In modern medicine, abbreviations are often used, which are not quite 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 the people call it simpler - 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 but 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 (the abbreviated name of that prostate gland) , which, as they grow, compress the urethra more and more.
Because of this, a man develops urination disorders. This disease has 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, atrophy of the gland or its increase is observed.
BPH disease most often develops in men over 45 years of age.
More than half of men from 40 to 50 turn to a specialist with this ailment, and only in rare cases can the disease overtake the young.
Causes of BPH
To date, it is impossible to indicate the exact reasons for the development of prostate BPH, as they simply have not been fully clarified. 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 age of the person.
Usually, as a man ages, the balance between estrogen and androgen 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 prostate BPH and sexual activity, orientation, bad habits, sexually transmitted and inflammatory venous diseases, and none of the above affects the onset of the disease.
Pathogenesis
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 proliferation of (tumor) paraurethral glands. As a result, the gland’s own tissue is shifted outward, and a capsule from it is formed around the growing adenoma.
Hyperplastic (i.e., affected by a tumor) prostate tissue cells also tend to grow both towards the rectum and to the bladder, and this causes the upward movement of the internal opening of the bladder and lengthening of the posterior urethra.
There are several forms of hyperplasia by the type of its growth:
- Bubble form of BPH. What it is? With this disease, the tumor grows in the direction of the rectum.
- Intravesical form of BPH. The medical history is characterized by the growth of a tumor to the bladder.
- Retrotrigonal form of BPH. The tumor in this case is located directly below the triangle of the human bladder.
Quite often, several forms of BPH can be seen in one person at a 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.
Prostate BPH 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 - a concomitant symptom). With BPH of the 1st degree, the prostate gland increases in size, has a dense-elastic consistency. Its borders are clearly defined, and in general, palpation of the gland (and its median sulcus) is painless. At this stage of the disease, the bladder is still completely empty and there is absolutely no residual urine. BPH of the 1st degree 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 completely empty (its walls thicken at the same time). 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 the urine begins to stand out involuntarily (the cause is an overflowing bladder). BPH of the 2nd degree is sometimes accompanied by symptoms of chronic renal failure (developing against its background).
- Decompensated, or third stage. The bladder is very distended due to residual urine, the urethra is still squeezed, and the urine is literally dropwise, sometimes even with an admixture of blood. At this stage, BPH entails impaired renal function (renal failure). Weakness, severe weight loss, poor appetite, constipation, anemia, and dry mouth are also observed.
Diagnosis of the disease
The basis for the diagnosis is the characteristic complaints of men for whom a special scale for assessing the symptoms of prostate adenoma has been created (in English I-PSS). Basically, the diagnosis of BPH is made after a clinical examination of the patient, as well as such research methods:
- Palpation (digital) rectal examination of the prostate gland. Thanks to him, doctors have an idea about the consistency and size of the gland, the presence of a beard between its lobes, as well as the degree of pain on palpation.
- Laboratory studies of BPH. What it is? First of all, this is a familiar general urinalysis. A biochemical blood test is also performed, with which the PSA level is determined (stands for prostatic specific antigen).
- Instrumental methods. Most often this is cystoscopy and urethroscopy. With their help, you can check the patency of the urethra, the condition of the lobes of the gland and neck of the bladder. Using these procedures, you can determine the volume of residual urine.
- Ultrasonography. This is also one of the types of instrumental methods that allows you to see the size of each lobe of the gland, its condition (the presence of stones, nodular formations). In addition to the usual ultrasound, another TRUS (transrectal) is also used .
- X-ray research methods. Excretory urography (with contrast) and panoramic radiography (without contrast) can help determine the presence of complications of BPH, the treatment of which has been started. Using X-ray, stones are found in the bladder and kidneys.
BPH treatment
At the moment, there are many ways to treat the disease, each of which is highly effective at a different stage of BPH. The treatment of this disease can be divided into three parts:
- Drug treatment
- Surgical treatment
- Other non-surgical treatments
Medication is usually used at the first sign of BPH.
In the first stages of prostate BPH, treatment is aimed at reducing the growth rate of hyperplastic prostate tissue, improving blood circulation in adjacent organs, reducing inflammation of the prostate and bladder, eliminating stagnation of urine, eliminating constipation, and making urination easier.
