyperplasia are evaporated by a laser beam, and the risk of complications is much lower.

If, as a result of the proliferation of glandular tissue, the prostate increases to 80 g, a prostatectomy is performed through an open approach. Under general anesthesia, a man is given an incision in the lower abdomen, which serves as a surgical access. The gland capsule is incised and the hyperplasia is removed.

Such surgical intervention is more difficult for men than when removing hyperplasia using the methods described above. In addition, you will have to stay in the hospital longer, wear a urinary catheter and strictly monitor the rehabilitation period.

If a man cannot undergo surgery, and there is no positive result from the drugs, a catheter is placed in the urethra, which is permanently in it. This measure will restore normal urine flow, although it will bring some inconvenience.

Physiotherapeutic treatment

In advanced cases of prostate hyperplasia, surgery gives good results, but is associated with various risks. Therefore, scientists are constantly looking for alternative methods, including those based on certain physiotherapeutic techniques.

These include:

1. Microwave therapy.
2. Ultrasound treatment.
3. Transurethral ablation.

The most promising developments are in the field of application of holmium crystals.

These techniques also include the currently practiced HoLEP treatment, which makes it possible to isolate the entire prostate in an anatomically correct projection with minimal risk of compromising the integrity of its capsule.

Exposure to the HoLEP laser allows the surgeon to work with prostatic hyperplasia of any size, the risk of internal bleeding and other complications will be negligible.

Conclusion

Most often, prostatic hyperplasia is a natural process that develops in the aging body. It is impossible to warn him. The only thing a man can do to help himself is an annual examination by a urologist. The sooner treatment for hyperplasia is started, the greater the chance of maintaining a normal lifestyle and not suffering from dysuric symptoms.

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Source: https://prostatits.ru/oslozhneniya/giperplaziya-predstatelnoj-zhelezy-lechenie.html

Prostatic hyperplasia: causes, symptoms and treatment

Prostatic hyperplasia is observed mainly in older men.

According to statistics, in people over 65 years of age, pathology is detected in 85% of cases and is expressed in the formation of a benign tumor, which increases in size over time.

As a result, representatives of the stronger sex have difficulty urinating due to compression of the urethra. In the absence of timely medical care, the disease causes serious complications.

What is this pathology?

Benign prostatic hyperplasia is changes in the tissues and cells of the prostate and further enlargement of this organ. The neoplasm is formed from glandular epithelium, which at the initial stage of development has the appearance of small nodules.

But over time, the nodules increase in size, leading to the growth of a benign tumor. The development of a tumor does not lead to the growth of metastases, but with advanced pathology and lack of timely treatment, prostate hyperplasia can develop into a malignant formation (carcinoma).

In medical terminology, there is another common name for this disease - prostate adenoma or prostatitis.

BPH of the prostate gland - causes

One of the most common factors in the development of adenoma is heredity.

If there are close relatives in the family who suffer from prostatitis, then the likelihood of the disease increases significantly.

This category of men is recommended to undergo an annual examination from the age of thirty for timely detection of pathology. In addition to the genetic factor, sources of risk also include:

• hormonal imbalances (changes in the balance between female and male hormones);
• inflammatory processes of the pelvic organs and urogenital area;
• old age;
• sedentary lifestyle, lack of physical activity;
• frequent hypothermia;
• bad habits (tobacco, alcohol);
• unhealthy diet (predominance of fatty meat foods and lack of plant fiber);
• previous venereal diseases;
• unfavorable environmental conditions and other environmental factors.

Prostatic hyperplasia - diagnosis

Timely diagnosis, especially in the early stages, is very important for quick and successful treatment.

As a rule, it involves a comprehensive examination and includes an examination of the patient, as well as a number of instrumental studies and laboratory tests.

During a medical examination, a palpation method is used, which makes it possible to determine the condition of the prostate gland, pain, compacted areas, etc.

Diagnostic methods are selected individually for each patient, depending on the complaints and the expressed clinical picture:

• examination by palpation;
• urine analysis for red blood cells, white blood cells, protein, glucose;
• blood analysis;
• Ultrasound;
• uroflowmetry (volume and speed of stream during urination);
• contrast urography (X-ray) is prescribed if the presence of stones in the bladder is suspected;
• cystomanometry allows you to determine the pressure on the walls of the bladder;
• Urethrocystoscopy makes it possible to see the structure and condition of the urethra and bladder.

