Ultrasound of the prostate gland signs of BPH

BPH what is it? Symptoms, treatment of benign prostatic hyperplasia

In modern medicine, abbreviations are often used that are not entirely clear to an ordinary person without honey. education. One of these obscure abbreviations is BPH. What it is? Speaking in the language of doctors, this is benign prostatic hyperplasia. But among the people it is called more simply - Prostate adenoma ( a variant of prostate adenoma is possible). Often, prostate adenoma is confused with a disease such as prostatitis. BPH is a benign formation, and it grows not without the participation of the stromal component of the prostate (in other words, the glandular epithelium), and prostatitis is nothing more than inflammation of the prostate gland. Do not confuse them.

BPH. What it is? Statistics

As mentioned above, BPH is a benign neoplasm. With it, small nodules form in the prostate (abbreviated name of the very prostate gland), which, as they grow, more and more compress the urethra.

Because of this, a man develops urination disorders. This disease has a benign growth, and this is what distinguishes BPH from cancer.

BPH is one of the most common diseases in urology today. According to statistics, it appears in almost 80 percent of men in old age. In 20 percent of cases, instead of BPH, there is atrophy of the gland or its increase.

BPH disease most often develops in men over 45 years old.

More than half of men from 40 to 50 years old turn to a specialist with this ailment, and only in rare cases can the disease overtake the young.

Causes of BPH development

To date, the exact causes of the development of BPH in the prostate gland cannot be specified, since they simply have not been fully elucidated. It is believed that the disease is one of the signs of menopause in men.

The only risk factors are the level of androgens in the blood and the person's age.

Usually, as a man ages, the balance between estrogens and androgens is gradually disturbed, which causes a violation of control over the growth and function of gland cells.

It is known that there is no connection between BPH of the prostate and a person's sexual activity, orientation, bad habits, sexually transmitted and inflammatory diseases, and none of the above has any effect on the onset of the disease.

BPH of the prostate gland most often appears in its central part, but sometimes it can also capture the lateral lobes. The growth of benign hyperplasia depends on the adenomatous growth (tumor) of the paraurethral glands. As a result, the gland's own tissue is displaced outward, and a capsule is formed around the growing adenoma.

Hyperplastic (that is, affected by a tumor) cells of the prostate tissue also tend to grow both towards the rectum and the bladder, and this causes the internal opening of the bladder to shift upwards and lengthen the back of the urethra.

There are several forms of hyperplasia according to the type of its growth:

• Subvesical form of BPH. What it is? In this disease, the tumor grows towards the rectum.
• Intravesical form of BPH. The case history is characterized by the growth of the tumor to the bladder.
• Retrotrigonal form of BPH. The tumor in this case is located directly under the triangle of the human bladder

Quite often, several forms of BPH can be seen in one person at the same time. This happens when the tumor grows in several directions at once.

BPH: symptoms

The signs of this disease directly depend on the location of the tumor, on its growth rate and size, as well as the degree of dysfunction of the bladder.

BPH of the prostate can be divided into three stages:

Compensated, or the first stage. This form of the disease is manifested by delays in the onset of urination (frequent urge to empty, especially at night, is a concomitant symptom). With BPH 1 degree, the prostate gland increases in size, has a dense elastic consistency. Its boundaries are clearly delineated, and in general, palpation of the gland (and its median sulcus) is painless. At this stage of the disease, the bladder is still completely emptied, and there is no residual urine at all. Grade 1 BPH can last from one to three years. Subcompensated, or second stage. As the tumor develops, it compresses the urethra more and more, and the bladder is no longer able to function normally and empty completely (its walls thicken). As a result, with grade 2 BPH, Residual urine appears, due to which the patient feels incomplete emptying of the bladder.Due to squeezing of the urethra, patients urinate in small portions, and after a while, urine begins to be excreted involuntarily (the reason for this is an overflowing bladder). Grade 2 BPH is sometimes accompanied by symptoms of chronic renal failure (developing against its background). Decompensated, or the third stage. The bladder is greatly distended due to residual urine, the urethra is still compressed, and urine is excreted literally drop by drop, sometimes even with an admixture of blood. At this stage, BPH leads to impaired kidney function (renal failure). There is also weakness, severe weight loss, poor appetite, constipation, anemia, dry mouth. Diagnosis of the disease The basis for diagnosis is the characteristic complaints of men, for which a special scale for assessing the symptoms of prostate adenoma (in English I-PSS) has been created. Basically, the diagnosis of BPH is made after a clinical examination of the patient, as well as such research methods:

BPH treatment

At the moment, there are many ways to treat the disease, each of which is highly effective at different stages of BPH. Treatment of this disease can be divided into three parts:

• Medical treatment
• Surgical treatment
• Other non-surgical treatments

Drug treatment is usually given at the first sign of BPH.

In the first stages of BPH of the prostate, treatment is aimed at reducing the growth rate of hyperplastic prostate tissue, improving blood circulation in nearby organs, reducing inflammation of the prostate and bladder, eliminating urinary stasis, eliminating constipation, and facilitating urination.

In addition to the use of medicines, the patient is advised to follow a mobile lifestyle, give up alcohol and harmful (too fatty, spicy, spicy) food, smoking.

It is also worth reducing fluid intake in the afternoon, especially before bedtime.

In the presence of clinical and laboratory signs of androgen deficiency, androgen replacement therapy is also prescribed.

Often, in parallel with the treatment of hyperplasia, its complications are treated - cystitis, prostatitis or pyelonephritis.

Sometimes (against the background of hypothermia or drinking alcohol), the patient may develop acute urinary retention. In this case, the patient needs to be urgently hospitalized and undergo a bladder catheterization.

Let's take a closer look at each type of treatment.

Drug treatment

Two types of drugs are most commonly used to treat BPH:

• Alpha-1 blockers (eg, tamsulosin, doxazosin, or terazosin). Their action is aimed at relaxing the smooth muscles of the prostate and bladder neck, which leads to easier passage of urine. The action of these drugs can be prolonged or short.
• 5-alpha reductase inhibitors (blockers) (permixon, dutasteride, or finasteride). These drugs prevent dihydrotestosterone (the biologically active form of testosterone) from being formed in the body of a sick person, due to which the prostate gland shrinks.

Surgical treatment

In especially severe cases, one Drug treatment is not enough, and, as a rule, one has to resort to surgical intervention. This can be excision of hyperplastic tissue (adenomectomy) or total resection of the prostate gland (prostatectomy).

There are two types of surgical intervention:

• Open surgery (transvesical adenomectomy). With this intervention, access to the tissue of the gland is obtained through the wall of the bladder. This type is the most traumatic, and is used only in advanced cases. Open surgery provides a complete cure for BPH.
• Minimally invasive surgery (in which there is little to no surgical intervention). They are performed using modern video endoscopic technology, without incision. Access to the prostate through the urethra.

There is another type of surgical intervention that cannot be compared with the above. Prostate artery embolization is an operation that is performed by endovascular surgeons (the above are performed by urologists) and consists in blocking the arteries of the prostate with small particles of a special medical polymer (through the femoral artery). Hospitalization is not required, the operation is performed under local anesthesia and is not traumatic.

After any type of surgery, there is a small risk of complications such as urinary incontinence, impotence or urethral stricture.

Non-surgical treatments

Non-surgical methods of treatment include the following:

Transurethral needle ablation;

Treatment with high intensity focused ultrasound;

Prostate microwave coagulation method or thermotherapy;

Introduction of prostatic stents into the area of narrowing;

Balloon dilatation of the prostate.

Postoperative period

Alas, at some stages of the disease, surgery is simply necessary. BPH is a serious disease, and even after surgery, you need to follow some rules in order to finally get rid of the disease and not provoke a reappearance. The three main points that you must follow after the operation are the correct diet, a healthy lifestyle and regular visits to the doctor.

The diet in the postoperative period is extremely important for the patient, as it can significantly contribute to a speedy recovery. The diet after the operation completely excludes fatty foods, spices, salty and spicy foods and, of course, alcohol. It is recommended to eat low-fat foods rich in fiber.

