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Causes and symptoms of benign prostatic hyperplasia(BPH)

What is it? Benign prostatic hyperplasia (previously known as prostate adenoma) - the very first common urological disease in men after fifty. In the prostate formed nodes of various sizes and shapes, causing urination disorders and a variety of complications that threaten the life of the patient.

Causes. The emergence and development of BPH depends on many factors. First of all, this is a violation of age-related metabolism of male sex hormone - testosterone and increase estrogen levels. And it is important not only to the concentration of hormones in the blood, and their ability to live within the prostate.

BPH develops slowly, over decades of microscopic nodules and leads to a significant increase in the prostate. In normal prostate weighs about 20 grams, and in patients with BPH, it reaches 100 g (some - 250-300).

BPH Symptoms. Accepted separate course of the disease into three stages:

I. At this stage, patients noted a sluggish stream of urine, there is frequent urination, accompanied by a strong urge, especially at night, as well as some difficulty urinating.

II. Stream of urine thinned and very sluggish and a feeling of incomplete emptying of the bladder, as part of urine after urination (100-200 ml) is still in it. At this stage it may be acute urinary retention, impaired renal function.

III. In the most severe stage of BPH and a so-called paradoxical ischuria - the bladder is full, the patient can not urinate because of complete lack of muscle tone in it, but the urine is released all the time drop by drop. Upper urinary tract extended, kidney function is increasingly impaired.

These BPH symptoms at various stages of joining the numerous complications:

  • ystitis;
  • hematuria (blood in the urine mixture);
  • urolithiasis;
  • pyelonephritis;
  • prostatitis;
  • orhoepididimit;
  • urethritis;
  • CRF;
  • hydronephrosis;
  • urinary retention.

Diagnostics. According to international standards, the patient with suspected benign prostatic hyperplasia initially completes a questionnaire consisting of 7 questions that relate to the degree of severity of symptoms of voiding, and one question, evaluating the quality of life. The patient chooses one of the 6 response options. Each response is evaluated from 0 to 5 points, and the answer to the question about the quality of life - from 0 to 6 points.

  none Less than 1 time for 5 cases Less than in half cases Approximately half of the cases More than half of cases Almost always
1. How often do you get the feeling of incomplete emptying of the bladder after urinating in the last month?
0
1
2
3
4
5
2. How often have you had a need to urinate less than 2 hours after the last urination, during the last month?
0
1
2
3
4
5
3. How often during the last month urination was intermittently?
0
1
2
3
4
5
4. In the past month, how often do you find it difficult to temporarily refrain from urinating?
0
1
2
3
4
5
5. In the past month, how often did you feel weak pressure of the urine stream?
0
1
2
3
4
5
6. In the past month, how often you had to make efforts to begin urination?
0
1
2
3
4
5
7. How often on average you have to get up to urinate during the period of time between retiring and rising in the morning during the last month?
0
1
2
3
4
5

The scores from 0 to 7 indicates minor violations, ranging from 8 to 19 - to moderate violations.

The scores from 20 to 35 indicates severe BPH symptoms.

A patient delivers Urinalysis and complete blood count, blood creatinine and the level of the prostate - specific antigen.

Then the doctor carries digital rectal examination. In BPH the prostate spherical shape, enlarged, groove, separating its share it.

Ultrasound of the prostate with mandatory rectal probe determines the size of the prostate, the volume of residual urine.

Ultrasound of the kidneys is performed to determine the state of the upper urinary tract.

Urodynamic study indicates the degree of urination.

All other examination methods are complementary and are used under specific indications: excretory urography - with kidney biopsy of the prostate - for suspected cancer, cystoscopy - if an operation.

Treatment. All the variety of treatments for benign prostatic hyperplasia combined into five major groups.

1. Observation - if the number of points on the international system for the assessment of the disease does not exceed 7. The patient in this case should go to a urologist at least once every six months for the control survey.

2. Medical treatment . Used in stage I-II disease, and if the patient abstains from surgery or have contraindications to it at the moment. Currently, there are three main groups of drugs used to treat benign prostatic hyperplasia.

  • Inhibitors of 5-alpha reductase. There are synthetic origin (finasteride, proscar) and natural (permikson). These drugs block the conversion of testosterone into the prostate to harmful substances, causing its growth, as well as long-term use reduces the size of the prostate.
  • Alpha-adrenergic blockers. Medications with the curious title lower the tone of the musculature of the bladder neck, urethra and prostate gland. As a result, urine is able to safely go outside, even with an enlarged prostate. Most of these drugs also reduce blood pressure.
  • Herbal preparations. Used as an adjunct in the treatment of BPH. Possess anti-edematous and anti-inflammatory action. This extract from the bark of the African trees, palms, nettle, pumpkin, poplar, etc. - trianol, prostaplant, tadenan, urtiron, peponen, gentos, prostagut, Speman. In these preparations contain phytosterols - the substances that provide the above-mentioned effects. Parts of these substances have not been studied, the effects on the prostate is not fully known.

Medical therapy is effective only with long-term continuous use. If the patient stops receiving tablets, all the symptoms of benign prostatic hyperplasia return.

3. Non-operational treatment. Includes impact on prostate warmth I (thermotherapy) and cold (cryolysis). It usually dies of cancer tissue and prostate is reduced in size.

4. Treatment with lasers. The laser vaporized parts of the tumor.

5. Operative treatment. Only the operation helps to finally solve the problem of this disease. All other methods are not radical. There are several types of operations.

  • Open adenomectomy. The tumor is usually removed through the incision the bladder. Shown in the large mass of nodes, residual urine of more than 150 ml, the various complications of the disease. Postoperative period rather complicated.
  • Transurethral resection of the prostate gland. In this case, special cystoscopy - rezektoskopom, which is introduced into the urethra, cut out part of the prostate for the free passage of urine. The operation is the so-called "gold standard" in the treatment of BPH and is used most often.
  • Transurethral elektrovaporizatsiya prostate. Prostate tissue near the urethra evaporated special roller electrode.
  • Transurethral laser coagulation of the prostate gland. Laser electrode is introduced into the prostate tissue and burn tissue tumors.
  • Transurethral needle ablation of the prostate gland. In the prostate fed radio frequency energy, destroying the tumor.
  • Transurethral elektrointsiziya prostate. The prostate is divided by the electrode at 5, 7 and 12 hours suspended dial. The indications for this operation is a relatively young age of the patient with preserved sexual function and a small volume of the prostate.

Forecast. If untreated, patients develop various complications, some of them may lead to his death, not to mention a sharp decline in the quality of life.

Prevention. At the age of 50 years - visiting urologist every six months.




 

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Clinical experience in Treatment of benign prostatic hyperplasia

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