Prostatic hyperplasia - symptoms

The main feature of prostate adenoma is that it is practically asymptomatic for a long time. This is where the danger lies, since the man does not even suspect the presence of a benign formation in the body. Sensations and discomfort become pronounced only when pathological changes in the organ have occurred and the tumor has grown.

The following are the main signs of BPH, which can manifest themselves at any stage of the disease:

• frequent urination, sudden onset of urge;
• emptying in small drops, weak jet pressure;
• the stream during urination is intermittent;
• the pelvic muscles tense when emptying;
• feeling of urine residue in the bladder;
• pain when visiting the toilet;
• involuntary bowel movement;
• chronic urine retention resulting from a narrowing of the canal;
• blood in urine.

If a patient notices at least one symptom, he should take it seriously and immediately consult a doctor. You should not take this lightly and self-medicate.

Stages of development of prostatitis

In the clinical picture of the development of pathology, 3 stages are distinguished.

Prostatic hyperplasia of the 1st degree (compression) is characterized by problems with urination, mainly in the evening and at night. At the same time, the urge to go to the toilet is frequent, and the stream is very sluggish. The duration of the stage can last up to 3 years, while the main symptoms are practically not expressed. At this stage, the tumor responds very well to drug therapy.

The second stage of hyperplasia (subcompensatory) begins with serious disturbances in the functioning of the bladder, when its release poses serious difficulties. The patient feels a constant urge to urinate and spontaneous release of cloudy urine, often mixed with blood. At this stage of the disease, chronic renal failure may develop.

The third stage (decompensation) is the most severe and dangerous, since there is a complete impossibility of emptying the bladder independently. And this is fraught with rupture of its walls.

People suffering from grades 2 and 3 prostatitis have a persistent smell of ammonia from their mouth.

Forms of the disease

Depending on the direction of tumor growth, hyperplasia has several forms:

• subvesical (tumor grows near the rectum). With this form, the patient often experiences discomfort not during urination, but during the act of defecation;
• intravesical (the formation grows in the direction of the bladder). Ingrowth of the prostate into the bottom of the bladder leads to deformation of the neck of the upper urethra;
• prevesical - expansion of the lateral parts of the prostate adjacent to the bladder.

Types of adenoma by growth form

Based on the form of tumor tissue growth, prostate adenoma is classified into 2 types.

Diffuse prostatic hyperplasia is characterized by a uniform increase in the organ during the development of the disease without pronounced foci. Adenomatous prostatic hyperplasia is characterized by the formation of nodules inside the prostate. There can be from one to several depending on the stage and course of the disease.

Prostate hyperplasia - treatment

The treatment regimen is selected by the doctor strictly individually after diagnosis and medical history. Currently, there are 3 methods of treating prostatitis.

1. Drug (conservative) therapy. As a rule, medications are used for mild cases of the disease, as well as for contraindications to surgical interventions.

Specialists have several groups of drugs at their disposal:

• alpha1 - adrenergic blockers help relax smooth muscles and improve the outflow of urine;
• 5-alpha reductase blockers stop the growth of prostate cells, which subsequently leads to normalization of the gland;
• phosphodiesterase blockers - 5 relax the muscles in the urogenital area, which significantly facilitates the outflow of urine;
• herbal preparations contain natural extracts and extracts of medicinal plants (African plum bark, rye, nettle, pumpkin seeds, etc.).

1. Surgical methods of treating prostatitis are indicated in cases where drug therapy does not bring the desired result. The following types of surgical intervention are used:

• Transurethral resection of the prostate is the most commonly used and standard method. A tube with a metal loop and a camera is inserted into the urethra. Under the influence of an electric current, the loop removes the overgrown formation layer by layer;
• Transurethral incision of the prostate is used when the gland is not overgrown. Overgrown tissue is removed between the prostate and the bladder neck;
• Holmium laser enucleation is the most progressive method of treating pathology. A laser is introduced into the urethra, which, under the influence of high power, gradually exfoliates the tissue of a benign tumor;
• open surgery is performed in advanced stages of the disease or in the presence of stones in the bladder. It is carried out through an incision in the bladder and is traumatic, but at the same time guarantees a complete cure.

