What does prostatic hyperplasia mean? Benign prostatic hyperplasia

Methods for determining prostate adenoma and its treatment depend on the stage of the pathology. At an early stage, conservative therapy is effective; in chronic and acute cases, the patient is prescribed surgery. Due to the possibility of dangerous complications, treatment of the pathology should begin immediately after diagnosis.

What causes the disease?

The exact nature of prostate adenoma and the causes of its occurrence have not been established. The tumor develops and grows gradually: first a nodule forms, which over time increases in size and compresses the urinary canal.

The causes of neoplasms can be:

• hormonal disorders;
• irregular sex life;
• STD;
• heavy physical activity;
• side effects of medications;
• alcohol abuse;
• smoking;
• pathologies of the cardiovascular system;
• inflammatory processes.

High testosterone contributes to the development of adenoma and its degeneration into prostate cancer.

Risk factors contributing to the appearance of a tumor:

• excess weight;
• heredity;
• atherosclerosis;
• sedentary lifestyle;
• poor nutrition;
• hypertension.

Pathological changes occur from constant stress and emotional overstrain. The neoplasm can develop against the background of chronic renal failure and disorders of the genitourinary system.

Stages and symptoms

Symptoms of prostate adenoma in men are divided into 2 groups: irritative and obstructive. As the pathology develops, increasing signs and complications are observed.

Modern medicine distinguishes 4 stages of development of the condition. The main signs of adenoma correspond to characteristic changes in the functioning of the urethra.

Compensated form

Prostate adenoma of the 1st degree is characterized by compression of the urethra, as a result of which urine is difficult to excrete.

Symptoms of the initial stage:

• frequent urge to urinate during the day;
• decrease in the volume of urine excreted;
• imperative urges become more frequent;
• periodically there is a delay in the outflow of urine;
• the need to tense the auxiliary muscles.

The kidneys and ureters do not undergo changes, so the general condition of the patient remains stable.

Subcompensation

Benign prostatic hyperplasia of the 2nd degree negatively affects the functioning of the bladder. Due to the constant increase in the volume of unremoved urine, the ureters dilate, signs of chronic renal failure and other changes appear in the upper parts of the urinary system.

Stage 2 symptoms are:

• portioned release of the bladder;
• the thickness of the bubble walls increases;
• some urine is retained;
• involuntary urination becomes more frequent;
• urine is cloudy and may contain bloody impurities.

Decompensation

At this stage, the clinical picture of chronic chronic renal failure increases. Complications from progressive kidney pathology may occur.

Symptoms of grade 3 adenoma:

• constant urge to urinate;
• the ureters dilate as much as possible;
• severe pain in the lower abdomen;
• excretion of urine in small portions.

Associated symptoms in men with pathology:

• weakness;
• nausea;
• loss of appetite;
• constipation;
• thirst.

There is a high probability of developing stage 3 cancer. Due to the large size of the tumor and complete dysfunction of the bladder, waste accumulates in the body, which leads to intoxication.

Terminal

The final stage, at which atony occurs and urination stops completely. The volume of accumulated urine can reach up to 2 liters.

Symptoms of grade 4 prostate adenoma are accompanied by symptoms of chronic renal failure that are incompatible with life. The nitrogen content in the patient's blood sharply increases, the water-electrolyte balance is disturbed and the patient dies from uremia.

How to diagnose

There is a special algorithm for diagnosing BPH.

The diagnosis is made based on a summary assessment of all symptoms and the patient’s quality of life.

Questioning and urological examination

During a conversation with the patient, the doctor asks questions related to the frequency and nature of urination. The international IPSS questionnaire and its QOL application were specifically developed by WHO.

To determine BPH and its degree, the following points are used:

• 0-7 - no therapy required;
• 8-19 - stage 1-2 prostate adenoma, conservative treatment is recommended;
• 20-35 - severe symptoms, surgery is necessary.

The urologist performs an external examination of the genital organs and examination of the gland through the rectum. Palpation of the prostate allows you to determine the size, consistency and tenderness of the prostate.

Laboratory and instrumental methods

To clarify the diagnosis and determine the stage of the disease, the patient is prescribed a series of laboratory and instrumental studies.

First of all, the patient needs to undergo tests:

1. OAM. A general urine test determines the presence of genitourinary infections, bleeding and chronic renal failure.
2. Kidney tests.
3. Prostate biopsy. Histological examination is carried out to determine the likelihood of degeneration of benign neoplasms into malignant ones.
4. Blood PSA. Testing for prostate-specific antigen levels is the main screening method.

Instrumental research methods are also prescribed:

1. Ultrasound. Determines the degree of damage to prostate tissue and kidney functionality.
2. X-ray methods. X-ray and excretory urography determine the presence and nature of changes in the kidneys and ureters.
3. Uroflowmetry. Study of the stream, urination speed, volume and duration.
4. Urethrocystoscopy. Allows you to assess the nature of the narrowing of the urethra and determine possible changes in the bladder.
5. Cystomanometry. Screening to determine pressure inside the bladder.
6. Cystography. Study of the circulatory system around the bladder.
7. MRI and CT. Diagnosis helps to study benign tumors in detail: their structure, size, degree of growth.

How to treat

There is no single method of treating prostate hyperplasia. Specialists select therapy taking into account the patient’s general condition, his age, the degree of pathology and other factors.

The most effective treatment methods depending on the stage of BPH:

1. Adenoma 1st degree. Conservative methods.
2. Treatment 2 degrees. Surgical intervention: minimally invasive and classical techniques.
3. 3rd degree of neoplasm. Therapy consists of a set of measures.

Medicines

For the medical treatment of prostate adenoma, drugs from different therapeutic groups are used.

1. Alpha adrenergic blockers. The medications Doxazosin, Prazosin, Terazosin, Alfuzosin and Tamsulosin help to relax the pressure on the urethra and facilitate the flow of urine.
2. 5-alpha reductase inhibitors. Dutasteride and Finasteride help reduce prostate volume by blocking the conversion of testosterone to its active form.
3. Herbal medicines. Herbal medicines Speman, Tentex forte and Himcolin help normalize the speed of urinary flow and the amount of residual urine.
4. Combined means. Simultaneous use of drugs from the groups Alpha adrenergic blockers and 5-alpha reductase inhibitors.
5. Antispasmodics and medications that have an analgesic effect. Recommended for exacerbation.
6. Orthomolecular therapy. Vitamins and mineral supplements.

In parallel with drug treatment, a number of therapeutic measures are carried out aimed at combating concomitant pathologies and disorders:

1. The antibiotic Levofloxacin has high antibacterial activity and helps in the treatment of infections of the urological tract.
2. Prostatilen works against inflammation and helps reduce swelling.
3. Timalin is used in the treatment of prostatitis and cystitis.

Contraindications to the treatment of BPH with medications: urolithiasis, functional kidney failure, acute pyelonephritis.

If the patient is taking medications, the attending physician must be notified. If you have BPH, you cannot use Anuzol rectal suppositories.

Physiotherapy

Treatment of adenoma in the early stages is carried out using physiotherapy. Procedures are divided into 2 types:

1. A complex aimed at stimulating blood flow and strengthening the immune system. This category includes: magnetic therapy, laser therapy and inductotherapy. With their help, you can cure prostatitis, which often accompanies the pathological condition.
2. The course is aimed at relieving inflammatory processes and eliminating the symptoms of benign prostatic hyperplasia.

In case of pathology, sanatorium-resort treatment is indicated.

The treatment course includes:

1. Urological massager.
2. Phonation is a new technology in the treatment of adenoma. It is a deep micromassage at the cellular level.
3. Magnetic therapy. The magnet is used to speed up blood flow and relieve symptoms.

Photodynamic therapy

Effective treatment helps with malignant and benign tumors, adenoma and other tissue pathologies.

Photosensitizers are introduced into the patient's body, relieving inflammatory processes and restoring damaged tissue cells.

Ozone therapy

The mechanism of action of this therapy lies in the natural properties of ozone, which contains active oxygen.

This procedure normalizes metabolism in the body, saturates the blood with vitamins and minerals. The therapy has no side effects. Combination with other treatment methods is possible.

Diet

The diet should be followed all the time while prostate adenoma is being treated, as well as for its prevention. The basis of the diet is foods high in selenium and zinc.

The menu should be light and balanced.

You cannot drink beer or other alcoholic drinks.

Hunger, like overeating, negatively affects health.

Authorized products:

• lean meat and fish;
• soups with vegetable broth, milk and water;
• cereals;
• vegetables and fruits: tomatoes, peppers, apples, pears.

Exercise therapy

Exercise therapy classes are prescribed at all stages. Physical exercise helps relieve inflammation and restore the functioning of the urinary system.

