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Ultrasound adenoma prostate preparation

Adenoma of the prostate or prostate is the most common disease among older men. Facts indicate that at the age of 40-49 years, 11% of men have this disease, and at the age of 80 years - no less than 80% of men.

The prostate gland is a male organ in the shape of a human heart, located next to the bladder, where the urethra comes out of it, and performs an important secretory function. The secret secreted by the prostate gland is one of the constituent parts of semen.

Recently, diseases of the prostate gland have significantly “rejuvenated”. At the age of 40-60 years, this organ is enlarged in almost all men, an adenoma is increasingly found even in thirty-year-olds. Most men turn to doctors complaining of signs of prostate adenoma too late when they notice poor bladder function. In such cases, the verdict is usually an operation on the gland, which can lead to impotence and other unpleasant complications. How to recognize prostate adenoma?

The course of the disease can be divided into three main stages. At the first stage, the functions of the bladder, urinary tract and kidneys are still preserved. If you take measures on time, this stage will never go to the next, characterized by damage to the urinary system. At the last stage of the course of the disease, the prostate gland is already greatly enlarged, and changes in the bladder are almost irreversible.

Symptoms of the first stage:

  • recurrent, mild urination disorders,
  • moderate enlargement of the prostate
  • there is no residual urine.

Symptoms of the second stage:

  • increased urination, thinning of the stream and other disorders, manifested more often,
  • a clear enlargement of the prostate gland,
  • beginning violation of the normal outflow of urine.

Symptoms of the third stage:

  • persistent urination disorder,
  • strong enlargement of the prostate gland,
  • the presence of residual urine of at least 50 ml,
  • disorders in the bladder - stagnation of urine, chronic urinary retention, etc.

How to recognize prostate adenoma yourself.

This disease is usually recognized based on complaints, age, and patient analysis. The nature of the stream of urine is carefully examined; in the presence of an adenoma, it is usually thin, lethargic, drops directly, and sometimes drops out.

For the diagnosis of adenoma, there are many modern methods, for example:

  • digital rectal examination, which determines the size, shape, soreness, mobility, surface structure and consistency of the rectal mucosa,
  • excretory urography, which allows to identify pathological changes in the upper urinary tract. The result of this examination is the construction of a cystogram - an image of the bladder with its defects, stones and neoplasms,
  • ultrasound is the most commonly used method that allows you to determine the size, configuration and structure of the prostate gland, as well as the amount of residual urine,
  • uroflowmetry - a method for determining pressure in the bladder.

Thus, the clinical symptoms of prostate adenoma depend on the progression of the disease and the presence of various complications. The clinical manifestations of the adenoma do not always correspond to its size, so it is very important to undergo regular preventive examinations, which will allow you to diagnose violations in the prostate gland in time and protect it from possible serious consequences.

Diagnosis of prostate adenoma is based on data from a medical history, physical examination of a patient, and clinical and laboratory studies.

Benign prostatic hyperplasia can be suspected even with careful collection medical history .

In the process of collecting an anamnesis, the doctor pays special attention to the following data:

  • The onset and duration of the symptoms of the disease
  • General health of the patient
  • The severity of symptoms and their impact on the patient's quality of life
  • Medicines taken continuously by the patient
  • Previous Treatment Data

The American Association of Urology has developed an index of prostatic symptoms to standardize the assessment of the severity of prostate adenoma. After you answer the questions of a specially designed questionnaire, the doctor will process your data and evaluate the severity of prostate adenoma as follows: up to 7 points - mild, from 8 to 19 points - moderate, 20-35 points - severe. This will help determine the stage of the disease and choose treatment tactics.

Symptoms characteristic of prostate adenoma can also be caused by other diseases, so physical examination and clinical and laboratory research methods help to rule out another etiology of the pathological process.

It is an integral part of the process of diagnosing prostate adenoma. Digital rectal examination of the prostate can be performed while standing or lying on its side with legs pulled up to the stomach. The doctor palpates the prostate with the index finger of the hand, after putting on the gloves and lubricating them with a lubricant for a smoother and more comfortable insertion. The finger is inserted into the rectum after relaxation of the anal sphincter, the prostate is palpated in a circular motion. In the process of this study, the doctor can obtain data on the size, shape and consistency of the prostate gland, to identify the presence of nodes and suspicious areas of the prostate gland. The normal prostate volume in young men is on average no more than 20 cc.