1. Benign prostatic hyperplasia - treatment with non-operative methods:

• introduction of prostatic stents (coils) into the urethra for long or short periods. Over time, stents must be removed, as untimely removal will worsen symptoms;
• microwave coagulation of the prostate – microwaves heat the prostate tissue to 70 degrees, resulting in its destruction;
• prostate lifting with an implant - this method expands the diameter of the urethra and improves the quality of life for many patients;
• cryodestruction, needle ablation, focused ultrasound, etc. are also performed.

Forecast

If you seek medical help in a timely manner and follow all the recommendations of the attending physician, the prognosis for recovery is very favorable.

Many men put off visiting a doctor for a long time because they are afraid that due to surgical intervention they will have to forget about the pleasures of their sexual life forever.

But this is a common misconception - on average, sexual function is completely restored after a month.

Prevention

In order to stop the disease in the early stages, it is advisable for men to undergo an annual medical examination by a urologist, starting at the age of 40. Since it is impossible to indicate the exact reason why an adenoma develops, all preventive measures are exclusively of a general strengthening nature.

They consist, first of all, of maintaining a proper and balanced diet - less fatty and flour products, and more fiber and protein. It is also necessary to drink a large amount of clean water, and in the evening its intake must be limited.

An active lifestyle and sports help normalize blood circulation in the pelvic organs, which helps prevent stagnation. At the same time, you should be careful about lifting heavy objects and other increased loads.

To create a normal and comfortable psychological environment, stress and other conflict situations should be avoided. But it is better to avoid taking sedatives.

High-quality regular sex will help ensure good sexual function and prostate health. But excesses in bed and promiscuity can negatively affect a man’s health.

If there are problems with the prostate gland, doctors recommend massaging it. It not only has a beneficial effect on sexual activity and the duration of sexual intercourse, but also removes harmful substances and pathogens.

Source: https://smartprost.ru/giperplaziya-predstatelnoj-zhelezy-prichiny-simptomy-i-lechenie/

Benign prostatic hyperplasia

Benign prostatic hyperplasia is the proliferation of glandular tissue and stroma of the transition zone of the prostate, leading to enlargement of the organ. Prostate adenoma can cause urinary disturbances: a weak stream of urine, a feeling of incomplete emptying of the bladder, frequent or nighttime urges, and paradoxical ischuria. Diagnosis is based on PSA levels, TRUS, uroflowmetry and the IPSS Symptom Assessment Questionnaire. Treatment correlates with the volume of the gland, age, concomitant pathology and severity of symptoms: waiting tactics, drug therapy, surgical interventions, including minimally invasive techniques are used.

Benign prostatic hyperplasia (BPH, BPH) is a common worldwide problem affecting one third of men over 50 years of age and 90% of patients who live to 85 years of age. According to statistics, about 30 million men have genitourinary dysfunction associated with BPH, and this figure is increasing every year.

The pathology is more common in African Americans with initially higher testosterone levels, 5-alpha reductase activity, growth factors, and androgen receptor expression (population-specific).

In residents of eastern countries, prostate adenoma is registered less frequently, which is apparently associated with eating a large amount of foods containing phytosterols (rice, soybeans and its derivatives).

Benign prostatic hyperplasia

It is obvious that prostate adenoma is a multifactorial disease. The main factor is changes in hormonal levels associated with natural aging with normal functioning of the testicles.

There are many hypotheses that explain the mechanisms of development of pathology (the theory of stromal-epithelial relationships, stem cells, inflammation, etc.), but most researchers consider the hormonal theory as fundamental.

It is assumed that the age-related predominance of dihydrotestosterone and estradiol stimulate specific receptors in the gland, which trigger cell hyperplasia. Additional background risk factors include:

• Overweight/obesity. The accumulation of fatty tissue, especially in the abdominal area, is one of the indirect causes of prostate enlargement. This is associated with lower testosterone levels in obese men. In addition, with hypoandrogenism, the amount of estrogen increases, which increases the activity of dihydrotestosterone, which promotes hyperplasia.
• Diabetes. High glucose levels and insulin resistance accelerate the progression of BPH. Glucose levels in diabetes are higher not only in the blood, but also in all prostate cells, which stimulates their growth. In addition, diabetes leads to damage to blood vessels, including the prostate gland, which can result in an enlarged prostate. A number of studies show that among men with diabetes and elevated levels of low-density lipoprotein, BPH is detected 4 times more often.
• Nutritional features. Eating a high-fat diet increases the likelihood of prostate hyperplasia by 31%, and daily inclusion of red meat in the diet increases the likelihood of prostate hyperplasia by 38%. The exact role of fatty foods in causing hyperplastic processes is unknown, but it is believed to contribute to the hormonal imbalance associated with BPH.
• Heredity . Genetic predisposition is of some importance: if first-degree male relatives were diagnosed early with prostate adenoma with severe symptoms, the risk of its development in the next generation of men increases.