After surgery, with the help of physical therapy, you can completely cure prostate adenoma and avoid the development of pathology in the future.

Hirudotherapy

An enlarged tumor reduces sexual ability. To treat erectile dysfunction in men, a course of hirudotherapy is prescribed.

The procedure helps normalize blood circulation and remove toxins from the body.

Only medicinal leeches are used for therapy. The treatment session lasts 7-15 minutes.

Operation

Surgical treatment represents the prostate gland. The patient is operated upon if complications, chronic renal failure, or infection occur.

Surgical methods:

1. Open prostatectomy (adenectomy). A complex abdominal operation performed under general anesthesia.
2. Transurethral resection. The operation is performed without incisions, through the urethra.

Minimally invasive methods:

1. Transurethral microwave thermotherapy. The affected tissues are exposed to high temperatures (55...80°C). The mechanism of action is the destruction of affected prostate tissue.
2. Prostatic urethral stenting.
3. Transurethral microwave therapy.
4. If indicated, the patient is prescribed free arterial embolization.

It is impossible to remove benign hyperplasia using surgical intervention in case of pathologies of the cardiovascular system, decompensated respiratory disorders, etc. If surgical treatment is impossible, palliative methods are resorted to.

Traditional methods

An alternative treatment for BPH is traditional medicine. Herbs, plants and other means are used as auxiliary and preventive therapy.

Popular folk remedies:

1. Onion peels with honey are used to prepare a decoction that is useful for normalizing the functioning of the genitourinary system.
2. For treatment, the following are used: pumpkin seeds with watermelon, fireweed tea and young potato juice.
3. For prevention, it is useful to drink aspen bark brewed with boiling water.
4. When treating adenoma, hydrogen peroxide is taken orally in the form of a weak diluted solution. At 2 tbsp. l. 1-2% peroxide solution is enough water.
   There are no contraindications to taking hydrogen peroxide. Healing is achieved by enriching the blood with oxygen.
5. In case of pathology, you can apply salt pads to the affected areas.
6. The method of programming the subconscious is new in the treatment of BPH. The White Noise channel helps on a subconscious level to set the body up for recovery.

Complications

In the early stages, treatment of a prostate tumor - adenoma - has a favorable prognosis. If you start treatment in a timely manner, you can get rid of the unpleasant condition using conservative methods.

BPH is a benign tumor that does not metastasize, but can develop into prostatic cancer.

If the pathology develops, complications may appear:

• pain when urinating;
• formation of stones in the bladder;
• acute urinary retention;
• hematuria;
• renal failure;
• osteodystrophy (pain in the lumbar region and spine in the lower part).

The consequences of refusing treatment can be life-threatening and lead to the death of the patient. If your lower abdomen hurts, discomfort occurs when urinating, or other symptoms of pathology, you should immediately consult a urologist.

How to prevent disease

Prostate adenoma is a benign tumor of the stroma or glandular tissue. Chronic urinary retention leads to intoxication and the development of chronic renal failure. To avoid the development of pathology, it is recommended to carry out preventive measures.

These include:

1. Complete cessation of smoking and alcohol.
2. Balanced diet.
3. Healthy lifestyle Regular exercise.
4. If you have prostate adenoma, you can have sex. Regular sex life stimulates the gland.

Regular examinations by a urologist, especially after 30 years, will help to identify disorders in time and begin treatment in a timely manner.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Main points

• Benign hyperplasia prostate gland (BPH)– non-cancerous enlargement of the prostate.
• The condition is believed to be part of the normal aging process.
• 50% of men over 60 years of age have clinically significant BPH.
• Prostate cancer and this disease are in no way connected.
• Symptoms do not necessarily progress and may change.
• Medical treatment can be very effective.
• Transurethral resection of the prostate (TURP) remains the “gold standard” in the treatment of benign prostatic hyperplasia.

Description

The prostate is a walnut-shaped gland located just below the bladder and in front of the rectum. It covers on all sides the upper part of the urethra (urethra), which is a tube that starts from the bladder and opens outward.

The prostate gland produces part (±0.5 ml) of seminal fluid containing nutrients. The bladder neck and prostate form the genital sphincter, which allows antegrade ejaculation and ejaculation of seminal fluid outward rather than backward into the bladder.

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate. Its development depends on male hormones: testosterone and dihydrotestosterone. Over time, the disease affects all men to varying degrees of severity, even those whose testicles and prostates function normally.

An enlarged prostate causes a deformation of the urethra, which interferes with the flow of urine from the bladder and causes obstructive or irritating symptoms.

The size of the prostate does not directly influence the severity of symptoms. Sometimes the course of disease of very large prostate glands is asymptomatic, while damage to a small prostate is characterized by very severe symptoms.

Clinically significant BPH is present in 50% of men aged 60-69 years. Of this amount, ±50% require treatment. The risk that a man will have to undergo prostate surgery during his lifetime is 10%.

Causes

The prostate gland consists of glandular structures and stroma. The second element contains smooth muscle fibers and connective tissue. With BPH, all components of the prostate enlarge, but the stroma is still relatively larger than the rest.

Male hormones (testosterone and dihydrotestosterone) are required for the growth of the gland. They are not the root cause of the appearance of benign hyperplasia, but without them its development is impossible.

Aging and male hormones are the only proven risk factors that can trigger the development of BPH. Every male with a healthy prostate and normally functioning testicles will develop this disease if he lives long enough.

The testicles produce 95% of the testosterone in the body. In the prostate gland, this hormone is converted into dihydrotestosterone, to which it is more sensitive than testosterone. An enzyme called 5-alpha reductase is an intermediate in the chain of transformation of testosterone into its active form. It is contained exclusively in the secretion of the male sex gland. 5-alpha reductose can be controlled with medications (see “Treatment”).

Over time, dihydrotestosterone stimulates the production of growth factors in the prostate, which in turn lead to an imbalance between cell growth and programmed cell death (apoptosis).

The result of all this is a slow, progressive enlargement of the prostate gland. The vast majority of older men have this clinically significant disease, however, in itself it does not necessarily cause symptoms or lead to complications.

Symptoms may occur because BPH affects the prostate directly or the bladder outlet, causing an obstruction (see "Symptoms" below).

Symptoms

BPH may be accompanied by the absence or presence of symptoms. They arise due to mechanical compression of the urethra by an enlarged prostate, secondary changes in the bladder due to obstruction, or complications of BPH.
An obstruction (blockage) of the bladder outlet can lead to various consequences, such as thickening and instability of the bladder muscles. Instability is thought to cause irritant (irritative) symptoms.

In addition, a narrowing of the lumen of the urethra can lead to insufficient contraction of the bladder muscles, or further aggravate their condition. The obvious result of this disorder is obstructive symptoms and insufficient emptying of the urinary bladder. Although the natural aging process is responsible for the appearance of these symptoms, it is the obstruction that will aggravate both signs of decline in the male body.

Obstructive symptoms:

• weak stream of urine;
• feeling of incomplete emptying of the bladder;
• intermittent stream of urine;
• difficulty starting urination (retention);
• tension during urination.

Irritant (irritative) symptoms:

• Frequency (going to the toilet frequently);
• Urgency (a strong urge to urinate that is difficult to suppress);
• Nocturia (the need to wake up at night to empty the bladder).

Symptoms indicating the presence of complications:

• Blood in the urine (hematuria): BPH can cause blood in the urine. However, this disease cannot be considered the culprit of bleeding, unless other, more serious reasons for this have already been excluded.
• Urinary tract infection with symptoms such as burning when urinating, pain in the bladder area, fever and frequent urination.
• Urinary retention (complete inability to go to the toilet).
• Urinary incontinence (urinary leakage due to a full bladder that does not empty properly).
• Renal failure (fatigue, weight loss, increase in total blood volume (hypervolemia), etc.).

Prevalence of BPH

The first microscopic changes of hyperplasia usually appear in the prostate when men approach 35 years of age. Eventually, all members of the stronger sex will develop BPH if they live long enough.

Only ±50% of men with histologically confirmed benign prostatic hyperplasia will develop symptoms. Enlargement of the male reproductive gland does not always lead to obstruction or symptoms.

The clinical syndrome (symptoms and signs) caused by prostate enlargement is known by various names including BPH, LUTS (lower urinary tract symptoms), prostatism and urinary tract obstruction.

50% of men aged 51-60 years and 90% over 80 years have histological BPH. However, only 25% of fifty-five-year-olds and 50% of seventy-five-year-old representatives of the stronger sex will be bothered by symptoms reminiscent of prostate enlargement.

