Pathology in the life of every man

Benign Prostatic hyperplasia is a disease that occurs mainly in men of mature age. After 60 years, it is observed in 50% of the male population, and after 75 years this figure rises to 70%. At this stage of modern medicine, it is effectively treated with the method of transurental resection.

Reasons

Age-related hormonal disorder is considered the main cause of the disease. The testes secrete the hormone testosterone, which is converted to dihydrotestosterone in the prostate. Over the years, this hormone leads to the growth of the gland, which in turn causes an imbalance between the maturation of cells and their death. Therefore, men with normal functioning of the prostate gland are not immune from this pathology. The occurrence of hyperplasia does not depend on the presence of bad habits, sexual preferences and inflammatory diseases of the reproductive system.

It is possible to identify such risk factors in which the possibility of an early manifestation of the disease increases:

• overweight;
• food abuse in fast food establishments;
• diseases such as hypertension, diabetes mellitus;
• increased estrogen relative to testosterone.

The risk of urban urbanization and environmental threats is not excluded, but has not yet been fully understood.

Initially, a tumor forms in the tissues of the gland in the form of a seal, which gradually grows and squeezes the tissue. This symptom begins to appear after forty years and affects the urethra and bladder. Benign lesions develop slowly with no metastases. Oncomarker of prostate specific antigen (PSA) of normal values.

Urology specialists clarify that the diagnosis of BPH is established only if there are difficulties with urination, which arise due to muscle hypertonicity and compression of the canal. The blood circulation in the bladder deteriorates and this negatively affects its contractility.

Symptoms of various stages of DHP

In some patients, the clinical picture is absent, and its manifestation is found already with complications of hyperplasia. Each stage of the disease has its own symptoms.

With BPH stage 1, the bladder is not very susceptible to changes, therefore, urination problems are at the initial stage (weakness of the stream and frequent nighttime urge to urinate). The organ is palpated without pain, although it is slightly enlarged. The duration of the compensated stage is from one to three years.

At stage 2 (subcompensated), the clinical picture deteriorates sharply:

• there is pain during urination;
• incontinence (urinary incontinence), often at night;
• feeling of not fully emptied bladder (weakness and intermittent flow);
• harsh and frequent urge to urinate;
• bloody discharge in cloudy urine;
• manifestations of renal failure;
• inflammatory urinary tract infections;
• long urinary retention is sometimes observed.

With decompensated stage 3 adenoma, an almost complete blockage of the urinary tract occurs:

• cloudy urine is excreted in drops with blood;
• body smells like urine;
• state of anemia;
• weight loss and general weakness;
• renal failure develops;
• problems with deification.

Diagnostics

If any of the symptoms described above manifest, it is necessary to make an appointment with a doctor as soon as possible. Men over 50 are annually diagnosed with BPH in consultation with a urologist for the early detection of pathology, and its treatment in the early stages without surgery.

According to the WHO protocols, BPH can be diagnosed only after the necessary examinations of the patient's gland:

Treatment methods

The choice of the direction of treatment depends on the stage of the disease. The adenoma does not necessarily progress, but its symptoms should not be left untreated either. It is known that 30% of men suffer from complications, 40% of the symptoms remain at the same level and only 30% of them disappear over time. If treatment is refused, up to 30% of patients are at risk of surgery. There are 3 methods:

Dynamic Surveillance

In case of weak manifestations of the clinical picture and the absence of complications in urology, it is possible to prescribe treatment at home (dynamic observation). In this case, it is necessary to strictly follow the doctor's prescriptions, measure the rate of urine outflow, and take all prescribed medications. Medicines for sinusitis and tranquilizers, which worsen the general condition and affect the manifestation of symptoms, are subject to an exception.

Also, if possible, reduce your caffeine and alcohol intake, especially before bedtime.Try to avoid colds, as medications contain components that reduce swelling, which leads to hypertonicity of the bladder muscles.

Medication

This method of treatment is prescribed in the absence of indications for surgery and its purpose is to localize inflammatory processes, improve blood circulation in the organ and outflow of urine.