Testosterone in a man’s body is contained in different concentrations: its level is higher in the blood, and lower in the prostate. In older men, testosterone levels decrease, but dihydrotestosterone levels remain high.

A significant role belongs to the prostate-specific enzyme 5-alpha reductase, thanks to which testosterone is converted into 5-alpha-dihydrotestosterone.

Androgen receptors and DNA of prostate cell nuclei are most sensitive to its action, which stimulate the synthesis of growth factors and inhibit apoptosis (disruption of programmed processes of natural death). As a result, old cells live longer, and new ones actively divide, causing tissue proliferation and adenoma growth.

As it progresses, morphological changes in the bladder wall appear: some muscle fibers are replaced by connective tissue. The capacity of the organ gradually increases, and the walls become thinner.

The mucous membrane also undergoes changes: hyperemia, trabecular hypertrophy and diverticula, erosive ulcerations and necrosis are typical. When a secondary infection occurs, cystitis develops.

Benign prostatic hyperplasia and stagnation of urine lead to reverse flow of urine, cystolithiasis, hydronephrotic transformation of the kidneys and chronic renal failure.

In andrology, several classifications of BPH are accepted. Depending on the volume of the gland (it is determined using ultrasound and measured in cubic centimeters), small (up to 25 cm³), medium (26-80 cm³), large (more than 80 cm³) and giant adenoma (over 250 cm³) are distinguished. Guyon's classification identifies three clinical stages of BPH:

• Compensation . Dysuric phenomena are absent or mildly expressed, there is no residual urine. Bladder, kidneys without visible signs of pathology.
• Subcompensation . Clinical phenomena are more pronounced, which is caused by the progression of the disease. Residual urine is determined. The upper urinary tract is modified, which is manifested by a violation of the functional ability of the kidneys.
• Decompensation. The functions of the bladder are impaired, there is paradoxical ischuria, severe ureterohydronephrosis, and the addition of chronic renal failure.

Symptoms depend on the degree of urethral obstruction.

If an enlarged prostate compresses the urethra, there are complaints of frequent urination in small portions, especially at night, a sluggish stream, a feeling of incomplete emptying, regardless of the frequency of urination.

As the adenomatous nodes grow, the innervation changes, resulting in urgency - an uncontrollable desire to urinate, followed by urinary incontinence.

At an advanced stage, paradoxical ischuria develops - the inability to completely urinate with the simultaneous leakage of urine drop by drop, which is associated with atony of the walls of the bladder, as well as with detrusor-sphincter dyssynergia - the lack of synchronous work between the muscle responsible for the expulsion of urine and relaxation of the sphincter of the urethra. To empty the bladder, some men are forced to urinate the female way - while sitting. Clinical manifestations of benign prostatic hyperplasia are non-pathognomonic and can accompany any obstruction, including urethral stricture, diverticulum, tumor, etc., therefore, it is impossible to establish a diagnosis based on symptom assessment alone.

Upon digital examination, the prostate is enlarged, homogeneous, painless, its consistency is elastic, the median groove is smoothed.

Prostate biopsy is not routine and is only indicated if prostate cancer is suspected. A patient with suspected renal dysfunction needs to consult a nephrologist.

There is a special questionnaire designed to assess the severity of symptoms of lower urinary tract obstruction. The questionnaire consists of 7 questions related to common symptoms of benign prostatic hyperplasia. The frequency of each symptom is rated on a scale from 1 to 5.

When summed, an overall score is obtained, which influences further treatment tactics (follow-up observation, conservative therapy or surgery): from 0-7 - mild symptoms, 8-19 - moderate, 20-35 - serious problem with urination.