Course of the disease

The natural progression of untreated BPH is variable and unpredictable. There is little reliable information on this matter in the medical literature. But what is clear is that prostatic hyperplasia is not necessarily a progressive disease.

Many studies have shown that in about 30% of patients, symptoms may improve or go away completely over time. In 40% of men they remain the same, and in 30% they worsen. 10% of patients who do not seek medical help will develop urinary retention in the future. And 10-30% of patients who reject medicine will eventually need surgery for an enlarged prostate.

Risk factors

Established risk factors:

• aging;
• testosterone.

Possible risk factors: Genetics.

Potentially possible risk factors:

• Western food;
• high blood pressure;
• overweight;
• industrialized environment;
• increased androgen receptors;
• imbalance of testosterone and estrogen levels.

Any healthy man who lives long enough will become a victim of prostate hyperplasia. Time and male hormones (dihydrotestosterone and testosterone) are the only risk factors whose influence on the development of BPH has been established.

Prostate cells are much more sensitive to dihydrotestosterone than to testosterone. An enzyme found exclusively in the prostate, 5-alpha reductase, converts testosterone to dihydrotestosterone. Those representatives of the stronger half of humanity who were castrated in their youth or suffer from a deficiency of 5-alpha reductase do not experience BPH.

Recent research suggests that there is a likely genetic link to BPH. A man's risk of surgery increases fourfold if his immediate family member has had surgery for the disease. The genetic link is especially strong for men with a large prostate under the age of 60.

Some medical research has found that the number of male hormone receptors (androgen receptors) may be increased in BPH cells. And the role of environmental factors, as well as nutrition, excess weight and the industrialized environment, is not fully understood.

The incidence among Oriental men (especially Japanese) is low. The diet typical of their region is rich in phytoestrogens and may have a protective effect.

When to see a doctor

If you experience any of the following disorders, contact your doctor immediately:

• Inability to urinate (urinary retention);
• Difficulty urinating;
• Blood in the urine;
• Urinary incontinence;
• Urinary tract infection or other complications of BPH;
• Suspicion of renal failure.

Acute (sudden) inability to urinate causes pain. If this symptom appears, you should immediately seek medical help. Urine retention can slowly develop, gradually weakening the stream, and ultimately lead to urinary incontinence due to bladder overflow.

In this scenario, the bladder never empties properly, which can cause obstructive kidney failure and other complications such as infections or stones.

You should not associate the appearance of blood with an enlarged prostate until other, more serious causes (bladder cancer) are excluded.

Every man over 50 years of age should be screened annually for prostate cancer. Black men, who are at higher risk of developing this type of cancer, and men with a genetic predisposition to it, should start getting regular screenings at age 40. The purpose of annual prostate examinations is to diagnose prostate cancer at an early stage, when it can still be cured.

As a rule, at an early stage, prostate cancer is asymptomatic. If a man has ever had gonadal surgery for BPH (namely, transurethral resection or open prostatectomy), this does not mean that he is no longer at risk of developing prostate cancer.

Prostate cancer usually occurs in the outer part of the gland that is not removed during BPH surgery.

Preparing to visit the doctor

You may be asked to complete a questionnaire to assess the severity of your symptoms (prostate symptom rating scale). During the physical examination, a digital examination of the rectum will be performed.

The health care provider will usually order a urine test and may ask you to urinate into a device to measure the flow rate. Shortly before visiting the doctor, it is better not to empty your bladder.

Diagnostics

The diagnosis of benign prostatic hyperplasia is made based on a medical history, physical examination, and some confirmatory tests.

Medical history

Symptoms of BPH are divided into obstructive and irritant (see section “Symptoms”). It is impossible to make a diagnosis based on symptoms alone, since many diseases mimic the symptoms of BPH. A thorough medical history will help identify other conditions other than BPH that are causing your symptoms.

Diseases similar to BPH:

• urethral stricture (narrowing of the lumen of the urethra in the penis);
• bladder cancer;
• bladder infection;
• prostatitis (chronic infection of the prostate gland);
• neurogenic bladder (dysfunction of this organ due to neurological disorders such as stroke, Parkinson's disease or multiple sclerosis);
• diabetes mellitus

Urethral stricture can occur as a result of previous injuries, the use of technical means in treatment (meaning a catheter) or infections (gonorrhea). Blood in the urine may indicate bladder cancer. Burning and pain when urinating may indicate an infection or stones.

A possible cause of frequent voiding and insufficient emptying may be diabetes, as it affects the muscles of the bladder and the functions of the nervous system.

To assess the severity of prostate symptoms, a scoring scale is used. It helps determine whether further assessment of the patient's condition is necessary or whether treatment should be started. The American Urological Association's Symptom Index is the most common assessment method.

Symptoms are classified according to the total score: 1-7 points - mild symptoms, 8-19 - moderate and 20-35 - severe. If the disorders are mild, then in most cases there is no need for treatment. With moderate symptoms, treatment is required, and in case of severe manifestations of the disease, surgical intervention is most often used.

Physical examination

During this examination, the doctor assesses the patient's general health and palpates the abdomen to check for a full bladder. A digital examination of the rectum is performed to determine the size, shape and consistency of the prostate gland. To do this, the doctor inserts a gloved finger into the rectum. The prostate is located next to the anterior intestinal wall and is easy to palpate in this way. This procedure is slightly unpleasant, but does not cause pain. With BPH the enlargement is smooth and uniform, but with prostate cancer it is nodular and uneven.

Unfortunately, prostate size alone is poorly correlated with symptoms or obstruction. It happens that men with large prostate glands do not show any symptoms and do not experience obstruction, and conversely, small prostate hyperplasia may be characterized by severe obstruction with symptoms and/or complications.

An enlarged prostate in itself is not an indication for treatment. The size of the prostate of patients who actually need therapy may influence the choice of treatment. Neurological testing is indicated if the medical history suggests that the cause of symptoms may be neurological.

Special studies

In order to eliminate all doubts about the correctness of the diagnosis, check for other causes of symptoms, confirm or refute obstruction and look for complications associated with it, special tests are prescribed.

The minimum list of examinations required to diagnose BPH:

• medical history, including symptom severity index (see above);
• physical examination including digital rectal examination (see above);
• urine test;
• urine flow rate;
• assessment of renal function (serum creatinine).

Additional tests:

• urodynamic pressure-flow study;
• determination of the level of prostate-specific antigen (PSA) in blood serum
• ultrasound examination of the abdominal organs;
• ultrasound of the kidneys, ureter and bladder;
• transrectal ultrasound of the prostate gland.

A simple urine test can be done in the office using a dipstick. If it indicates a possible infection, a urine culture is taken. If blood is found in the urine, further testing is necessary to rule out other causes of this symptom.

To determine the rate of urine flow, the patient is asked to urinate into a special machine that produces a reading. Most devices measure the volume of urine, the maximum flow rate and the length of time it takes to empty the bladder. In order for the result to be accurate, you need at least 125-150 ml of urine excreted at one time.

The most useful parameter is the maximum urine flow rate (Q max), measured in milliliters per second. Despite the fact that the mentioned parameter is an indirect sign of urinary tract obstruction, it turns out that in most patients whose urine flow rate is less than 10 ml/sec, the presence of this disorder is confirmed. At the same time, those whose urine flow rate exceeds 15 ml/sec do not show signs of obstruction.

Moreover, patients with low urine flow rates measured before surgery fared better after surgery compared to those with higher urine flow measurements. It is important to understand that a low value of this parameter does not indicate whether the cause of the weak urine flow is obstruction or impaired bladder muscle function.

The level of creatinine is determined in the serum of a blood sample taken. The result gives an idea of ​​how the kidneys function. Creatinine is one of the waste products excreted by the kidneys. If the level of this substance is elevated due to urinary tract obstruction, it is better to drain the bladder with a catheter, which will allow the kidneys to recover before prostate surgery.

Urodynamic pressure-flow testing is the most accurate method to determine the presence of urinary tract obstruction. Bladder pressure and urine flow pressure are measured at the same time. Obstruction is characterized by high pressure and low flow. This is an invasive test that involves inserting sensors into the bladder and rectum. Many scientists do not recommend this procedure for patients with severe prostate symptoms. At the same time, such a study is indispensable if there are doubts about the diagnosis.

Indications for urodynamic examination:

• any neurological disorder, such as seizure disorder, Parkinson's disease and multiple sclerosis;
• acute symptoms, but normal urine flow rate (>15 ml/sec);
• long-term diabetes;
• Previous unsuccessful prostate surgery.

Serum prostate-specific antigen (PSA) levels increase in the presence of BPH. There is controversy surrounding the use of this test to detect prostate cancer. The American Urological Association, like most urologists, recommends that serum PSA levels be tested annually in patients over 50 years of age who have a life expectancy of 10 years.