In addition to the use of drugs, the patient is recommended to observe a mobile lifestyle, to abandon 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, treatment of its complications is carried out - cystitis, prostatitis or pyelonephritis.
Sometimes (due to hypothermia or alcohol), the patient may develop acute urinary retention. In this case, the patient urgently needs to be hospitalized and catheterized.
Let's take a closer look at each type of treatment.
Drug treatment
Most often, two types of drugs are used to treat BPH:
- Alpha-1-blockers (e.g., tamsulosin, doxazosin or terazosin). Their action is aimed at relaxing the smooth muscles of the prostate and the neck of the bladder, which facilitates the passage of urine. The action of these drugs can be prolonged or short.
- 5-alpha reductase inhibitors (blockers) (permixon, dutasteride or finasteride). These drugs do not allow dihydrotestosterone (a biologically active form of testosterone) to form in the body of a sick person, due to which the prostate gland decreases.
Surgical treatment
In especially severe cases, one medication can not do, and, as a rule, you have 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 gland tissue is obtained through the wall of the bladder. This type is the most traumatic, and is used only in advanced cases. An open operation provides a complete cure for BPH.
- Minimally invasive surgery (in which there is practically no surgical intervention). Conducted using modern video endoscopic technology, without an incision. Access to the prostate through the urethra.
There is another type of surgical intervention that cannot be compared with the above. Embolization of the prostate arteries is an operation performed by endovascular surgeons (the above are performed by urologists) and consists in blocking the prostate arteries 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 little risk of complications, such as urinary incontinence, impotence, or urethral stricture.
Non-surgical treatments
Non-operative methods of treatment include the following:
- cryodestruction;
- transurethral needle ablation;
- treatment using focused ultrasound of high intensity;
- method of microwave coagulation of the prostate or thermotherapy;
- the introduction of prostatic stents in the area of narrowing;
- balloon dilatation of the prostate.
Postoperative period
Alas, surgery is necessary at some stages of the disease. BPH is a serious disease, and even after surgery, you need to follow some rules to completely get rid of the disease and not provoke a reappearance. The three main points that you must observe 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, since he can significantly contribute to a speedy recovery. The diet after surgery completely eliminates fatty foods, spices, salty and spicy dishes and, of course, alcohol. It is recommended to eat low-fat foods rich in fiber.
As for work, if your profession does not imply frequent physical workloads, then you can return to your workplace after a couple of weeks after the operation. When sedentary work every half hour is recommended to do a warm-up. A sedentary lifestyle can contribute to stagnation of blood in organs, from which the disease only worsens. The first few days after surgery do not even think about lifting weights!
Stop smoking at least in the postoperative period (two weeks after surgery) if you can’t quit addiction at all. Nicotine damages the walls of blood vessels, and this affects the blood circulation of the prostate, as a result of which an inflammatory process can occur.
Many people think that after the removal of BPH, you should forever forget about sexual activity. This opinion is erroneous, and the sexual function of a man is fully restored after some time. However, to resume sexual intercourse is not earlier than 4 weeks after surgery.
Another tip that you should pay attention to: drive a car no earlier than a month after the removal of BPH.
In general, the postoperative period lasts about a month, after which the patient can already return to his usual life. However, experts strongly recommend leading a healthy lifestyle to prevent the re-emergence of the disease.
Urination after surgery
Almost immediately after the operation, the urine stream becomes stronger, and emptying the bladder is easier. After removal of the catheter, pain during urination may occur for some time, the reason for this is the passage of urine through a surgical wound.
Experts do not exclude the occurrence of urinary incontinence or urgent urination in the postoperative period, these phenomena are completely normal. The more worried you are during your illness symptoms, the longer your recovery period will be. Over time, all problems will disappear and you will return to the normal rhythm of life.
There may be blood clots in the urine for some time. This phenomenon is associated with wound healing. Drinking as much fluid as possible is recommended to rinse your bladder properly. But with severe bleeding, you should immediately consult a specialist.
Forecasts
Prolonged urinary retention (if treatment for prostate adenoma is not performed) can ultimately 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 renal failure.
In addition, prostate adenoma can give rise to malignant growth - prostate cancer.
Forecasts with adequate and timely treatment of the disease are 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), 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 come in handy. Be healthy!