Instrumental and laboratory diagnostics for BPH include:

• Ultrasound. TRUS and transabdominal ultrasound of the prostate and bladder are complementary imaging modalities. Ultrasound examination is performed twice - with a full bladder and after urination, which allows you to determine the amount of residual urine. Asymmetry, density, heterogeneity of structure, increased blood supply to the prostate indicate an adenoma.
• Radiography . With X-ray diagnostics (excretory urography, cystography), it is possible not only to determine the size of the prostate, but also to evaluate kidney function, developmental anomalies, and diagnose pathologies of the bladder and urethra. The study involves intravenous administration of a contrast agent.
• Urodynamic studies . Uroflowmetry is a simple test to assess urine flow, graphically showing the rate of bladder emptying and the degree of obstruction. The study is performed to determine indications for surgical treatment and monitor dynamics during conservative therapy.
• PSA study. Prostate-specific antigen is produced by the cells of the organ capsule and periurethral glands. In patients with benign prostatic hyperplasia and prostatitis, PSA levels are elevated. The result is influenced by many factors, so a diagnosis cannot be made using one analysis.
• Urine tests . In men with prostate adenoma, concomitant inflammation of the bladder and kidneys is often diagnosed, so the OAM pays attention to signs of inflammation - leukocyturia, proteinuria, bacteriuria. Blood in the urine may indicate varicose changes in the vessels of the bladder neck, their rupture when straining. When changes occur, urine is cultured on nutrient media to clarify the composition of the microbial flora and sensitivity to antibiotics.

Differential diagnosis is carried out with a tumor process of the bladder or prostate, cystolithiasis, trauma, interstitial and post-radiation cystitis, neurogenic bladder, urethral stricture, prostate sclerosis, meatostenosis, urethral valves, phimosis, prostatitis.

CT scan of the pelvis. Benign hyperplasia of prostate tissue (prostate adenoma).

Therapy for prostate adenoma correlates with the severity of obstructive symptoms and complications; the choice of treatment tactics is influenced by the patient’s age and concomitant pathology. All existing treatment methods are aimed at restoring adequate urine diversion. Treatment options include:

• Watchful waiting. This strategy is used in men with mild symptoms ≤7 on the IPSS scale and in patients with an IPSS score ≤8 whose symptoms are not considered to impair quality of life in the absence of complications. Once a year, such patients undergo TRUS, PSA test, and digital examination. Drug therapy is not indicated, as it does not lead to improvement in well-being and has large risks that can significantly affect the quality of life (for example, erectile dysfunction during treatment with alpha-blockers).
• Drug therapy . With the advent of alpha-blockers, many patients with prostatic hyperplasia have the opportunity to avoid surgery. The drugs relax the muscles in the prostate, urethra and bladder neck, which increases the strength of the urine stream. Drug therapy is carried out in patients with severe, moderate and severe urinary disorders of 8 points and above. 5-alphareductase inhibitors are prescribed to prevent progression of symptoms of urinary obstruction. According to indications, combination therapy is possible. The inclusion of 5-phosphodiesterase inhibitors in the regimen improves urine output and has a positive effect on erectile function.
• Surgical treatment . There are several options for surgical interventions: adenomectomy, which is a radical operation (can be performed either open or laparoscopic) and transurethral resection of the prostate gland. Each operation has its own indications, advantages and disadvantages. In case of severe concomitant pathology, when the likelihood of an unfavorable outcome is high, epicystostomy is performed as a palliative measure. After normalization of the condition, it is possible to resolve the issue of removing the drainage and restoring independent urination.
• Minimally invasive therapy . There are a number of techniques available to avoid the adverse effects associated with TURP and adenomectomy. These include laser destruction (vaporization, coagulation) by contact or non-contact method, needle ablation, electroincision, transurethral microwave therapy (microwave energy), radiofrequency water thermotherapy, etc. A large volume of the prostate gland is a contraindication to minimally invasive treatment methods.

The prognosis for life is favorable; for most patients, long-term (lifelong) use of modern medications is sufficient to normalize urinary function. The need for surgery occurs only in 15-20% of men.

After adenomectomy, the recurrence of the disease does not exceed 5%; minimally invasive techniques do not provide a 100% guarantee of healing and can be performed repeatedly. The improvement of the prognosis in the last decade has been facilitated by the introduction of minimally invasive treatment methods, which allows minimizing complications that threaten the lives of patients.

To normalize erectile function, a consultation with an andrologist-sexologist is necessary. 

