In modern medicine, abbreviations are often used that are not entirely clear to an ordinary person without honey. education. One of these obscure abbreviations is BPH. What it is? Speaking in the language of doctors, this is benign prostatic hyperplasia. But in the people it is called more simply - prostate adenoma (a variant of "prostate adenoma" is possible). Often, prostate adenoma is confused with a disease such as prostatitis. BPH is a benign formation, and it grows not without the participation of the stromal component of the prostate (in other words, the glandular epithelium), and prostatitis is nothing more than inflammation of the prostate gland. Do not confuse them.
BPH. What it is? Statistics
As mentioned above, BPH is a benign neoplasm. With it, small nodules form in the prostate (the abbreviated name of the same prostate gland), which, as they grow, squeeze the urethra more and more.
Because of this, a man develops urination disorders. This disease has a benign growth, and this is what distinguishes BPH from cancer.
BPH is one of the mostcommon diseases in urology today. According to statistics, it appears in almost 80 percent of men in old age. In 20 percent of cases, instead of BPH, there is atrophy of the gland or its enlargement.
BPH disease most often develops in men over 45.
More than half of men aged 40 to 50 go to a specialist with this ailment, and only in rare cases can the disease overtake the young.
Causes of BPH
To date, the exact causes of the development of BPH of the prostate gland cannot be specified, since they simply have not been fully elucidated. It is believed that the disease is one of the signs of menopause in men.
The only risk factors are the level of androgens in the blood and the person's age.
Usually, as a man ages, the balance between estrogens and androgens is gradually disturbed, which causes a violation of control over the growth and function of gland cells.
It is known that there is no connection between BPH of the prostate and a person's sexual activity, orientation, bad habits, sexually transmitted and inflammatory diseases, and none of the above has any effect on the onset of the disease.
Pathogenesis
BPH of the prostate most often appears in its central part, but sometimes it can also capture the lateral lobes. The growth of benign hyperplasia depends on the adenomatous growth (tumor) of the paraurethral glands. Therebythe gland's own tissue is displaced outward, and a capsule is formed around the growing adenoma.
Hyperplastic (that is, affected by a tumor) cells of the prostate tissue also tend to grow both towards the rectum and the bladder, and this causes the internal opening of the bladder to shift upwards and lengthen the back of the urethra.
There are several forms of hyperplasia according to the type of its growth:
- Subvesical form of BPH. What it is? In this disease, the tumor grows towards the rectum.
- Intravesical form of BPH. The case history is characterized by the growth of the tumor to the bladder.
- Retrotrigonal form of BPH. The tumor in this case is located directly under the triangle of the human bladder.
Quite often, several forms of BPH can be seen in one person at the same time. This happens when the tumor grows in several directions at once.
BPH symptoms
Signs of this disease directly depend on the location of the tumor, its growth rate and size, as well as the degree of dysfunction of the bladder.
BPH of the prostate can be divided into three stages:
- Compensated, or the first stage. This form of the disease is manifested by delays in the onset of urination (frequent urge to empty, especially at night, is a concomitant symptom). With BPH 1 degree, the prostate gland increases in size, has a dense elasticconsistency. Its boundaries are clearly delineated, and in general, palpation of the gland (and its median sulcus) is painless. At this stage of the disease, the bladder is still completely emptied, and there is no residual urine at all. Grade 1 BPH can last from one to three years.
- Subcompensated, or the second stage. As the tumor develops, it compresses the urethra more and more, and the bladder is no longer able to function normally and empty completely (its walls thicken). As a result, with grade 2 BPH, residual urine appears, due to which the patient feels incomplete emptying of the bladder. Due to squeezing of the urethra, patients urinate in small portions, and after a while, urine begins to be excreted involuntarily (the reason for this is an overflowing bladder). Grade 2 BPH is sometimes accompanied by symptoms of chronic renal failure (developing against its background).
- Decompensated, or the third stage. The bladder is greatly distended due to residual urine, the urethra is still squeezed, and urine is excreted literally drop by drop, sometimes even with an admixture of blood. At this stage, BPH leads to impaired kidney function (renal failure). There is also weakness, severe weight loss, poor appetite, constipation, anemia, dry mouth.
Diagnosis of disease
The basis for diagnosis is the characteristic complaints of men, for whom a special scale for assessing the symptoms of prostate adenoma (based onEnglish I-PSS). Basically, the diagnosis of BPH is made after a clinical examination of the patient, as well as the following research methods:
- Palpatory (finger) rectal method for examining 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 urine test. They also conduct a biochemical blood test, which determines the level of PSA (stands for prostate specific antigen).
- Instrumental methods. The most common are cystoscopy and ureteroscopy. With their help, you can check the patency of the urethra, the condition of the lobes of the gland and the neck of the bladder. These procedures can determine the volume of residual urine.
- Ultrasound. 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 conventional ultrasound, TRUS (transrectal) is also used.
- X-ray methods of research. Excretory urography (with contrast) and plain radiography (without contrast) can help determine the presence of complications of BPH that has been treated. An X-ray is used to find stones 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 different stagesBPH. The treatment of this ailment can be divided into three parts:
- Medicated treatment
- Surgical method of treatment
- Other non-surgical treatments
Medicated treatment is usually given at the first sign of BPH.
In the early stages of prostate BPH, treatment is aimed at reducing the growth rate of hyperplastic prostate tissue, improving blood circulation in nearby organs, reducing inflammation of the prostate and bladder, eliminating urinary stasis, eliminating constipation, and facilitating urination.