Representatives of the Negroid race and men with a genetic predisposition to prostate cancer should undergo such a study starting at age 40. PSA levels rise before prostate cancer becomes clinically evident. Thanks to this, it is possible to establish a diagnosis at an early stage and begin timely treatment.

An abdominal ultrasound can help identify renal hydronephrosis (enlarged kidneys) and determine the amount of urine that remains in the bladder after the patient has relieved himself. This indicator does not directly explain the appearance of other symptoms and signs of prostatism, and the outcome of surgery cannot be predicted on its basis.

It is also unknown whether a large residual urine volume indicates impending bladder or kidney problems. Most experts believe that it is necessary to more carefully monitor patients with a high value of this indicator if they prefer non-surgical therapy.

Renal failure with obstruction occurs as a result of increasing dilation of the kidneys (hydronephrosis). Ultrasound examination of patients with elevated serum creatinine levels can determine whether the deficiency is due to obstruction or other factors.

Transrectal ultrasound of the prostate is not always performed in patients with benign hyperplasia. But still, during this examination you can very accurately measure the volume (size) of the prostate. The main function is to help perform a biopsy of the gland in case of suspected cancer of this organ.

Treatment

Dynamic observation, drug therapy and surgery are the main treatment options. For patients who are not suitable for surgery and have not received positive results from drug treatment, indwelling catheters are placed, intermittent (periodic) self-catheterization is performed, or an internal urethral stent is installed (read more). Complications arising from BPH are usually an indication for surgery. Therefore, patients with complications are not treated with follow-up or medications.

Home treatment

Dynamic observation is a non-emergency treatment strategy that involves medical monitoring of the patient’s health at regular intervals. The course of benign prostatic hyperplasia is not necessarily progressive. For many patients, symptoms are stable or may even improve. Dynamic observation is suitable for men with a minimal arsenal of symptoms and not experiencing any complications. Patients may be screened annually, have their symptoms scored, have a physical examination, and have their urine flow rate measured. If the patient is receiving this treatment at home, they should not take tranquilizers, over-the-counter medications, or sinus medications, which can worsen symptoms and cause urinary retention.

To improve the symptoms of BPH, consider these recommendations. Drink alcohol and caffeinated drinks in moderation, especially in the late evening before going to bed. Tranquilizers and antidepressants weaken the bladder muscles and prevent complete emptying. Cold and flu medications typically contain decongestants, which increase smooth muscle tone in the bladder neck and prostate, leading to worsening symptoms.

Herbal medicine is the use of plant extracts for medical purposes. Recently, this method of treating BPH symptoms has received attention in the press. The most popular extract is the dwarf palm (also known as saw palmetto). The mechanism of action of herbal medicine is unknown, and its effectiveness has not been proven. The extract of this plant is believed to have an anti-inflammatory effect that reduces prostate swelling and inhibits hormones that control the growth of prostate cells. It is possible that the positive results obtained from the use of plants are only a consequence of the placebo effect.

Drug treatment

There are two groups of drugs that have shown their effectiveness in the treatment of benign prostate hyperplasia. These are alpha blockers and 5-alpha reductase inhibitors.

Alpha blockers
The prostate gland and bladder neck contain large numbers of smooth muscle cells. Their tone is under the control of the sympathetic (involuntary) nervous system. Alpha receptors are called receptors on nerve endings. Alpha blockers are medications that block alpha receptors, thereby reducing muscle tone in the prostate and bladder neck. As a result, the flow rate of urine increases and the symptoms of prostate disease improve. Alpha receptors are also found in other parts of the body, particularly in blood vessels. Alpha blockers were originally developed to treat high blood pressure. Not surprisingly, the most common side effect of these medications is orthostatic hypotension (dizziness caused by a drop in blood pressure).

Commonly used alpha blockers include:

• prazosin;
• doxazosin;
• terazosin;
• tamsulosin.

The latest medication is a selective α1A-adrenergic receptor blocker, designed specifically to inhibit the alpha receptor subtype found primarily in the bladder and prostate.

Alpha blockers are effective in treating patients with residual urine volume less than 300 ml and no absolute (vital) indication for surgery. Most studies have found that these medications reduced symptoms by 30-60% and moderately increased urine flow. All of the above alpha-blockers, taken in therapeutic dosages, have the desired effect. The maximum result is achieved within two weeks and lasts for a long time. 90% of patients tolerate treatment well. The main reasons for stopping treatment are dizziness due to hypotension and lack of effectiveness. Direct studies comparing different alpha blockers with each other have not been conducted. Therefore, claims that any one of them is better than the others are not justified. As a rule, treatment must be continued throughout life. A less common side effect is abnormal or retrograde ejaculation, which is experienced by 6% of patients taking tamsulosin.

5-alpha reductase inhibitors
The enzyme 5-alpha reductase converts testosterone into its active form, dihydrotestosterone, in the prostate gland. Finasteride prevents this transformation from happening. Taking this drug relieves the symptoms of BPH, increases urine flow, and reduces the size of the prostate. However, such improvements can be called no more than modest, and they are achieved within a period of up to six months. Recent studies have shown that finasteride may be more effective for men with large prostates, and less effective in treating patients with small prostates. The medicine in question actually reduces the incidence of urinary retention. Thanks to it, the need for prostate surgery is reduced by 50% in four years. Side effects include: breast enlargement (0.4%), impotence (3-4%), decreased ejaculate volume and a 50% drop in PSA levels.

Surgery (prostatectomy)

This is the most common urological procedure. In the United States alone, 200,000 surgeries are performed annually. BPH prostatectomy involves removing only the inner part of the prostate. This surgery is different from a radical prostatectomy for cancer, which involves removing all of the prostate tissue. Prostatectomy is the best and fastest way to improve the symptoms of benign prostatic hyperplasia. However, it may not relieve all irritative bladder symptoms. Unfortunately, this is more the case in older men over 80 years of age, where bladder instability is thought to be the cause of most symptoms.

Indications for prostatectomy:

• urinary retention;
• renal failure due to obstruction;
• recurrent urinary tract infections;
• large residual volume of urine (relative indication);
• unsuccessful drug therapy (proved to be ineffective or accompanied by severe side effects);
• patients who are not enthusiastic about the prospect of undergoing drug therapy.

Transurethral resection of the prostate (TURP)
This operation is still considered the “gold standard” in the treatment of BPH, to which all other treatment options are equal. TURP is performed using a resectoscope, which is inserted through the urethra into the bladder. A wire loop that conducts electrical current is used to cut out prostate tissue. The catheter is left in place for one to two days. The hospital stay is usually three days. TURP is virtually painless or causes little discomfort. By the third week after surgery, the patient has fully recovered.

Significant improvements after this operation are observed in 93% of men with severe symptoms, and in 80% of those with moderate symptoms.

Complications associated with TURP may include:

• mortality rate less than 0.25%;
• bleeding requiring transfusion - 7%;
• stricture (narrowing) of the urethra or bladder neck - 5%;
• erectile dysfunction - 5%;
• incontinence – 2-4%;
• retrograde ejaculation (during ejaculation, seminal fluid enters the bladder) - 65%;
• the need for another transurethral resection – 10% within five years.

There are several types of TURP:
Transurethral incision of the prostate/prostatotomy/incision of the bladder neck.
As with TURP, the instrument is inserted into the bladder. Instead of a loop, an electric knife is used to make one or more cuts in the prostate to relieve pressure on the urethra. The gonad tissue is not removed, and if it is removed, it is only a very small piece. Results achieved with prostatotomy of a small prostate (
Transurethral vaporization of the prostate
This type of resection is performed using a resectoscope inserted through the urethra. However, in this case, the tissue is not cut off, but is exposed to powerful electrical energy. As a result, the tissue is evaporated with minimal blood loss. Possible benefits of electrovaporization include shorter catheter wear, shorter hospital stay, and lower cost compared with TURP or laser prostatectomy.

Open prostatectomy
Larger prostates are less suitable for TURP because complications are common due to the longer resection process. Open prostatectomy is the preferred treatment method if the prostate is larger than 70-80g. To expose the bladder and prostate, a transverse incision is made in the lower abdomen. The gonad capsule is incised and the benign hyperplasia is exfoliated. It is possible to open the bladder and remove the prostate through it. To do this, one catheter is placed into the bladder through the urethra, and the second through the lower abdomen. The catheters are left in place for four to five days. This operation gives good results, but it is more severe than TURP. The hospital stay and recovery period is longer, and the complications are slightly worse. However, open prostatectomy is considered a very effective way to remove BPH tissue. And only a very small number of patients subsequently have difficulty emptying their bladder normally.