Source: https://www.KrasotaiMedicina.ru/diseases/zabolevanija_andrology/BPH

Prostatic hyperplasia: what is it and how to treat it

After 45 years, a gradual change in hormonal balance begins in the male body.

An age-related decrease in the amount of androgens leads to excessive cell growth in the prostate and a subsequent increase in organ volume.

In this case, the patient is diagnosed with “prostatic hyperplasia” (before the introduction of the International Classification of Diseases, the name “prostate adenoma” was used).

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Reasons for the development of the disease

The main factor provoking the appearance of prostate hyperplasia is considered to be age-related metabolic disorders. As a result, prostate cells live longer and divide more times during their life cycle. Thus, there is a gradual proliferation of glandular tissues and an increase in the size of the organ.

According to medical statistics, a benign prostate tumor is diagnosed in almost half of men aged 50-60 years. In older age groups, the risk of detecting the disease increases: by 75-80 years, the probability of detecting pathology is 90%.

Additional causes of hyperplasia: excess weight, lack of physical activity, unbalanced diet, chronic inflammatory processes.

Benign prostatic hyperplasia: main symptoms

The prostate is located under the bladder, with its lobes surrounding the urethra. The initial stage of development of the disease is practically asymptomatic, but with further growth of the organ, additional pressure is created on the neck of the bladder, causing dysuric disorders.

In medical practice, it is customary to divide the signs of BPH into two groups:

• Obstructive symptoms include difficulty urinating, which becomes intermittent and longer. To completely empty the bladder, you have to additionally strain the pelvic muscles, and the urine stream becomes thin and sluggish.
• Irritative symptoms in later stages of BPH are manifested by functional disorders of the neuromuscular apparatus of the bladder. The patient experiences a frequent urge to urinate, regardless of the amount of urine collected, and feels heaviness and pain in the lower abdomen.

Types of BPH

There are two main classifications of prostate hyperplasia: according to the location and composition of the cells that form the tumor. Based on the type of localization, the following types of BPH are distinguished:

Type of hyperplasia	Location
Intravesical	Intravesical growth of a benign prostate tumor occurs upward, towards the bladder neck. Subsequently, prostate tissue may partially penetrate into its cavity, causing serious disturbances in the outflow of urine.
Prevesical	In this case, the tumor forms in front of the bladder. This location of the tumor does not affect the outflow of urine, and therefore the disease is practically asymptomatic.
Subvesical	The lateral lobes of the prostate gland do not change in size, tissue growth occurs towards the rectum. In the later stages of this type of BPH, dysfunction of the upper urinary tract may occur.

Depending on the tissues in which pathological processes occur, the following types of adenoma are distinguished:

• Glandular or nodular prostatic hyperplasia is formed from secretory cells. Initially, single adenomatous nodules appear in the tissues, subsequently their size and number increase.
• Fibrous or glandular-stromal hyperplasia of the prostate gland is formed from cells of glandular and connective tissues. In the absence of timely treatment, cystic cavities may appear in the prostate, which can degenerate into malignant neoplasms.
• Muscular or diffuse prostatic hyperplasia is formed from smooth muscle epithelium.

Stages of prostatic hyperplasia

The development of pathology is conventionally divided into three stages: compensated, subcompensated and decompensated. Determining the stage of the disease is mandatory when making a diagnosis, since the choice of treatment method and the prognosis for the patient depend on this.

First stage of the disease

BPH of the 1st degree lasts from 1 to 5 or more years and is manifested by minor urination problems. The first sign indicating diffuse changes in the prostate is an increase in nighttime urges up to 3-4 times. An increase in the size of the gland leads to a narrowing of the lumen of the urethra; therefore, emptying the bladder may occur with delays and interruptions.

At the first stage, there are no noticeable changes in the structure and functioning of the organs of the urinary system.

Second stage of hyperplasia

The subcompensated stage is characterized by significant disturbances in the urination process. To completely empty, you need to additionally strain the muscles of the pelvic floor and abdomen.

Constant pressure on the walls of the bladder causes stretching and loss of tone of the muscle fibers and the formation of diverticula - bulging and sagging pouches.

Subsequently, urine begins to accumulate in the diverticula, which is not excreted during urination.