More accurate prostate size data can be obtained by transrectal ultrasound examination of the prostate . This procedure involves the introduction of an ultrasound transducer into the rectum, which sends high-frequency sound waves to the tissues, the perceived reflected echo waves allow the device to analyze how far the test object is located, its size, shape and consistency, to identify suspicious foci in the tissues of the prostate gland. The resulting image is immediately displayed on the monitor of the ultrasound machine. In the process of diagnosing prostate adenomas, an ultrasound examination of the abdominal cavity is also used, which allows you to determine the volume of residual urine in the bladder.

Blood test for prostate-specific antigen and prostatic acid phosphatase allow the doctor to screen for prostate cancer as the cause of the symptoms of the lower urinary tract. A prostate-specific antigen is a protein produced by prostate cells. Its blood content is measured in ng / ml (nanograms per milliliter). The level of prostate-specific antigen ≤ 4 ng / ml is considered normal, 4-10 ng / ml is slightly increased, 10-20 ng / ml is a moderately elevated level of prostate-specific antigen, and 20-35 ng / ml is significantly increased. The level of prostate-specific antigen can increase with malignant and benign conditions of the prostate gland (prostate adenoma, prostatitis, etc.). In addition, the level of prostate-specific antigen is determined by the size and weight of the prostate and the age of the patient. So, for example, for men aged 50-59 years, the level of a prostate-specific antigen equal to 3.5 ng / ml is considered normal, while in patients older than 70 years this figure can be 6.5 ng / ml.A blood test for the level of a prostate-specific antigen often gives false-positive and false-negative results when screening for prostate cancer and does not always exclude prostate cancer in a patient, which requires the appointment of a prostate biopsy procedure.

To exclude the inflammatory process of the genitourinary system, as the cause of the symptoms of the lower urinary tract, it is prescribed Analysis of urine with sediment microscopy. Detection of leukocytes (inflammation cells) and bacteria in the urine may indicate the presence of an infection of the genitourinary system.

Urodynamic tests allow you to determine the volume and pressure of urine in the bladder and evaluate the strength of the stream of urine. These tests are of great importance in the diagnosis of urinary tract sphincter insufficiency, urinary incontinence, changes in the functional activity of the bladder, etc. The following methods are used to diagnose prostate adenoma:

Uroflowmetry - an easy test to perform, which allows you to graphically record the volumetric speed of the urine stream during urination and to assess the completeness and speed of emptying the bladder. Thus, this method for the diagnosis of prostate adenoma gives the doctor an idea of ​​the tone and functional activity of the muscles of the bladder and the patency of the urethra. The essence of the method is that the patient needs to urinate in a special device that measures the volume of urine, the time of urination, and records the change in the volumetric flow rate of urine in the form of an uroflowogram. Reduced volumetric velocity of the urine stream may indicate the presence of prostate adenoma.

Definition residual urine volume allows you to measure the amount of urine remaining in the bladder after urination. The essence of the method is that the patient is asked to urinate, after which the volume of residual urine is measured by catheterization of the bladder or ultrasound. A residual urine volume of less than 50 ml indicates adequate emptying of the bladder, a volume of more than 100-200 ml indicates the presence of obstruction or a change in the tone of the detrusor muscle.

Pressure / flow study makes it possible to measure the speed of urine flow and pressure in the bladder during the act of urination. To conduct this study, an urethral catheter is inserted into the bladder. A pressure / flow study allows you to evaluate in detail the functional activity of a bladder detrusor and to identify obstruction of the urinary tract.
In addition, according to the indications, the patient may be prescribed radioisotope research methods, excretory urography, cystoscopy, etc.

Learn about modern diagnostic methods for such an insidious disease as prostate adenoma.

Adenoma of the prostate gland is considered a benign neoplasm in which specific nodules form in the prostate. The gland increases in size and thus puts pressure on the urethra. Therefore, the patient has a violation of urination.

Until now, doctors can not determine the exact cause of the disease. Today, doctors agree that prostate adenoma is a manifestation of male menopause. Key factors are the age and level of male sex hormones - androgens.

According to statistics, about 50% of men after 50 years turn to andrologists and urologists with prostate adenoma. And almost 80% of men, sooner or later, but face this problem.

How to identify the disease?

It’s easy to diagnose prostate adenoma. For this, various diagnostic methods are used.

Hello! I have prostate adenoma, the doctor insists on treatment and scares that everything can end badly 18 October 2013, 17:25 Hello! I have prostate adenoma, the doctor insists on treatment and scares that everything can end badly.Doctor, tell me, is it so serious, from adenoma, I, I think, do not die.