As for work, if your profession does not involve frequent physical activity, then you can return to the workplace a couple of weeks after the operation. When sedentary work, it is recommended to do a warm-up every half an hour. A sedentary lifestyle can contribute to stagnation of blood in the organs, from which the disease only worsens. For the first few days after the operation, do not even think about lifting weights!

Give up smoking at least in the postoperative period (two weeks after surgery), if you can not quit the addiction completely. Nicotine damages the walls of blood vessels, and this affects the blood circulation of the prostate, as a result of which an inflammatory process may occur.

Many people think that after removing BPH, you should forget about sexual activity forever. This opinion is erroneous, and the sexual function of a man is completely restored after a while. However, it is worth resuming sexual relations no earlier than 4 weeks after the operation.

Another piece of advice worth paying attention to: you can't drive a car until a month after BPH removal.

In general, the postoperative period lasts about a month, after which the patient can already return to normal life. However, experts strongly recommend leading a healthy lifestyle to prevent the recurrence of the disease.

Urination after surgery

Almost immediately after the operation, the urine stream becomes stronger, and the emptying of the bladder is easier. After the catheter is removed, pain may occur during urination for some time, the reason for this is the passage of urine through the surgical wound.

Specialists do not exclude the occurrence of urinary incontinence or urgent urge to urinate in the postoperative period, these phenomena are completely normal. The more your symptoms bothered you during your illness, the longer your recovery period will be. Over time, all problems will disappear and you will return to the normal rhythm of life.

Some time after the intervention, there may be blood clots in the urine. This phenomenon is associated with wound healing. It is recommended to drink as much liquid as possible to properly flush the bladder. But with severe bleeding, you should immediately contact a specialist.

Prolonged urinary retention (if BPH is not treated) can eventually lead to urolithiasis, in which stones form in the bladder, and later infection. In this case, the most serious complication that a patient can expect without proper treatment is pyelonephritis. This ailment further exacerbates kidney failure.

In addition, prostate adenoma can give rise to malignant growth - prostate cancer.

The prognosis for adequate and timely treatment of the disease is very favorable.

Disease prevention

The best prevention of BPH is regular monitoring by specialists and timely treatment of prostatitis.

It is also worth eating right (reduce the amount of fried, salty foods, as well as spicy, spicy and smoked foods), stop smoking and alcoholic beverages. In general, a healthy lifestyle significantly reduces the risk of BPH.

So now you know what BPH is. The signs of this disease, treatment, postoperative period and even prevention are described in detail above.

In any case, this knowledge will be useful to you. Stay healthy!

Benign prostatic hyperplasia

Benign prostatic hyperplasia - growth of glandular tissue and stroma of the transitional zone of the prostate, leading to an increase in the organ.Prostate adenoma can cause urinary disorders: a weak stream of urine, a feeling of incomplete emptying of the bladder, frequent or nocturnal urges, paradoxical ischuria. Diagnosis is based on PSA, TRUS, uroflowmetry, and the IPSS Symptom Assessment Questionnaire. Treatment correlates with the volume of the gland, age, comorbidity and severity of symptoms: waiting tactics, drug therapy, surgical interventions, including minimally invasive techniques are used.

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH, BPH, BPH) is a common worldwide problem that affects one third of men over 50 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 (a population trait). In Eastern countries, prostate adenoma is registered less frequently, which, apparently, is associated with the consumption of a large amount of food containing phytosterols (rice, soy and its derivatives).

BPH Causes

It is obvious that prostate adenoma is a multifactorial disease. The main factor is a change in the hormonal background associated with natural aging with the normal functioning of the testicles. There are many hypotheses explaining the mechanisms of pathology development (the theory of stromal-epithelial relationships, stem cells, inflammation, etc.), however, most researchers consider the hormonal theory as fundamental. It is assumed that the age 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 adipose tissue, especially in the abdomen, is one of the indirect causes of prostate enlargement. This is due to lower testosterone levels in obese men. In addition, with hypoandrogenism, the amount of estrogens increases, which increases the activity of dihydrotestosterone, which promotes hyperplasia.
• Diabetes. High glucose levels and insulin resistance accelerate the progression of BPH. The level of glucose in diabetes is higher not only in the blood, but also in all cells of the prostate, 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.
• Features of nutrition. Eating a diet high in fat increases the likelihood of prostatic hyperplasia by 31%, and the daily inclusion of red meat in the diet by 38%. The exact role of fatty foods in the occurrence of hyperplastic processes is unknown, presumably, they contribute to the hormonal imbalance associated with BPH.
• Heredity. Genetic predisposition is of some importance: if first-line male relatives were diagnosed early with BPH with severe symptoms, the risk of its development in the next generation of men increases.