Minimally invasive methods for treating BPH

Despite the success of TURP, scientists are constantly searching for less invasive, safer and less expensive procedures that can be performed in one day under local anesthesia without leaving the person in the hospital overnight. A variety of energy sources have been tested to specifically heat prostate tissue and destroy it. Laser, microwave thermotherapy, high-intensity focused ultrasound therapy, radiofrequency therapy and transurethral needle ablation of the prostate (TUIA) are based on this principle. All these types of manipulations lead to fewer complications during therapy, but are characterized by less efficiency and greater postoperative troubles. The hospital stay is shorter than with TURP, but the catheter wear time is longer. As a result, many patients require retreatment, which is usually done with TURP. Various laser methods are also used to treat the prostate gland. The newest and most promising invention is holmium laser therapy, which is similar to TURP in that the prostate tissue is actually removed. According to studies, blood loss with this therapy is significantly less than with transurethral resection.

Fighting obstruction

There are patients for whom any type of surgical intervention is contraindicated. To help such patients, intraurethral stents are placed in the prostatic part of the male urethra to support it in an open position. Thanks to this, the patient can pass urine normally. Stents can be inserted under local anesthesia. In the short term, this method gives good results. Due to displacement and other complications, in 14-33% of cases these devices are removed. Of course, it is better not to wear an indwelling catheter all the time. But they are the only salvation for people who are sick, weakened or bedridden. As an alternative they suggest
intermittent (periodic) self-catheterization, which the patient or the person caring for him can do himself.

Disease Prevention

Unfortunately, the development of benign prostatic hyperplasia cannot be prevented. It is unknown whether long-term treatment with finasteride, starting before clinical manifestations of the disease, significantly affects the pathological process of BPH. Before use, you should consult a specialist.

2673 0

Treatment goals for benign prostatic hyperplasia:

Improving the quality of life of patients suffering from urinary disorders caused by benign prostatic hyperplasia (BPH); preventing the progression of BPH;

Prolonging or saving the lives of patients - at the present stage of development of medicine, such a goal is rarely pursued, only in complicated forms of the disease.

The role of the patient in choosing a treatment method

If there are subjective manifestations of the disease, the patient should be aware that the indications for therapy are dictated primarily by the degree of concern caused to him by the symptoms of BPH.

If only risk factors for the progression of BPH are identified, we can talk about preventive treatment.

At this stage, the key position is to inform the patient in detail and provide him with all available reliable, scientifically proven information regarding the disease and the risks associated with it, the advantages and disadvantages of various treatment options, and the characteristics of treatment for this patient. In a number of countries, special booklets and educational computer programs have been developed for the purpose of medical education of the patient, which makes it easier for the doctor to inform the patient.

The feasibility of this approach is due to the fact that when we touch on the issue of influence on the quality of life, no one is better than the patient in determining what is most significant for him both in the disease itself and in the methods of its treatment. As a result, the optimal type of treatment is determined not only based on the individual characteristics of the disease, but also taking into account/based on the personal preferences of the patient. We emphasize that such an approach is justified only in the absence of complications of BPH, which are absolute indications for surgical treatment, as well as when the patient’s ability to perceive information and make independent decisions is intact.

If a particular complication of prostate hyperplasia is identified, which is an absolute indication for surgical treatment, the nature of the intervention is determined by the doctor, based on the availability of the treatment method, the somatic status of the patient, the potential effectiveness and safety of the method for a particular patient, as well as taking into account the patient’s preferences.

Dynamic observation

The recommended interval between visits to the urologist and repeated examinations is 6 months after the first consultation, then 12 months.

Dynamic observation is considered preferable for mild (IPSS up to 7 points) and acceptable for moderate (TPSS up to 19 points) urinary disorders that do not cause significant concern to the patient, provided there are no absolute indications for surgical treatment.

As part of dynamic monitoring, it is important to change the lifestyle of patients and increase their educational level in matters relating to BPH and other prostate diseases.

As part of lifestyle changes, the following may be recommended:

Limiting fluid intake in the evening/before bed or in situations where increased urination is undesirable;
limiting the consumption of alcohol, coffee and other drugs and substances with diuretic activity;
eliminating constipation;
correction of concomitant therapy;
regular physical and sexual activity, breathing exercises and gymnastics aimed at strengthening the muscles of the genitourinary diaphragm.

Drug treatment

Given the progressive nature of this disease, drug therapy for its symptoms should be carried out for a long time (sometimes throughout the patient’s entire life).

The most commonly used drugs for the medical treatment of BPH are 5-α-reductase inhibitors, α1-blockers and herbal extracts. In recent years, muscarinic receptor antagonists (m-anticholinergic blockers), desmopressin analogues, as well as various combinations of drugs have become increasingly used in patients with BPH.

5-a-reductase inhibitors

Currently, two drugs of this pharmacological group are available: finasteride (an inhibitor of type II 5-a-reductase) and dutasteride (an inhibitor of both type I and type II 5-a-reductase). Since dutasteride is an inhibitor of 5-a-reductase types I and II, it causes a more pronounced decrease in the content 5-a-dihydrotestosterone (DHT) in the prostate gland than finasteride, which inhibits only type II enzyme. Both drugs, by affecting the amount of DHT, activate the processes of natural apoptosis in the prostate and cause a decrease in its volume.

The maximum clinical effect from the use of drugs of this group in patients with BPH develops 6-12 months after the start of treatment.

The main clinical effects of 5-a-reductase inhibitors:

Reduction in prostate volume by an average of 18-28%;
reduction in total IPSS score by approximately 15-30%;
increase in maximum urination rate by approximately 1.5-2.0 ml/s;
decrease in concentration prostate specific antigen (PSA) blood serum by 50%.

Considering the latter fact, to determine the true PSA level when screening patients for prostate cancer, the values ​​obtained after 6 months or more of continuous therapy with 5-a-reductase inhibitors must be doubled. In this case, 5-a-reductase inhibitors do not reduce the diagnostic value of PSA as a marker of prostate cancer.

Clinical features of the use of 5-a-reductase inhibitors:

Retain their effectiveness with long-term (7-10 years) administration;
drugs of this group are more effective when the prostate gland volume is more than 40 cm3;
unlike o-blockers, they reduce the risk of progression of BPH (by 64%), the occurrence of acute urinary retention (57-59%) and surgical intervention (by 36-55%);
reduce the likelihood of developing prostate cancer by 25%;
effective in the treatment of gross hematuria caused by prostatic hyperplasia;
have a good safety profile.

The most common side effects when taking finasteride are:

Decreased libido (6%);
impotence (8%);
reduction in ejaculate volume (4%); engorgement/enlargement of the mammary glands (less than 1%).

Finaeteride - 5 mg 1 time/day;
dutasteride - 0.5 mg 1 time / day.

A follow-up examination (filling out the IPSS questionnaire, uroflowmetry, determining the volume of residual urine) is recommended to be carried out after 3 and 6 months, and subsequently annually.

a1-Adrenergic blockers

Drugs in this group include terazosin, alfuzosin, and doxazosin. Tamsulosin is an α1-adrenergic receptor antagonist.

The mechanism of action of drugs in this group is to block stromal adrenoreceptors of the prostate gland, which helps relax the smooth muscles of the organ and reduce the dynamic component of bladder outlet obstruction. They have the ability to suppress irritative symptoms (filling symptoms).

The prescription of α1-blockers is the most common option for drug therapy in patients with mild, moderate and severe lower urinary tract symptoms (LUTS). This treatment is appropriate in the absence of risk factors for BPH progression in monotherapy.

Patients may notice symptomatic improvement within 48 hours of starting to take α1-blockers. The effectiveness of therapy is best assessed after 1 month from the start of treatment. The drugs in this group do not differ significantly from each other in the severity of their clinical effects.

The main clinical effects of α1-blockers:

Increase the maximum rate of urination by an average of 20-30%;
improve the quality of life of patients by reducing the severity of LUTS by 20-50%;
effective in eliminating acute urinary retention that has already occurred;
reduce the risk of developing postoperative acute urinary retention;
reduce the severity and duration of dysuria after transurethral resection (TUR) prostate gland;
do not reduce the volume of the prostate;
do not affect the concentration of PSA in the blood serum;
do not prevent the progression of BPH.

If, within 2 months, taking α1-blockers has not led to a decrease in the severity of LUTS, treatment should not be continued. Drugs in this group are ineffective in approximately a third of patients.