The first thing a doctor does is interview a patient. The following symptoms that the patient can tell about the disease can indicate:

  • difficulty urinating
  • weak stream when urinating,
  • urinate dropwise
  • intermittent urination
  • the presence of blood in the urine (hematuria),
  • the inability to completely empty the bladder.

Digital rectal examination

This method is the most “ancient”, the simplest, and at the same time one of the most effective. Thanks to this method, the doctor can probe the gland, determine its density, assess the condition of the median groove between the prostate lobes, and also check the condition of other tissues around the gland.

The value of this procedure lies in the cheapness, great information content, as well as the unnecessary additional tools. All that is needed is the experience of a research doctor.

With prostate adenoma, a general urinalysis and blood biochemistry are indicated. These tests are standard for any disease, and such tests do not carry any specific information for prostate adenoma. However, the doctor needs information about the presence of certain inflammatory processes in the patient's body.

Another laboratory test method is to check the level of PSA - a prostate-specific antigen - the most important diagnostic indicator for prostate adenoma. PSA is a protein secreted by prostate cells. The main function of PSA is to liquefy sperm after ejaculation. The American Urological Association recommends that all men older than 50 check their PSA levels.

If a prostate adenoma is suspected, ultrasound is usually performed. In this case, two types of ultrasound are distinguished: simple, which is performed with a full bladder and transrectal, when the sensor is inserted into the rectum.

Conventional ultrasound is usually sufficient for diagnosis. The doctor resorts to the transrectal method of research if all the previous research methods give an unclear picture of the disease.

The endoscopic method, the essence of which is that a thin elastic catheter with a miniature video camera and a light source is inserted into the urethra. Using this method, you can evaluate the degree of narrowing of the urethra with prostate adenoma.

Thanks to the method of urofluometry, you can study such a parameter as the rate of urination. The norm is urination at a speed of 15 ml per second. There are special urofluometers equipped with minicomputers, which automatically give the result in the form of numbers and graphs.

Contrast excretory urography

The essence of the method is that a special contrast agent is administered intravenously to the patient. After that, X-rays of the kidneys are made, with which you can assess the condition of the kidneys: the presence of inflammation, stones and other disorders that may be associated with prostate adenoma.

Prostate adenoma is otherwise called benign hyperplasia. Most often, the disease is diagnosed in men in old age. Moreover, signs of prostate adenoma are not always pronounced, which significantly complicates the diagnosis at an early stage of the pathological process and often makes treatment impossible with minimal changes.

The specific reasons provoking a change in the structure of tissues are not currently highlighted due to the presence of several opinions regarding the etiology of the process.

But specific risk factors can be noted, due to the action of which the symptoms of adenoma in men develop:

  • Imbalance of sex hormones (androgens and estrogens) due to age-related changes,
  • Decreased activity, a tendency to a sedentary lifestyle,
  • Bad habits in the form of alcohol abuse and smoking,
  • The presence of a history of sexually transmitted diseases or inflammatory processes, the development of atherosclerosis,
  • Negative environmental situation.

Also, as the reason why prostate adenoma develops, doctors tend to consider the influence of psycho-emotional overload and stress.

Symptoms

The prostate gland is a small organ composed of glandular and muscle structures. The location of the prostate is the area under the bladder. A characteristic anatomical feature is that the organ encompasses the initial portion of the urethra. The purpose of the prostate gland in men is to develop a secret that supports sperm activity after mixing with seminal fluid.

Symptoms of a violation of the state of the tissues of the organ are associated with proliferation of tissues, an increase in the prostate and subsequent violation of the outflow of urine. The danger of the disease lies in the possibility of developing pathologies of the kidneys, urolithiasis, cystitis.

The signs that reveal the violation in men are not associated with soreness of the prostate gland, but the urinary system is involved in the process, which entails significant discomfort and inconvenience. When the first complaints appear, it is extremely important to immediately contact a specialist so that prostate adenoma can be differentiated with prostatitis, a life-threatening cancer process or a pathological decrease in contractile activity that ensures the functioning of the muscles of the bladder.

Symptoms of pathology in men are divided into two groups.

Obstructive signs

They are caused by squeezing a part of the urethra, called the prostatic section, and a decrease in its clearance.