Testosterone in the body of a man is contained in various concentrations: in the blood, its level is higher, in the prostate - less. In older men, there is a decrease in testosterone levels, but the level of dihydrotestosterone remains high. A significant role belongs to the prostate-specific enzyme 5-alpha reductase, due 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 (violation of programmed processes of natural death). As a result, old cells live longer, and new cells actively divide, causing tissue proliferation and adenoma growth.

An enlarged prostate contributes to difficulty urinating against the background of a narrowing of the prostatic part of the urethra (especially if the growth of the adenoma is directed inside the bladder) and an increase in the tone of the smooth muscle fibers of the stroma. At the initial stage of the pathology, the condition is compensated by the increased work of the detrusor, which, by straining, allows the urine to be evacuated completely. As the progression progresses, morphological changes in the bladder wall appear: part of the muscle fibers is 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 ulceration and necrosis are typical. When a secondary infection is attached, cystitis develops.Benign prostatic hyperplasia and urinary stasis lead to backflow of urine, cystolithiasis, hydronephrotic transformation of the kidneys and CRF.

Classification

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 cms), medium (26-80 cms), large (more than 80 cms) and giant adenoma (over 250 cms) are distinguished. Guyon's classification distinguishes three clinical stages of BPH:

• Compensation. Dysuric phenomena are absent or slightly 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, chronic renal failure.

Symptoms of BPH

Symptoms depend on the degree of urethral obstruction. If the 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 urgent urges - an uncontrollable desire to urinate, followed by urinary incontinence.

At the advanced stage, paradoxical ischuria develops - the inability to completely urinate with simultaneous leakage of urine drop by drop, which is associated with atony of the walls of the bladder, as well as with detrusor-sphincter dyssynergy - the lack of synchronous work between the muscle responsible for the expulsion of urine and the relaxation of the sphincter urethra. To empty the bladder, some men are forced to urinate in the female pattern - sitting. Clinical manifestations of benign prostatic hyperplasia are non-pathognomonic and can accompany any obstruction, including urethral stricture, diverticulum, tumor, etc., so it is not possible to establish a diagnosis based on symptoms alone.

Complications

Complications of a hyperplastic prostate can include a number of conditions. Against the background of BPH, acute urinary retention is manifested in 35% of cases. Residual urine tends to crystallize, in which case calculi with secondary inflammation form in the bladder. Increased intravesical pressure contributes to the formation of vesicoureteral refluxes, hydronephrosis and chronic renal failure. If we consider the complications of the treatment of prostate adenoma, then there is a possibility of developing urethral strictures after transurethral resection (5-7%), urinary incontinence (1-2%), erectile dysfunction (9-14%), retrograde ejaculation (74-87%) , cervical sclerosis of the bladder (2-4%).

Diagnosis

The diagnosis is established by a urologist or andrologist. Rectal examination is informative only if the location of the tumor is achievable. On 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 impaired renal function should 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 assessed on a scale from 1 to 5. When summed up, an overall score is obtained that affects further treatment tactics (dynamic observation, conservative therapy or surgery): from 0-7 - mild symptoms, 8-19 - moderate, 20- 35 - a serious problem with urination. Instrumental and laboratory diagnostics for BPH includes:

• TRUS and transabdominal ultrasound of the prostate and bladder are complementary imaging modalities. Ultrasound examination is performed twice - with a full bladder and after the act of urination, which allows you to determine the amount of residual urine. Asymmetry, density, heterogeneity of the structure, increased blood supply to the prostate indicate an adenoma.
• X-ray. X-ray diagnostics (excretory urography, cystography) can not only determine the size of the prostate, but also evaluate kidney function, developmental anomalies, and diagnose pathologies of the bladder and urethra. The study involves the intravenous administration of a contrast agent.
• Urodynamic studies. Uroflowmetry is a simple test to evaluate 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 the dynamics against the background of conservative therapy.
• PSA study. Prostate-specific antigen is produced by 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 the diagnosis cannot be established by one analysis.
• Urine tests. In men with prostate adenoma, concomitant inflammation of the bladder and kidneys is often diagnosed, therefore, 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 during straining. With changes, urine is sown 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.