Stage 2 prostate hypertrophy provokes kidney dysfunction, which is manifested by thirst and the smell of acetone from the mouth. The course of the disease can occur in waves: alcohol consumption, hypothermia, and stressful situations cause short-term exacerbations with deterioration in well-being.

Third stage of the disease

At the last stage of the disease, the volume of residual urine increases to 1 liter. The smooth muscles of the bladder almost completely lose their ability to contract.

During periods of exacerbation, the patient may develop acute urinary retention. At the same time, ammonia contained in urine inhibits the metabolism of amino acids and negatively affects the functioning of the brain and nervous system.

The absence of urine outflow for a long time leads to general poisoning of the body, followed by death.

Diagnostic methods

When contacting a urologist, the patient is prescribed a comprehensive examination to make an accurate diagnosis, identifying the stage and type of BPH. The list of required studies includes:

• palpation;
• uroflowmetry (measurement of jet pressure);
• Ultrasound (characteristic echo signs of BPH: heterogeneous tissue structure, irregular shape and lack of clear outlines of the organ);
• cystomanometry (measurement of urine pressure).

Patients with a predisposition to cancer require additional differential diagnosis to exclude the presence of cancer.

What is bacterial prostatitis

Prostatic hyperplasia: code according to ICD-10

In the International Classification of Diseases, adenoma is included in the section of diseases of the genitourinary system called BPH (ICD-10 code - No. 40).

The reference book describes in detail the standards for the treatment of BPH, provides clinical recommendations, and lists the groups and names of drugs recommended for use.

Treatment of prostatic hyperplasia

After a man is diagnosed with BPH, the attending physician selects the most appropriate treatment method. In urology, several effective techniques have been developed and successfully used that make it possible to avoid surgical intervention even in the later stages of adenoma.

Patient monitoring

When diagnosing the initial stage of the disease, the patient may be recommended periodic examinations and monitoring of the condition without drug treatment. Correcting your diet and lifestyle, and agreeing with your doctor on the use of medications often leads to reversible processes.

Drug therapy

In cases where prostatic hyperplasia was detected at the first stage, the patient is prescribed drug therapy. The course of treatment includes taking two main groups of drugs:

• Alpha-blockers help eliminate urinary disorders: they reduce the number of urges, increase the lumen of the urethra and ensure complete elimination of fluid. Medicines in this group include Omnic, Adenoprost, Urocard, Artezin.
• The action of 5-alpha reductase inhibitors is aimed at blocking enzymes that promote uncontrolled cell division. Long-term use of drugs helps slow tumor growth, and in some cases, reduce its size. Patients are usually prescribed Finasteride or Dutasteride.

If necessary, in addition to basic medications, antibiotics and herbal medicines are introduced into the course. Folk remedies can be used as maintenance therapy.

Natural remedy for PREVENTION and RIDAL OF PROSTATITIS “Predstanol”. Its effective composition has anti-inflammatory, antimicrobial and soothing effects. Thanks to extracts of sabal palm fruit and pygeum bark, blood circulation is improved and cell regeneration is enhanced. Predstanol is absolutely safe, has no side effects and helps enhance the effectiveness of drug treatment.

TOUR

If, after reviewing the medical history and deciphering the research results, the attending physician determines the second stage of the development of the pathology, the patient may be recommended surgical intervention. Modern medicine offers minimally invasive methods for removing tumors. The most effective is transurethral resection.

The procedure involves inserting a special instrument through the urethra. Using a loop located at the end of the instrument, parts of the adenoma are sequentially cut off until the tumor is completely removed.

TUR of the bladder is contraindicated if there is a risk of hyperplasia degenerating into a malignant tumor.

Open adenomectomy

At the last stage, when treating BPH with other methods is ineffective, adenomectomy is performed. The operation involves opening the abdominal cavity and completely removing the prostate.

Prevention

To preserve men's health, you should give up bad habits, avoid hypothermia, review your diet (if possible, exclude fatty foods, limit the consumption of spices, baked goods, strong tea and coffee). Regular sex life will help normalize the balance of hormones.

After reaching 50-55 years of age, it is recommended to undergo annual examinations with a specialist. After 60 years, you need to visit a urologist twice a year.

Timely detection of prostate hyperplasia will slow down the progression of the disease and improve the quality of life without the use of surgical intervention.

Source: https://men-zdrav.ru/bolezni-prostaty/giperplaziya-predstatelnoj-zhelezy.html