As a result, there is a violation of the outflow of urine, as evidenced by such symptoms:

  1. Difficulty urinating and increasing its duration.
  2. Sluggish stream of escaping urine.
  3. The inability to exit urine without stress of the abdominal wall.
  4. Sensation after the act of urination that the bladder is devastated incompletely.
  5. The combination of urine output and incontinence. In a professional environment, such a violation in men is called paradoxical ishuria.

Irritative symptoms

Along with the symptoms of prostate adenoma listed above, it is accompanied by signs characterizing changes in the muscle tissue of the bladder, and an excessive effect on the nerve endings present in the neck of the bladder, prostatic urethra, and the gland itself.

These are the following phenomena:

  1. The need for frequent awakenings during the night sleep for urination.
  2. Soreness of the process of urine output, the doses of which are too small.
  3. Accompanying urination by urinary incontinence.

If there is no timely treatment, the symptoms of the disorder in men can be aggravated due to the development of a number of complications:

  • Formation of stones in the bladder cavity,
  • Inflammation of the tissues of the urinary or kidney, turning into a chronic form,
  • Renal failure as a chronic disease,
  • Acute delayed urine output,
  • The presence in the cavity of the bladder of a residual portion of urine,
  • Detection in the urine of blood inclusions.

Diagnosis of the disease by concomitant symptoms

In men, when a certain period is reached, which begins, in most cases, at the 60-year-old turn, or earlier, there is an increased growth of glandular tissue cells in the area of ​​the bladder isthmus. Additional glands adjacent to the urethra, as well as the prostate's own tissues, increase. As a result of this process, benign prostatic hyperplasia (BPH) develops, that is, prostate adenoma.

Sprawling tissues deform the urethra, interfering with the full flow of urine.During a trip to the toilet due to narrowing of the lumen of the urethra, men begin to strain, squeezing out fluid from the bladder.

Signs of the disease are present both during emptying and when the bladder is full. When emptying:

  • difficulty starting the urethra,
  • the need for muscle tension in the peritoneum to remove urine,
  • weak stream
  • at the end of the urethra, dripping urine is observed for some time,
  • worried about urinary retention and incomplete emptying.

When filling, the following painful manifestations may be disturbing:

  • unbearable and frequent desires at any time of the day,
  • urinary incontinence appears.

Why does urination suffer with BPH? The thing is that during filling, pressure is created on certain areas located on the inner walls of the bladder. The enlarged prostate also begins to crush in these places. Because of what, the patient's life is complicated by the frequent urge to urinate.

Prostate adenoma is slow, progressing with age. Symptoms are not always permanent. During the course of the disease, there are periods when they increase or decrease. The listed symptoms worsen as a result of overcooling of the body, its physical or emotional overstrain, as well as with the abnormal use of alcohol, tobacco, smoked, fried, spicy food.

In case of suspicious symptoms, one should not delay a visit to the doctor, who, first of all, will ask the patient about complaints and manifestations of the disease: about its onset, dynamics, concomitant chronic diseases, injuries, allergic reactions, living conditions. Information about the presence of diseases that can cause disturbances in urination is especially important:

  • spinal injuries
  • multiple sclerosis
  • spinal cord problems
  • diabetes
  • alcoholism and others.

By analyzing the information collected and taking into account the patient examination data, the doctor makes a preliminary diagnosis. Subsequently, it can be confirmed or refuted by additional diagnostic measures.

Rectal examination of the prostate

Rectal palpation of the prostate is mandatory for men of the older age category (after 40 years), in whom the urologist diagnosed prostate disease. This method is quite informative and it is owned by any urologist. From the patient does not require any special training.

On palpation, the patient may be in the following positions:

  • standing, bending down and resting his hands,
  • on all fours, resting on the elbows and knees,
  • in a horizontal position, with bent and pressed legs to the body.

The doctor, dressed in examination gloves, applies grease to one of the fingers. It can be liquid paraffin or a special gel. Then he spreads the halves of the buttocks and carefully, slowly, introduces a finger through the anus into the rectum. Before this, the doctor informs the patient about the nature and purpose of the rectal examination, so as not to provoke an undesirable reaction in him.

This examination allows you to get enough information about the size and shape of the prostate gland, the distinctness of its interlobar groove, the symmetry of the lobes, the consistency, the presence of formations, stones, and more. A visual and laboratory assessment of the secretions of the prostate is performed.

In a healthy state, the prostate is round in shape with clear contours, has two equal lobes separated by a groove, a smooth surface, a uniform consistency, non-palpable seminal vesicles, and painlessly transfers the procedure.