The main side effects when taking α1-blockers:

Dizziness;
headache;
orthostatic arterial hypotension;
asthenia, drowsiness;
nasal congestion;
retrograde ejaculation,

Modified-release dosage forms of tamsulosin, alfuzosin and doxazosin generally have slightly lower rates of adverse events than other α1-adrenergic receptor antagonists.

Doxazosin. Start taking 1 mg at night, gradually increasing the dose to 2-8 mg/day; the maximum recommended dose is 16 mg/day.
Doxazosin modified release. Reception begins with 4 mg/day; the maximum recommended dose is 8 mg/day.
Terazosin. The initial dose is 1 mg at night, it is gradually increased to 5-10 mg/day; the maximum recommended dose is 20 mg/day.

Alfuzosin modified release. Prescribe 5 mg in the morning and evening, starting with the evening dose.
Tamsulosin. Prescribe 0.4 mg/day in the morning, after breakfast.
Tamsulosin modified release. Prescribed at 0.4 mg/day. A follow-up examination (filling out the IPSS questionnaire, uroflowmetry, determining the volume of residual urine) is recommended to be carried out after 1.5 and 6 months, and subsequently annually.

Plant extracts

Herbal medicine for LUTS/BPH has been popular in Europe for many years and has spread to America in recent years. Several short-term randomized trials and meta-analyses have shown clinical efficacy without significant side effects of herbal components such as Serenoa repens and Pygeum africanum.

In some studies, herbal extracts of Serenoa repens and Pygeum africanum have demonstrated efficacy similar to finasteride and α1-blockers. An important feature of this group of drugs is the combination of a pathogenetic effect on BPH and a high safety profile with long-term use.

The mechanism of action of herbal medicines is difficult to assess, since they consist of various plant components, so it is difficult to determine which of them has the greatest biological activity.

Pharmacological effects of Serenoa repens extract:

Aptyapdrohepic;
antiproliferative;
decongestant;
anti-inflammatory.

Pharmacological effects of Pygeum africanum extract:

Regulation of contractile activity of the bladder (reducing hyperactivity, reducing metabolic disorders in the wall and increasing its elasticity);
decongestant;
anti-inflammatory;
antiproliferative.

It is advisable to evaluate the effect of herbal medicine therapy after 2-3 months from the start of treatment.

Serenoa repens preparations are prescribed 160 mg 2 times a day or 320 mg 1 time / day after meals. Pygeum africanum preparations are prescribed 50 mg 2 times a day before taking the niche.

It is advisable to carry out a follow-up examination (filling out a TPSS questionnaire, uroflowmetry, determining the volume of residual urine) after 3 and 6 months, and then annually.

It should be noted that currently the clinical recommendations of the European Association of Urology state the insufficiency of the evidence base, the diversity of plant materials and the difficulty of taking into account the dosage of the active substance in existing herbal preparations. In this regard, the place of drugs containing herbal extracts in the treatment of BPH should be clarified in the course of large randomized placebo-controlled trials.

Muscarinic receptor antagonists

The prescription of m-anticholinergic drugs to men with bladder outlet obstruction is currently not officially permitted. In men with LUTS without signs of obstruction, only two drugs from this group were used as monotherapy - tolterodine and fesoterodine. The duration of studies using these drugs was usually 12 weeks and did not exceed 25 weeks. When using m-anticholinergic drugs, the severity of urgency, as well as night and daytime pollakiuria, decreased, and there was a slight decrease in the total IPSS score.

Tolterodine is prescribed 2 mg 2 times a day, fesoterodine - 4-8 mg 1 time a day, m-anticholinergic blockers are not considered the standard of drug therapy for patients with BPH. When prescribing them to patients with LUTS in the older age group, careful monitoring of the volume of residual urine is necessary through ultrasound examination (Ultrasound).

Vasopressin analogues

Desmopressin is an antidiuretic hormone analogue that significantly increases tubular reabsorption and reduces urine output. The administration of this drug is an effective method of combating nocturia if its cause is polyuria. Desmopressin has no effect on all other components of LUTS. It should be used with caution, monitoring the sodium content in the blood serum 3 days, a week and a month after the start of use, and then every 3-6 months with continuous use.

Desmopressin is prescribed sublingually at 10-40 mcg at bedtime. Before prescribing and while taking vasopressin analogues, consultation with a general practitioner/cardiologist is recommended, since fluid retention in the body is associated with the risk of decompensation of a number of cardiovascular diseases, in particular heart failure.

Combination therapy

5-a-reductase inhibitors + a1-blockers

Large studies have convincingly demonstrated that combination treatment with a 5-α-reductase inhibitor plus an α-1 blocker reduces LUTS to a greater extent than either drug alone. At the same time, it has been proven that combination therapy minimizes the risk of BPH progression.

Thus, in the MTOPS study, when using a combination of finasteride with doxazosin, the risk of BPH progression was 64% lower than in the placebo group, and the likelihood of surgical intervention was 67% lower. In a 4-year study using the dual 5-α-reducase inhibitor dutasteride and the superselective α-blocker tamsulosin (the CombAT study), the overall risk of BPH progression was reduced by 41%, the risk of acute urinary retention was reduced by 68%, and the risk of surgical intervention was reduced. by 71%. It is important that the CombAT study included only patients at high risk of BPH progression.

Thus, the combination of 5-a-reductase inhibitors with α-blockers is optimal for patients over 50 years of age with moderate or severe symptoms of BPH (IPSS >12), prostate volume >30 cm3, a decrease in maximum urine flow rate of 1.5 (but within normal values).

a-Adrenergic blockers + m-anticholinergic blockers

If there are signs of bladder overactivity (severe pollakiuria, urgency) in patients with prostate hyperplasia, it may be advisable to prescribe combination therapy with an α1-blocker and an m-anticholinergic blocker. Such combination therapy is effective in 73% of patients who previously did not notice improvement with monotherapy with α1-adrenergic receptor antagonists.

The few studies on the combined use of these drugs have provided experience with the use of doxazosin, tamsulosin or terazosin with oxybutynin, solifenapine or tolterodine.

If the patient is suspected of bladder outlet obstruction, treatment should be prescribed with caution, under ultrasound control of the volume of residual urine.

Surgical treatment

Currently, the “gold standard” of surgical treatment for BPH is considered transurethral resection (TOUR) prostate gland. Transurethral incision of the prostate or open adenomectomy can also be performed.

The main goal of surgery for BPH is to relieve the patient of iphravesical obstruction and improve urination.

Absolute indications for surgical treatment:

Chronic urinary tract infection;
acute urinary retention after catheter removal;
resistant to therapy with a 5-a-reductase inhibitor, gross hematuria;
bilateral ureterohydronephrosis and renal failure:
bladder stones;
a large bladder diverticulum or a large (> 200 ml) volume of residual urine caused by prostatic hyperplasia.

Relative indications for surgical treatment:

Ineffectiveness or intolerance of drug therapy;
the presence of a middle lobe of hyperplasia;
unacceptability or unavailability of conservative treatment methods for the patient (for psychological, economic or other reasons);
relatively young age of the patient with LUTS.

Selection of surgical treatment method

Transurethral incision of the prostate is the method of choice in patients with a prostate volume of 20-30 cm3 in the absence of the middle lobe.
TUR of the prostate and SS modifications (transurethral vaporization of the prostate, bipolar TUR of the prostate, rotoresection) are the optimal surgical intervention in 95% of patients. It is most effective and safe when the prostate gland volume is from 30 to 80 cm3.
Open adenomectomy (retropubic, transvesical or perineal) for BPH is advisable when the prostate volume is more than 80-100 cm3 and in combination with large stones or diverticula of the bladder.

It is important to note that methods of surgical treatment of patients with BPH are constantly being improved. Thus, in a recent randomized study, it was found that in patients with a prostate gland with a volume of more than 100 cm3, transurethral enucleation of adenoma with a holmium laser has an effectiveness that is not inferior to open adenomectomy, with a significantly lower degree of severity and frequency of complications. Currently, there are all the prerequisites for this technique to become the new “gold standard” for surgical treatment of patients with BPH.

The results of TUR of the prostate, transurethral incision of the prostate or open adenomectomy are comparable. When using each method, the total 1PSS score is reduced on average by 71%. The maximum urinary flow rate after TUR of the prostate increases by approximately 115% (from 80 to 150%), or by 9.7 ml/s; after open adenomectomy - by 175%, or by 8.2-22.6 ml/s. The volume of residual urine is reduced by more than 50% (by 65% ​​after open adenomectomy, by 60% after TUR of the prostate and by 55% after transurethral incision of the prostate).

Long-term intra- and perioperative complications

Mortality after surgical interventions for BPH in modern clinics does not exceed 0.25%. The risk of TUR syndrome (hemodilution combined with a decrease in blood plasma Na+ concentration less than 130 nmol/l) does not exceed 2%.