BPH treatment

Therapy of prostate adenoma correlates with the severity of obstructive symptoms and complications, the choice of treatment tactics is influenced by the patient's age and comorbidities. All existing methods of treatment are aimed at restoring adequate urinary derivation. Therapy options include:

• Watchful waiting. This tactic is used in men with mild symptoms of IPSS 7 and in patients with an IPSS score of 8, whose symptoms are not considered to impair quality of life in the absence of complications. Once a year, such patients undergo TRUS, PSA analysis, digital examination. Drug therapy is not indicated, as it does not lead to an improvement in well-being and has great 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 or more. 5α-Reductase inhibitors are prescribed to prevent the progression of urinary obstruction symptoms. Combination therapy is possible according to indications. 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 refers to radical operations (can be performed both by open access and laparoscopically) and transurethral resection of the prostate gland. Each operation has its indications, advantages and disadvantages. In severe comorbidity, when the likelihood of an adverse outcome is high, epicystostomy is performed as a palliative measure. After normalization of the condition, it is possible to resolve the issue of removing drainage and restoring independent urination.
• Minimally invasive therapy. There are a number of techniques to avoid the adverse effects associated with TURP and adenomectomy. These include laser destruction (vaporization, coagulation) in a contact or non-contact way, needle ablation, electroincision, transurethral microwave therapy (microwave energy), radio frequency water thermotherapy, etc. A large prostate gland is a contraindication to minimally invasive methods of treatment.

Forecast and prevention

The prognosis for life is favorable, for most patients a long-term (lifelong) intake of modern drugs is sufficient to normalize the function of urination. 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 give a 100% guarantee of healing and can be performed repeatedly. The introduction of minimally invasive treatment methods has contributed to the improvement of prognosis in the last decade, which allows minimizing life-threatening complications in patients. To normalize erectile function, it is necessary to consult an andrologist-sexologist. Evidence from prostate cancer prevention studies suggests that a diet low in animal fat and red meat and high in protein and vegetables may reduce the risk of symptomatic BPH. Physical activity for at least 1 hour a week reduces the chance of nocturia by 34%.

Norms and pathologies based on the results of ultrasound of the prostate gland: transcript

Often, when receiving the conclusion of a diagnostician after an ultrasound scan, the patient will remain at a loss: the form is mostly numbers, incomprehensible parameters and their characteristics. The attending physician can decipher and explain the data obtained, however, having previously prepared and read the necessary article, the patient himself will be able to determine whether his indicators are a variant of the norm or indicate the presence of a pathology. Deciphering the results of ultrasound of the prostate gland in adult men is the basis for prescribing further treatment.

What are they watching?

An ultrasound examination of any organ is accompanied by the issuance of a form with its description and characteristics. The prostate gland is no exception. And to make the interpretation of the obtained indicators more understandable, consider what exactly is determined on the ultrasound of the prostate.

Examining the prostate gland, the doctor determines the clarity of its contours and dimensions, the homogeneity of the structure and echogenic parameters of the organ, finds out about the presence of cysts, stones and calcifications (-sand-). In addition, the condition of the ejaculatory ducts is assessed. Each of these parameters deserves special attention.

Uniformity

Normal, the prostate gland should have a homogeneous structure, its contours should be clear and even. If there is heterogeneity, this may be evidence of any disruption in the functioning of the organ from inflammatory diseases to edema and purulent inclusions.

The size of the prostate changes with age. In a healthy man, it acquires a constant size by about 25 years and stops growing, a subsequent increase should not occur - it will be the result of pathological processes.

In the future, neglected pathologies can lead to the development of malignant tumors.