In the case of BPH, a symmetric increase in the lobes is observed, while maintaining a uniform consistency, a smooth surface, a slightly smoothed median groove, the upper part of the gland due to its strong increase is not accessible for finger examination, the sensitivity of the organ is small.

Despite the improvement of the technical equipment of medical facilities, palpation examination is still in demand, and in many cases irreplaceable.

Compensation

Symptoms of the first stage are associated with urination disorder amid complete emptying of the bladder. Violation of urine can be determined by the flow of urine in a sluggish flow, the appearance in men of uncontrolled urges to empty the bladder (especially during night sleep), and a slight difficulty in urinating. The kidneys and upper parts of the urinary tract are not involved in the pathological process.

Subcompensation

Specific symptoms are explained by the preservation of a residual amount of urine in the bladder cavity and a clear violation of its functioning. As a result, there is a significant thinning of the outgoing stream and its lethargy, a feeling of insufficient emptying of the bladder, in which there is residual urine in a volume of 100 to 200 ml. Also, it is possible to ascertain an acute urinary retention in men associated with impaired renal function due to such a reason as difficult release of the upper urinary tract.

Symptoms and signs

How to identify prostate adenoma? Each organism always gives an alarm in a timely manner, if something is wrong with it, some organ malfunctions. There are a number of signs, in the presence of which you need to undergo a full examination in order to protect yourself from the development of prostate adenoma. Among them, the most common are lower back pain, an increased sensation of dryness and an irresistible desire to consume more water and painful ejaculation.

Symptoms of adenoma, following from the testimony of patients, identified:

  • frequent urination, especially at night,
  • late onset of urination
  • very squabbling urine stream
  • spotting rarely occurs.

The presence of the above symptoms depends on the level of neglect of this ailment. There are three stages of the disease. At the first stage of BPH, the bladder is still fully emptied; no noticeable changes occur in the upper urinary tract.

At the second stage of prostate adenoma, the increasing difficulty in the outflow of urine from the bladder systematically increases, a compensatory thickening of its muscular wall forms, which is illustrated by urine residues during the process of natural need management.

The patient has a certain feeling of incomplete emptying, he urinates several times in a row with a small stream. Cases of urinary retention due to the intake of various alcoholic beverages are also quite possible.

For the last stage, a typical sign was a loss of muscle tone of the bladder.

This manifests itself in a hitch or sudden incontinence, expressed in the form of involuntary discharge of urine in small doses, even if the bladder is actually completely full of fluid.

Diagnosis of prostate adenoma: methods and preparation. Diagnosis of prostate adenoma

How to identify prostate adenoma? - This question is often asked by male patients to the attending physician. Of course, great importance is attached to the method for determining this disease, since it is not only the diagnosis that depends on it, but also the treatment model chosen subsequently. What methods does modern medicine offer today to detect prostate adenoma?

Decompensation

Symptoms occur that characterize a pronounced impaired renal function. Negative manifestations are due to absolute atony (loss of muscle tone) of the bladder and are clearly visible during ultrasound examination by the expansion of the upper urinary tract. As a rule, at this stage, treatment is possible only through radical methods.

In addition to the listed stages, prostate adenoma is classified depending on the form of the disease for which the appropriate treatment is selected.

Possible options are:

  • Subvesical, if tissue growth occurs towards the rectum,
  • Retrotriagonal, when the altered tissues are localized under the triangle of the bladder,
  • Intravesical, if the tissue grows in the direction of the bladder,
  • Multifocal - they diagnose mixed growth in various directions.

Causes of adenoma

The prostate is located in the projection of the anterior wall of the rectum and consists of two lobes. The shape of the gland resembles a chestnut. The size of the normal organ is about 3 × 3 cm, the consistency is tightly elastic. The total tissue volume is normally 28 cm³.

After 30 years, in men, connective tissue begins to grow in the prostate gland. The size of the organ increases every year, which affects the quality of life and can lead to the development of cancer. Upon rectal examination, the doctor finds an increased dense formation, sometimes with tuberous contours, as a rule, painless.

The concepts of "hyperplasia" and "adenoma" of the prostate are synonymous, but the first of them is a modern term, and the second is an outdated one.

It is impossible to prevent the process of growth in the organ of connective tissue. The older the man, the more pronounced the changes. Pathological degeneration can only be slowed down by eliminating provocative factors from your life, which include:

  • sedentary lifestyle,
  • long work at the computer,
  • obesity,
  • malnutrition.