Initially, antibiotics are prescribed to remove bacterial infection and medicines with extracts of the prostate gland of animals to improve blood circulation of the organ and reduce its size. Then, in the treatment of prostatic hyperplasia, adrenergic blockers are used.

The principle of alpha blockers is the blocking of alpha receptors, which reduce the tone of smooth muscle cells in the bladder. They help to improve the outflow of urine and eliminate various signs of the disease. Because these drugs were developed to treat high blood pressure, they have side effects such as dizziness when pressure drops.

The treatment will be positive if the residual urine volume is 300 ml or more. The effect of the treatment is long lasting.

The enzyme 5-alpha reductase promotes the conversion of testosterone to the active hormone dihydrotestosterone, and the inhibitor finasteride prevents this. When taken, the size of the organ decreases, and the rate of urine outflow increases. To relieve symptoms, take it for about six months. In 4 years, the need for a surgical method of treatment is reduced by 50%. Adverse reactions: decrease in PSA level and ejaculate volume by half, impotence - 3-4%; breast growth - 0.4%.

To maintain immunity and the general condition of the body, it is recommended to drink vitamins, undergo a complex of physiotherapy procedures, sufficient physical activity, and treatment of concomitant diseases.

Surgery

One of the main urological procedures is surgery. During it, part of the inner tissue is removed, and not completely the gland.

Indications for surgery:

• diagnoses such as urolithiasis, renal failure;
• recurrent urinary tract infections;
• too much residual urine;
• long urinary retention, even after catheter insertion;
• unsuccessful drug therapy.

Contraindications to surgery:

• diseases of the cardiovascular system; Doctor's recommendations
• renal failure;
• pathological enlargement of the aortic area (aneurysm);
• acute cystitis, pyelonephritis;
• damage to the vessels of the brain (atherosclerosis).

The most effective operation is considered to be transurethral resection (transurethral incision and transurethral vaporization). It is performed with a resectoscope by introducing it through the urethra into the bladder. With the help of a loop, which serves as a conductor of electric current, the tissue of the gland is removed. A catheter is inserted for several days. Discharge home is possible in 3 days. Recovery occurs within three weeks. Improvement of well-being occurs in 80% of patients with moderate symptoms and more than 90% in severe disorders.

Possible complications:

• mortality - less than 0.25%;
• decrease in potency - 5%;
• incontinence - 2-4%;
• heavy bleeding - 7%;
• narrowing of the urethra - 5%;
• additional surgery in the next five years - 10%;
• retrograde ejaculation - 65%.

When making an incision, the loop is replaced by a knife and the prostate is dissected, which reduces the pressure. A small piece of tissue (less than 30 g) is removed.

During vaporization, the resectoscope is inserted into the urethra and a powerful electrical effect is exerted on the tissue. The positive aspects of such an operation are minor bleeding, short wearing of a catheter and a fairly low cost.

For large sizes (over 70 g), TURP is not suitable, therefore, open prostatectomy is used. A transverse incision is made in the lower abdomen to open the bladder and prostate. The capsule of the sex gland is cut, and sometimes the bladder itself, and the hyperplasia or prostate is removed. 2 catheters are used: the first is inserted through the urethra into the bladder, the second is inserted there through the lower abdomen (4-5 days). It is more laborious than the first operation, but complications arise only in some patients.

Laparoscopy is characterized by a small incision in the lower abdomen and the use of an ultrasonic knife as a tool. In laser prostatectomy, laser waves of different lengths are used instead of a scalpel.

Radio waves are also used to cauterize unnecessary tissue. Transurental needle ablation is performed without hospitalization and does not require a catheter to be worn.

Prostatic hyperplasia can also be treated with prostatic stents, flexible devices inserted into the urethra to improve urine waste.Like the previous method, it is performed without hospitalization under local anesthesia.

The disadvantages are the short-term result due to the displacement of the stent, as well as the impossibility of their long-term use due to the resulting irritation. This treatment is often used for people who are bedridden.

It is impossible to prevent such a disease, even if you take medications in advance. But compliance with the most important rules for the prevention of diseases of the genitourinary system and maintaining a rational lifestyle will reduce the risks of early onset of this pathology.