Risk factors for developing TUR syndrome:

Severe bleeding with damage to the venous sinuses;
long-term surgical intervention;
large prostate size;
history of smoking.

The need for blood transfusion after TURP of the prostate occurs on average in 2-5% of patients; after open surgery, the frequency is usually higher. With transurethral incision of the prostate gland, there is almost never a need for blood transfusion.

Long-term complications:

Stress urinary incontinence. The average probability of its occurrence is 1.8% after transurethral incision of the prostate, 2.2% after TUR of the prostate and up to 10% after open surgery.
Urethral strictures. The risk of their development after open adenomectomy is 2.6%, after TUR of the prostate gland - 3.4%, after transurethral incision of the prostate gland - 1.1%.
Contracture of the bladder neck occurs in 1.8% of patients after open adenomectomy, in 4% after TUR of the prostate gland and in 0.4% of patients after transurethral incision of the prostate gland,
Retrograde ejaculation occurs in 80% of patients after open adenomectomy, in 65-70% of patients after TUR of the prostate and in 40% of patients after transurethral incision of the prostate.
Erectile dysfunction (ED) after TUR of the prostate gland occurs on average in 6.5% of patients, which is comparable to the frequency of ED in patients with BPH of the same age during dynamic observation.

The timing of follow-up examinations after the above-mentioned surgical interventions is every 3 months. It is imperative to examine the histological material obtained during the operation.

Recommended methods of postoperative patient management include questionnaires using the 1PSS scale, uroflowmetry, and determination of residual urine volume. At the discretion of the doctor, a bacteriological examination of urine can be performed.

BPH is a current condition affecting a significant proportion of middle-aged and elderly men. BPH develops from the transition zone of the prostate gland and leads to disruption of the act of urination due to an increase in the size of the prostate, changes in the tone of the smooth muscles of the gland, bladder neck, posterior urethra and detrusor.

Numerous methods for diagnosing BPH are aimed primarily at assessing the severity of obstructive and irritative symptoms of urinary dysfunction, measuring the size of the prostate gland and urine flow rate, as well as the risk of disease progression in the future. Currently, there is no standard treatment for BPH that is suitable for any patient.

Depending on a number of symptoms, dynamic observation, drug treatment in mono- and combination therapy, surgical treatment, as well as various minimally invasive interventions are used. When choosing a treatment method, each patient should be approached individually, taking into account all associated factors (medical and social) and with the active participation of the patient himself.

P.V. Glybochko, Yu.G. Alyaev

Prostatic hyperplasia (prostate adenoma) is a common urological disease in which proliferation of cellular elements of the prostate occurs, which causes compression of the urethra and, as a consequence, urination disorders. The neoplasm develops from the stromal component or from the glandular epithelium.

Source: radikal.ru

Most often, the disease is diagnosed at 40-50 years of age. According to statistics, up to 25% of men over 50 years of age have symptoms of prostatic hyperplasia; at 65 years of age, the disease is found in 50% of males, and at an older age - in approximately 85% of men.

With timely and correctly selected treatment, the prognosis is favorable.

Diagnostics

Diagnosis of prostatic hyperplasia is based on the collection of complaints and anamnesis (including family history), examination of the patient, as well as a number of instrumental and laboratory tests.

During a urological examination, the condition of the external genitalia is assessed. Digital examination allows you to determine the condition of the prostate gland: its contour, pain, the presence of a groove between the lobes of the prostate gland (normally present), areas of compaction.

General and biochemical blood tests are prescribed (the content of electrolytes, urea, creatinine is determined), a general urine test (the presence of leukocytes, red blood cells, protein, microorganisms, glucose). The concentration of prostate-specific antigen (PSA) in the blood is determined, the content of which increases with prostate hyperplasia. Bacteriological culture of urine may be required to exclude infectious pathology.

The main instrumental methods are:

• transrectal ultrasound examination (determining the size of the prostate gland, bladder, the degree of hydronephrosis if present);
• urofluometry (determination of the volumetric flow rate of urination);
• survey and excretory urography; etc.

Most often, the disease is diagnosed at 40-50 years of age. According to statistics, up to 25% of men over 50 years of age have symptoms of prostate hyperplasia.

If differential diagnosis with bladder cancer or urolithiasis is necessary, cystoscopy is used. This method is also indicated if there is a history of sexually transmitted diseases, prolonged catheterization, or trauma.

Treatment of prostatic hyperplasia

The main goals of treatment for prostatic hyperplasia are to eliminate urinary disorders and prevent further development of the disease, which causes severe complications in the bladder and kidneys.

In some cases, they are limited to dynamic observation of the patient. Dynamic observation involves regular examinations (with an interval of six months to a year) by a doctor without any therapy. Watchful waiting is justified in the absence of pronounced clinical manifestations of the disease and the absence of absolute indications for surgical intervention.

Indications for drug therapy:

• the presence of signs of disease that cause anxiety to the patient and reduce his quality of life;
• the presence of risk factors for progression of the pathological process;
• preparing the patient for surgery (in order to reduce the risk of postoperative complications).

As part of drug therapy for prostatic hyperplasia, the following may be prescribed:

• selective α 1 -blockers (effective in cases of acute urinary retention, including postoperative origin, in which it is impossible to empty a full bladder for 6–10 hours after surgery; improve cardiac activity with concomitant coronary heart disease);
• 5-alpha reductase inhibitors (reduce the size of the prostate gland, eliminate gross hematuria);
• preparations based on plant extracts (reducing the severity of symptoms).

In case of acute urinary retention, a patient with prostatic hyperplasia is indicated for hospitalization with bladder catheterization.

Androgen replacement therapy is carried out in the presence of laboratory and clinical signs of age-related androgen deficiency.

Suggestions have been made about the possible malignancy of prostatic hyperplasia (i.e., degeneration into cancer), but they have not been proven.

The absolute indications for surgical treatment of prostatic hyperplasia are:

• relapses of acute urinary retention after removal of the catheter;
• lack of positive effect from conservative therapy;
• formation of diverticulum or large bladder stones;
• chronic infectious processes of the urogenital tract.

There are two types of surgery for prostatic hyperplasia:

• adenomectomy – excision of hyperplastic tissue;
• prostatectomy – resection of the prostate gland.

The operation can be performed using traditional or minimally invasive methods.

Transvesical adenomectomy with access through the bladder wall is usually used in cases of intratrigonal tumor growth. This method is somewhat traumatic compared to minimally invasive interventions, but is highly likely to provide a complete cure.

Transurethral resection of the prostate gland is characterized by high efficiency and low trauma. This endoscopic method involves the absence of the need to dissect healthy tissue when approaching the affected area, makes it possible to achieve reliable control of hemostasis, and can also be performed in elderly and senile patients with concomitant pathology.

Transurethral needle ablation of the prostate gland involves the introduction of needle electrodes into the hyperplastic tissue of the prostate gland, followed by the destruction of pathological tissues using radiofrequency exposure.

Transurethral vaporization of the prostate is carried out using a roller electrode (electrovaporization) or a laser (laser vaporization). The method consists of evaporating hyperplastic prostate tissue with its simultaneous drying and coagulation. Also, for the treatment of prostatic hyperplasia, the method of cryodestruction (treatment with liquid nitrogen) can be used.

Embolization of prostate arteries refers to endovascular operations and involves blocking the arteries feeding the prostate gland with medical polymers, which leads to its reduction. The operation is performed under local anesthesia through the femoral artery.

In order to reduce the risk of developing prostatic hyperplasia, timely seeking medical help at the first signs of urinary disorder is recommended, as well as annual preventive examinations by a urologist upon reaching 40 years of age.

Endoscopic holmium laser enucleation of prostatic hyperplasia is performed using a holmium laser with a power of 60–100 W. During the operation, hyperplastic prostate tissue is removed into the cavity of the bladder, after which the adenomatous nodes are removed using an endomorcellator. The effectiveness of this method approaches that of open adenomectomy. The advantages are a lower likelihood of complications compared to other methods and a shorter rehabilitation period.

Possible complications and consequences

Against the background of prostatic hyperplasia, serious pathologies of the urinary tract can develop: urolithiasis, pyelonephritis, cystitis, urethritis, chronic and acute renal failure, bladder diverticula. In addition, advanced hyperplasia can result in orchiepididymitis, prostatitis, bleeding from the prostate gland, and erectile dysfunction. Suggestions have been made about possible malignancy (i.e., degeneration into cancer), but they have not been proven.

Forecast

With timely and correctly selected treatment, the prognosis is favorable.