Almost all the male population of the planet is affected by these factors. Therefore, it is important to analyze your lifestyle and correct it in time.

Prostate Adenoma - Diagnosis in Men

The presence of prostate adenoma is possible only after a thorough history and complaints of the client. To conduct a full examination and prescribe the right treatment, prevention can only be a narrow specialist in the field of medicine - a urologist. There are several options for the correct diagnosis of BPH (benign prostatic hyperplasia).

The methodology for identifying prostate adenoma includes a number of procedures:

  1. Rectal examination - the doctor inserts a finger into the opening of the rectum in order to check the prostate for its enlargement.
  2. Blood test - determines the presence or absence of kidney problems. With uncomplicated prostate adenoma, blood tests should be normal.
  3. Urinalysis - the body is checked for infections.
  4. Ultrasound examination - diagnosis of the functional state of the entire bladder, determination of the amount of residual fluid in it.
  5. A biopsy is a sampling of prostate tissue to rule out prostate cancer.
  6. Inspection of the bladder using a special endoscope.

The combination of all the above methods of examination guarantees accuracy in diagnosing the disease and choosing the most effective treatment for prostate adenoma: medication or surgery.

Ultrasound of the prostate differs from other ultrasound examinations due to the fact that in most cases it is performed by the transrectal method (through the rectum).

On ultrasound, the signs of BPH are the most accurate, they serve as the basis for the appointment of the correct treatment. Such an examination is carried out with a special small sensor to maximize avoidance of the patient’s discomfort. At the same time, during the procedure itself, the latter is forced to lie on his left side, legs pressed to the abdomen.

In medical practice, there is another method of ultrasound - transabdominally, when the sensor is located on the skin of the anterior abdominal wall. This option has a significant drawback in that such a study can only provide a general idea of ​​the clinical picture of the disease.

Ultrasound of the prostate adenoma - preparation:

  1. When it is carried out in the first way, the patient is organized a couple of hours before the procedure to cleanse the rectum with an enema or inject a glycerin suppository into it. All this is done in order to ensure that feces do not become an obstacle when viewing the gland and also do not serve as a source of inconvenience for the patient and doctor, respectively.
  2. Another condition for observing all the rules for ultrasound is the filling of the bladder.For this purpose, it is necessary to drink at least a liter of liquid (it can be stewed fruit, water without gas, fruit drinks or even just tea).
  3. You need to go to the doctor when you identify the urge to urinate. Then you can start an ultrasound examination of the prostate adenoma.

Diagnosis of prostate adenoma: methods and preparation. Diagnosis based on the patient’s general medical history

The patient’s old age, characteristic complaints of a dysuric disorder and difficulty urinating, first of all, make the doctor assume the presence of prostate adenoma. However, a violation of the outflow of urine along the lower urinary tract can be caused by other diseases. In addition, prostate adenoma is often combined with other diseases of the genitourinary organs, intercurrent diseases. Therefore, a thorough clinical examination, laboratory research data are of significant value for the differential diagnosis of prostate adenoma, the choice of treatment method and preoperative preparation, management of the postoperative period.

Each patient must be carefully examined before surgery. The more severe the course of the disease, the more you need to get information about the function of various organs and systems. This is crucial for determining the scope of preoperative preparation, the choice of anesthesia method and treatment, and the prevention and treatment of postoperative complications. It is necessary not only to diagnose the disease, but also to determine the stage of the disease, the condition of other vital organs.

In patients under the age of 60 years with stage I and II, to make a diagnosis and determine the indications for surgery, it is enough to find out the anamnesis, examine the prostate gland through the rectum, study blood tests, urine tests (according to Zimnitsky), determine the content of urea, creatinine, blood group and its rhesus affiliation, blood coagulation, and also to exclude contraindications to surgical treatment from other organs.

Patients with symptoms of impaired renal function and urodynamics need a comprehensive study of x-ray, radiological, biochemical methods.

In elderly people, intercurrent diseases are more often observed. Therefore, along with purely urological research methods, the function of the heart, lungs, liver, pancreas, etc. is determined.

The study of urination is an important method for diagnosing prostate adenoma. The attending physician, first of all, must visually assess the act of urination, determine the color of the urine, and clarify whether there is an admixture of blood and pus in the urine. With adenoma, the urine stream is thinned, sluggish, intermittent, sometimes urine from the urethra is released dropwise. An admixture of blood is observed with a rupture of the vei of the mucous membrane of the bladder and prostate gland, pus is contained during infection of the urinary tract.