Let's consider the normal indicators of the physical parameters of the prostate:

• length 24-40 mm;
• width 30-45 mm;
• volume 18.7-26.8 cms;
• thickness 15-25 mm;
• contours are clear and even;
• tissue density (echogenicity) - medium;
• heterogeneity and fine-grained structure are allowed;
• organ shape - triangular or semicircular.

In men over 45, an increase in the gland is often observed and this is already a deviation. Unless, of course, doctors have established that this is the anatomical feature of a particular organism.

The volume index of the prostate, according to the norms of ultrasound examinations, should not exceed 26 cms. However, it cannot be 100% accurate, because each man is individual, and besides, the gland can increase, although this process is pathological.

A normal prostate is shaped like a symmetrical chestnut. Doctors say that the prostate is the second heart of a man because the gland is also similar to the human heart. Any asymmetry or unevenness of the contours is a sign of deviations. The normal prostate is visually clearly outlined, which is easily fixed on the screen of the ultrasound monitor.

Echogenicity

Echogenicity in medicine is the ability of a tissue to reflect a non-ultrasonic wave directed at it. A normal prostate gland is homogeneous in its structure and should not contain foreign inclusions, such as calcifications, cysts or other neoplasms.

During the procedure, the state of the ducts is necessarily assessed. It directly depends on their permeability, that is, the presence or absence of overlapping inclusions. Clean and well-passable ducts allow us to draw a conclusion about the health of the prostate gland and the absence of deviations in its functioning.

Unfortunately, inflammation in the prostate (prostatitis) today is very widespread. One of the ultrasound signs of inflammation is an increase in the size of the gland - this is the first sign of the trouble of the organ. It happens that cysts form in the structure of the prostate, which look like cavities with liquid contents on the monitor screen.

This visual picture will be accompanied by deviations in echogenicity. Ultrasound also allows you to differentiate malignant tumors from the rest. The fact is that they are clearly visible on the screen of an ultrasound monitor and are pronounced structures with high echo activity.

Symmetry and amount of residual urine

One of the key indicators of prostate health is its symmetry and the absence of residual urine (detected using the OOM procedure - determination of residual urine) after emptying in the bladder cavity.

In order to assess whether urine remains after urination, the patient is invited to visit the toilet after the initial diagnosis, and then continue the examination.

If the rest of the urine is not only detected, but also has a significant volume, this is a direct signal of the development of adenoma or prostatitis in the patient.

Vascularization

Vascularization is the process of formation of additional blood vessels in the prostate gland. The process speaks of the development of various diseases that have arisen due to excessive blood supply to some parts of the organ and congestion in other parts of it.

Calculate gland volume

To find out exactly whether the size of the prostate corresponds to normal parameters, you need to use the formula of A.I. Gromov (doctor of medical sciences).

The formula is: V0.13*B+16.4, where V is the prostate volume and B is the patient's age.

Based on this figure, the doctor will draw a conclusion about the health of the gland. And if for a forty-year-old man the norm is 21.6 ml, then by the age of 60 it is already 24.2 ml. The ultrasound protocol usually contains both values: real and permissible according to the Gromov formula.

Photo 1. A sample protocol for ultrasound of the prostate.

An acute condition that can occur with diseases of the prostate is urinary retention. Violation of e outflow will entail the onset of inflammatory processes in the cavity of the bladder, in the kidneys and the excretory system as a whole. Consider the main pathological conditions characteristic of the prostate gland.

What until recently in medicine was designated as -prostate adenoma-, today is called benign prostatic hyperplasia- (or BPH - benign prostatic hyperplasia). The disease is a benign tumor that develops from glandular epithelium or connective tissue.

The main symptom of adenoma is a serious increase in the size of the gland. In the nodular form of the disease, inclusions of about 7-8 mm in size with increased tissue density appear in the body of the prostate. On the surface of these inclusions (nodes), calcifications or cysts can be identified.

In the diffuse form of the disease, the heterogeneity is more pronounced, but there are no inclusions. The interlobar track, which is normally present in the gland, is smoothed out with adenoma, and the organ acquires a spherical shape.