Prevention

In order to reduce the risk of developing prostatic hyperplasia, the following are recommended:

• upon reaching 40 years of age - annual preventive examinations by a urologist;
• timely seeking medical help at the first signs of urinary disorder;
• giving up bad habits;
• avoiding hypothermia;
• regular sex life with a regular partner;
• sufficient physical activity.

Video from YouTube on the topic of the article:

Content

Any disease of the prostate gland leads to problems with male sexual health. Prostate adenoma is a common disease among the male population of the planet. According to WHO statistics, every third man on earth over the age of 40 is susceptible to this disease or has prerequisites for its occurrence. Urologists note the annual “rejuvenation” of the disease. Treatment of prostate adenoma includes various methods of “fighting” this disease.

What is prostate adenoma

Prostate adenoma is a common male disease, manifested in the form of nodular growth of tissue, the appearance of a neoplasm, and enlargement of the gland. This interferes with the ability of the normal physiological process of urine excretion due to the narrowing of the sphincter.

But difficulty urinating is not the only problem that occurs with prostate adenoma. Patients with this disease also develop kidney failure, which increases the poisoning of the body with toxins. The functioning of the stomach worsens, disturbances occur in the activity of the liver and excretory system. Signs of gastritis, cholecystitis, colitis and other diseases appear.

The urinary system ceases to function normally, which causes the accumulation of harmful nitrogenous substances in the body. To treat benign prostatic hyperplasia, various methods are used; non-surgical methods are gentle on the body.

Non-surgical treatment methods

Non-surgical methods of treating prostate adenoma are aimed at combating the disease without removing the affected gland. There are several types of non-surgical treatment:

• Minimally invasive
• Medication
• Traditional methods

Minimally invasive treatment methods

1. Urethral dilatation using a balloon, which expands the urethra and promotes normal urine outflow. The duration of the effect of the procedure is up to 6 months.
2. Stenting. It differs from the insertion of a balloon in that an elastic, durable stent is inserted into the urethra, which expands the lumen of the urethra, improving the ability to excrete urine. The stent is installed for varying periods of use, both temporarily and permanently.
3. Local thermal effect on certain areas of the gland. Using devices with different types of radiation: ultrasonic, radio and microwave. The radiation temperature is selected individually in the range of 40 – 120 °C and destroys only the focus of diseased cells without damaging healthy tissue.
4. Thermoablation provides for the action of ultrasonic waves of a certain range on the gland - from 50 to 100 kHz. This method destroys diseased cells; they die after the procedure.
5. Laser vaporization is based on the impact of a directed laser beam on the problem area. As a result of the procedure, fluid evaporates from the cells, the surface of the wounds heals, and the size of the gland decreases.
6. Embolization of prostate arteries– the newest method of non-surgical treatment. When using it, special medical spherical devices block the arteries, stopping the access of nutrients to the gland. Due to a decrease in nutrition, the gland “loses weight” and deflates.

The urologist selects minimally invasive methods for treating prostate adenoma for each patient individually.

Drug treatments

In the treatment of adenoma, various medications are used:

• Alpha blockers. They act on the muscles around the urethra, relaxing them and facilitating the passage of urine. Improvements are noticeable within a few days after treatment with Omnic, a new effective drug.

• 5-alpha reductase inhibitors, which reduce the production of the hormone dihydrotestosterone, which affects the growth of prostate cells. Drugs in this group are taken for a long time - 3-4 months.
• IN mistletoe therapy medicines based on white mistletoe are used. The plant is rich in alkaloids and activates the immune system, which destroys swollen and inflamed cells.
• In photodynamic treatment, intravenous sensitizers, which linger in tumor cells longer than in healthy cells. Then, under the influence of a laser beam of a certain length, a biochemical reaction occurs in these cells with the formation of oxygen free radicals, which locally destroy the tumor.
• In the system peptide therapy biologically active substances – peptides – are used. Preparations containing them help restore the body’s antitumor immune defense and reduce the risk of disease progression. Active peptides kill tumor cells.

Alternative medicines are varied, and their recipes have been passed down by word of mouth for hundreds of years. Here are some recipes for the treatment of prostate adenoma, subject to an established diagnosis:

• Fir oil gives good results. 5-6 drops of oil are added to the body cream, and the perineum is lubricated with this mass daily. The ointment is not used on the scrotum and anus.
• Decoction of fir bark: 2 tbsp. pour 200 ml of water into spoons of fine bark, heat in a water bath for 35 - 40 minutes, cool. Drink 0.5 glasses 30 minutes before meals, twice a day for 14 days.
• Herbal mixture of white mistletoe, burdock root, corn silk, cinquefoil, pepper knotweed. Mix 15 g of each herb, and pour 1 tablespoon of the mixture with 200 ml of boiling water. Cool naturally. Take up to 3 glasses daily for a month.
• There are pumpkin seeds. They contain the trace element zinc. It prevents cell growth and swelling of the gland.

Surgical methods of treatment

Surgical methods are used in cases of large size of the prostate and the period of development of the disease, as well as in cases of a later stage of tumor development. They are performed in a hospital setting after examination.

The following surgical methods exist to solve the problem:

• Transurethral resection (TUR). This method is more effective than other surgical options; a positive result is observed in 90 out of 100 patients. Under anesthesia, tumor cells are removed with a special device, and improvement in urination occurs 3-4 days after the operation.
• Transurethral incision (TUI) is used for slight enlargement of the gland and is considered a gentle surgical procedure - patients do not experience complications after it. During the operation, several incisions are made on the prostate gland, with the help of which the cause of difficulty urinating is eliminated. Sometimes the procedure needs to be repeated to completely cure the patient.
• Open adenomectomy is effective in cases of large prostate size. In addition, experts recommend using this treatment if the patient has complications: stones in the bladder, tissue damage from stones, a narrow lumen of the urethra. During surgery, a doctor makes a skin incision in the lower abdomen to “reach” the diseased gland. An adenomectomy involves removing the inner part of the gland.

Symptoms of adenoma

Symptoms of the disease that signal the presence of the disease:

• Difficulty in the physiological process of urination, especially at its beginning
• Frequent “demand” from the body to empty the bladder
• Feeling of incomplete emptying of the bladder
• Weak pressure of urine stream during urination, or interrupted process, urinary retention
• Pain during urination
• Uncontrollable urge, frequent urge to urinate at night, urinary incontinence

Causes and factors causing prostate adenoma disease

There are many reasons for the occurrence of prostate adenoma, here are the most common of them:

• Age-related changes
• Hormonal imbalance in the body as a result of complications after illnesses
• Decrease in the amount of sex hormones produced
• Genetic predisposition, inherited
• Individual physiological features of the structure of the genitourinary system
• Hypothermia, chronic inflammation of the kidneys, ureters, bladder

There is a risk of developing the disease if the patient:

• No regular sex life
• Genital trauma
• Poor nutrition
• Drinking large amounts of alcohol
• Low physical activity
• Taking a large number of medications and reducing the protective reaction of the body's immune system

Stages of prostate adenoma

According to medical tests and clinical studies, three stages of disease development are identified:

Stage 1 - compensated - is determined by a weak stream of urine during urination. There is a frequent desire to go to the toilet, especially at night. Complete emptying of the bladder occurs with the help of the detrusor - the muscular wall of the bladder and its ability to perform compensatory contractions. The duration of the first stage is purely individual, sometimes up to 10-12 years.

Stage 2 – subcompensated. At this stage, significant compression of the bladder disrupts the functioning of the urinary system and does not allow the walls of the bladder to “pulse” evenly at the time of emptying. Symptoms of an “unempty” bladder appear, the act of urination occurs in several stages, in small portions, spontaneous urine release and incontinence appear. At this stage, renal failure begins to develop.

Stage 3 - decompensated - is manifested by stagnation of a large amount of urine in the bladder, the walls of which are stretched because of this, involuntary emptying, drop by drop, and pain. The general condition of the body worsens, weakness, blood loss, weight loss, lack of appetite, constipation, anemia, and the release of urine vapor along with breathing appear.

Prevention of adenoma

To prevent and detect prostate adenoma, urologists recommend using the following preventive measures:

• Be sure to visit a urologist once a year.
• Remove fried, fatty and spicy foods from your diet.
• Avoid high-energy foods.
• Stop drinking alcoholic beverages and smoking.
• Increase physical activity - daily exercise, every other day exercise in the pool or gym, walking.
• Monitor your weight and avoid the appearance of fat deposits.

The main condition for curing prostate adenoma is timely consultation with a doctor and completion of a course of treatment. From the video below you will learn about modern medical biotherapeutic methods of treating the disease.

Anonymous 590

Very clear and useful article.

3 days Answer