Examination of the prostate gland. A classic method for diagnosing prostate adenoma is a digital examination of the gland through the rectum. At the same time, it is possible to clarify the size of the prostate gland, to determine the degree and uniformity of the increase in lobes, the consistency, the presence of nodes and seals, the state of parastatic fiber, the mobility of the rectal mucosa above the gland. To determine the size of the gland, special electronic devices are used.

Adenoma of the prostate gland has a rounded shape (in the form of a sphere). With increase, the interlobar groove is smoothed. Often, its upper pole with a finger cannot be reached. The smoothness of the interlobar grooves, the smooth surface even with a slight enlargement of the prostate indicates the presence of adenoma.

The clinical picture of the disease is determined not by the size of the adenoma, but by the location of the nodes, that is, their effect on urodynamics. A small average lobe growing in the form of a valve into the lumen of the bladder or subtrigonal, palpation through the rectum is not widely available. According to this growth, the most dramatic changes in the urodynamics of the upper and lower urinary tract are observed. Of great importance for the diagnosis is the definition of the borders of the prostate gland. With adenoma, the borders (especially the lateral ones) are clearly expressed, and the gland itself is painless, of elastic consistency, without knots and seals. Dense nodes may indicate cancerous degeneration of the gland or adenoma. Soft nodes are observed in inflammatory infiltrates. Sometimes prostate stones (in the absence of crepitus) during a digital examination are mistaken for tumor nodes. If during palpation of the gland, a softening center and sharp pain are determined, you should think about an emerging abscess. Multiple small dense foci under the capsule, alternating with softening areas, are characteristic of tuberculosis.

With intravesical growth, the prostate gland from the rectum may be small.

Instrumental examination of the urethra. This manipulation is performed to study the length, deviation and patency of the urethra, as well as for the differential diagnosis between prostate adenoma and urethral stricture. In this case, the amount of residual urine is determined. A catheter or bougie is usually inserted. This study must be carried out very carefully so as not to damage the mucous membrane and not make a false move. Elongation of the posterior urethra and its deviation indicate prostate adenoma.

A study of the bladder is undertaken to clarify the state of muscle tone, emptying it, and determine the stage of the disease, identify secondary cystitis, stones, tumors, diverticulums, and a source of hematuria. In acute and chronic urinary retention (especially in emaciated patients with a flabby anterior abdominal wall), a spherical tumor-like formation above the bosom can be visually determined. On palpation, the distended bladder has clear boundaries, a smooth surface. With pressure on the distended bladder, the urge to urinate increases. With catheterization of the bladder, a lot of information can be obtained, in particular, the flow rate of urine or flushing fluid can be determined. The flow of urine stream under pressure indicates the preservation of muscle tone. With atony of the bladder, urine through the catheter is secreted by a sluggish stream or drops. The method of catheterization can determine the amount of residual urine, its volume is inversely dependent on the tone of the muscle emptying the bladder. In addition, using a two-way catheter and apparatus for measuring venous pressure, you can determine the tone of the muscle of the bladder.

Cystoscopy

In the initial stage of the disease, protrusions appear at the level of the ureteric ligament, making it wavy. With further growth, characteristic smooth nodes appear under the mucous membrane, changing the shape of the ureter fold. You can trace the increase in not only the middle, along and the lateral lobes of the prostate gland. With a subbubble growth of adenoma, the ureteral orifice is raised, and a recess is seen behind the ureteric ligament. The height of the mouth determines the size of the adenoma. When examining the mucous membrane of the bladder, it is necessary to pay attention to the state of the vessels and folding. Enlarged veins can be a source of hematuria. A slight trabecularity indicates the initial stage of hypertrophy of the muscle of the bladder, more pronounced - about the late stage of the disease, smooth mucous membrane with a large capacity - its atony.From the mouths of the ureters, it is possible to notice the discharge of purulent, bloody or transparent urine. The displacement of the ureteric fold indicates a compression by the adenomatous nodes of the ureters. Cystoscopy allows you to establish concomitant diseases of the bladder (tumors, stones, diverticulums, etc.) Approximate information about the function of the night and the urodynamics of the upper urinary tract can be obtained with chromocystoscopy.