With hyperplasia, the size of the prostate will differ from normal:

• top-bottom cut becomes 2.4-4.1 cm;
• transverse - 2.7-4.3 cm;
• anteroposterior - 1.6-2.3 cm;
• volume - 16-18 cm.

Ultrasound examination data are crucial in determining the degree of hyperplasia. The results are divided into 3 categories according to severity: difficult, medium and simple.

Prostatitis, like any inflammatory disease, can occur both in an acute form (this is evidenced by a reduced echogenicity of the gland), and in a chronic form (a sign here is an increased density of the organ). Other signs of the disease are the loss of sharpness by the contours of the prostate, as well as difficulty in the visual separation of fibrous tissue from glandular tissue.

It is possible to form areas of increased and decreased echogenicity, and if inflammation is accompanied by an abscess, then a hypoechoic or anechoic inclusion will be noticeable on the monitor.

The acute course of prostatitis is a generalized decrease in the echogenicity of the prostate against the background of an increase in volume. If the seminal vesicles are involved in the pathological process, then their filling becomes heterogeneous, and the size increases. The picture of the disease is complemented by an increase in the vascular pattern and the formation of its diffuse structure. Vesiculitis often becomes a companion of the acute form of the disease, in this case, vascular manifestations intensify precisely around the seminal vesicles.

If the prostatitis is parenchymal in nature, then hyperechoic zones with heterogeneity, which is caused by the location of multiple small pustules, will be clearly visible on the monitor. At the same time, the prostate gland is enlarged, as in the acute form of the disease, besides, it often determines the primary areas.

The prostate gland, as a delicate and fragile organ, is prone to the formation of fibrosis after a man has prostatitis.

Doctors consider fibrosis to be the result of inflammation of the gland, no matter what form and etiology they were.

The doctor can identify cysts by changes in echogenicity in the structure of the gland: they look like hypo- or anechoic areas. Small formations up to 5 mm can be found even in healthy representatives of the stronger sex.

Determining and assessing the presence of stones in the prostate gland has some peculiarities. Stones are small areas with an increased echo signal, which can be either single or multiple and vary in size.

Neoplasms

The first sign of a malignant lesion of the gland is the loss of clarity of contours, despite the fact that echogenicity may not change.

The formations that the doctor detects in the central region of the prostate gland are most often benign. But the structural restructuring of the marginal part of the prostate often indicates the malignancy of the pathological process.

The characteristic signs of an oncological process in the marginal zone of the prostate include the presence of nodes of arbitrary shape with a reduced echo signal.

The marginal or peripheral zone occupies a significant part of the prostate (about 75%) - it is in this part of the organ that oncological tissue lesions occur in 80% of cases. Most of the tumors are formed at a shallow depth of 3-4 mm from the upper layer of the organ.

The central part of the prostate occupies only 20% of the total volume of the gland, and, according to statistics, only 5% of the total number of malignant tumors occur in it.

Tumours located in the transitional or central zone of the prostate are the most difficult to diagnose. Cancer often develops in combination with benign hyperplasia and, in terms of tissue density, almost merges with the surrounding structural elements. Therefore, diagnostic errors occur quite often, and the final diagnosis is formed only during the study of postoperative histology.

Pros and cons

Ultrasound will remain the most accessible and meaningful research method - that is why most prostate diseases are detected during ultrasound diagnostics. The reliability of this method is close to 80%, so an ultrasound examination is the first doctor's appointment for suspected pathology of the male urinary system or genital organs.

And if there is a need to assess the blood flow in the prostate gland, then Doppler diagnostics, similar to ultrasound, will come to the rescue. The combined use of both methods will allow you to determine the intensity of blood flow, which is an important part of a comprehensive urological examination.

Conclusion

Ultrasound is the first thing a doctor prescribes, if necessary, to diagnose any disease of the genitourinary system. However, you need to understand that not a single study automatically confirms or refutes a possible diagnosis - only the attending physician does this. He evaluates all the parameters of the medical report issued in the ultrasound room and forms a picture of the disease. Only after that, treatment is prescribed, which should become truly effective.

Periodic ultrasound after 60 should be the norm for every man.