In addition to the use of drugs, the patient is recommended to follow a mobile lifestyle, give up alcohol and harmful (too fatty, spicy, spicy) food, smoking.
You should also reduce your fluid intake in the afternoon, especially before bed.
In the presence of clinical and laboratory signs of androgen deficiency, androgen replacement therapy is also prescribed.
Often, in parallel with the treatment of hyperplasia, its complications are treated - cystitis, prostatitis or pyelonephritis.
Sometimes (against the background of hypothermia or drinking alcohol), the patient may develop acute urinary retention. In this case, the patient needs to be urgently hospitalized and undergo a bladder catheterization.
Let's take a closer look at each type of treatment.
Medicated treatment
Two types of drugs are most commonly used to treat BPH:
- Alpha-1 blockers (such as tamsulosin, doxazosin, or terazosin). Their action is aimed at relaxing the smooth muscles of the prostate and bladder neck, which leads to easier passage of urine. The action of these drugs may be prolonged or short.
- Inhibitors (blockers) 5-alpha reductase (permixon, dutasteride or finasteride). These medications prevent the production of dihydrotestosterone (the biologically active form of testosterone) in the sick person's body, causing the prostate gland to shrink.
Surgical method of treatment
In particularly severe cases, one drug treatment is not enough, and, as a rule, one has to resort to surgical intervention. This can be excision of hyperplastic tissue (adenomectomy) or total resection of the prostate gland (prostatectomy).
There are two types of surgery:
- Open operations (transvesical adenomectomy). With this intervention, access to the tissue of the gland is obtained through the wall of the bladder. This type is the most traumatic, and is used only in advanced cases. Open surgery provides a complete cure for BPH.
- Minimally invasive surgery (in which there is practically no surgical intervention). They are performed using modern video endoscopic technology, without incision. Access to the prostate through the urethra.
There is another type of surgery that cannot be compared with the above. Embolization of the arteries of the prostate is an operation that is performed by endovascular surgeons (the aboveconducted by urologists) and consists in blockage of the arteries of the prostate with small particles of a special medical polymer (through the femoral artery). Hospitalization is not required, the operation is performed under local anesthesia and is not traumatic.
After any type of surgery there is a small risk of complications such as urinary incontinence, impotence or urethral stricture.
Non-operative treatments
Non-operative treatments include the following:
- cryodestruction;
- transurethral needle ablation;
- high intensity focused ultrasound treatment;
- microwave prostate coagulation method or thermotherapy;
- insertion of prostatic stents in the area of narrowing;
- balloon dilatation of the prostate.
Post-operative period
Alas, at some stages of the disease, surgery is simply necessary. BPH is a serious disease, and even after surgery, you need to follow some rules in order to finally get rid of the disease and not provoke a reappearance. The three main things you should follow after surgery are a proper diet, a he althy lifestyle and regular visits to the doctor.
The postoperative diet is extremely important for the patient, as it can greatly contribute to a speedy recovery. The diet after the operation completely excludes fatty foods, spices, s alty and spicy foods and, of course, alcohol. It is recommended to eat a low-fat diet rich infiber.
As for work, if your profession does not involve frequent physical activity, then you can return to the workplace a couple of weeks after the operation. When sedentary work, it is recommended to do a warm-up every half an hour. A sedentary lifestyle can contribute to stagnation of blood in the organs, from which the disease only worsens. For the first few days after surgery, don't even think about lifting weights!
Give up smoking at least in the postoperative period (two weeks after surgery) if you can not quit the addiction completely. Nicotine damages the walls of blood vessels, and this affects the circulation of the prostate, resulting in an inflammatory process.
Many people think that after removing BPH, you should forget about sexual activity forever. This opinion is erroneous, and the sexual function of a man is completely restored after a while. However, it is worth resuming sexual relations no earlier than 4 weeks after the operation.
Another piece of advice worth paying attention to: you should not drive a car until a month after BPH removal.
In general, the postoperative period lasts about a month, after which the patient can already return to normal life. However, experts strongly recommend leading a he althy lifestyle to prevent the recurrence of the disease.
Urination after surgery
Almost immediately after the operation, the urine stream becomes stronger, and the emptying of the bladder is easier. After removal of the catheterfor some time, pain may occur when urinating, the reason for this is the passage of urine through the surgical wound.
Specialists do not exclude the occurrence of urinary incontinence or urgent urge to urinate in the postoperative period, these phenomena are completely normal. The more your symptoms bothered you during your illness, the longer your recovery period will be. Over time, all problems will disappear and you will return to the normal rhythm of life.
Some time after the intervention, there may be blood clots in the urine. This phenomenon is associated with wound healing. It is recommended to drink as much liquid as possible to properly flush the bladder. But with heavy bleeding, you should immediately contact the specialists.
Forecasts
Prolonged retention of urine (if BPH is not treated) can eventually lead to urolithiasis, in which stones form in the bladder, and later infection. In this case, the most serious complication that a patient can expect without proper treatment is pyelonephritis. This ailment further exacerbates kidney failure.
In addition, prostate adenoma can give rise to malignant growth - prostate cancer.
Prognosis with adequate and timely treatment of the disease is very favorable.
Disease prevention
The best prevention of BPH is regular follow-up with specialists and timely treatment of prostatitis.
It is also worth eating right (reducethe amount of fried, s alty foods, as well as spicy, spicy and smoked), stop smoking and alcoholic beverages. In general, a he althy lifestyle significantly reduces the risk of BPH.
So now you know what BPH is. The signs of this disease, treatment, postoperative period and even prevention are described in detail above.
In any case, this knowledge will be useful to you. Stay he althy!