Uroflowmetry

For the study of urodynamics, visual control of the urine stream is performed and the amount of residual urine is determined. Functional diagnosis of the lower urinary tract is still not given enough attention. Therefore, it is necessary to characterize them in more detail. Determining the uroflowmetric index is the simplest method for studying the urodynamics of the lower urinary tract. The time from the beginning to the end of urination is measured by a stopwatch. Urine is collected in a measuring vessel. The uroflowmetric index (UFM) is determined by the formula: UFM = v / t ml / s, where v is the amount of urine (ml), and t is the time of urination (s). The normal UVM is 11-17 ml / s. With UVM below 11 ml / s, a violation of the urodynamics of the lower urinary tract should be assumed. With a decrease in UVM, it is recommended to additionally determine the amount of residual urine by catheter.

Using retrograde cystomanometry, contractility, tone and reflex excitability of a muscle emptying the bladder are evaluated. These data are necessary for choosing tactics for acute urinary retention. Examination via a one-way catheter is called fractional cystomanometry. When a two-way catheter is installed, the study is performed by continuously filling the bladder. An antiseptic solution is fed into the bladder cavity through a dropper at a speed of 50-60 ml / min. on one of the channels. Another channel is connected to a water pressure gauge or electric manometer and a recording device. The amount of fluid injected into the bladder prior to urination and at the time of urination is noted. The sensitivity threshold is determined by the amount of solution introduced prior to the first urination. Normally, this is 120-300 ml with a maximum bladder capacity of 300-600 ml. A decrease in these indicators indicates a decrease in the sensitivity threshold of the bladder muscle and, conversely, late urge and an increase in bladder capacity are characteristic of a high sensitivity threshold. In the first case, they talk about hypertonicity of the muscle of the bladder, in the second - about hypotension or atony. The maximum intravesical pressure reflects the state of contractility of the muscle emptying the bladder. Normally, it is 39-78 hPa.

The choice of treatment option

More recently, the treatment of this pathology in men has been reduced to surgical intervention performed in the late stages of adenoma. The disadvantage of operations is the greater likelihood of complications that may accompany not only the operation, but also the postoperative period. Therefore, today prostate adenoma is increasingly being treated through drug therapy.

According to statistics, treatment with the use of special drugs is possible for 80% of patients. Modern tools can affect the causes of the pathological process.

The most popular are:

  • Polyene antibiotics, including Levorin, Nystatin, Natamycin,
  • Alpha-adrenergic blocking drugs, including Alfuprost, Artesin, Hyperprost and some others,
  • Medicines that are inhibitors of 5-alpha reductase, reducing the effect of androgens on the prostate. This is Avodart, Proscar,
  • Means of plant origin. These include Palprostes, Prostamol Uno, Prostaplant.

For maximum effect, treatment is usually carried out in combination, involving the simultaneous administration of several medications.

Symptoms of the disease

Prostate adenoma, like many other diseases of the human body, has its own symptoms.

They are divided into two broad categories:

Irritative symptoms are:

  • frequent incontinence
  • nocturia
  • increased urination
  • urgent urination.

Obstructive signs are:

  • a feeling of speedy emptying in the bladder,
  • drip urine at the end of the emptying process,
  • low "pressure" of the jet,
  • prolonged urination,
  • delayed onset of urination,
  • straining when the bladder is empty,
  • difficulty urinating.

All these symptoms signal changes that have occurred in the body and are pathogenic in nature. If one of these symptoms is found in oneself, one should go to the hospital for a mandatory diagnosis of the genitourinary system.

Adenoma surgery

If prostate adenoma is not amenable to conservative therapy and the symptoms persist, the following surgical options for men are considered:

  • An operation during which chemoablation of the prostate gland is performed,
  • Transurethral thermotherapy (treatment based on exposure to microwaves),
  • Transurethral needle ablation,
  • Carried out by the method of transurethral resection, incision of the prostate,
  • Electrovaporization of the prostate
  • Laser operation. Interstitial coagulation, visual ablation is possible.

In addition to proven techniques over the years, adenomas are also treated using new methods of radical therapy, which include surgery using focused high-intensity ultrasound and water-induced therapy.

Thus, due to the diversity of the proposed methods, it is possible to treat the pathology as efficiently as possible, restoring the impaired function. Prostate adenoma is not a sentence. Provided that a specialist is contacted in a timely manner, it is possible to eliminate the negative symptoms of the disease and return to normal life as soon as possible.

As such, prevention of prostate adenoma does not exist, but doctors emphasize that it is possible to reduce the risk of developing a disorder by leading a healthy lifestyle, abandoning bad habits, and maintaining activity even with age. Also, quality of food matters. And, of course, we must not forget about the necessity of undergoing preventive examinations by a urologist.

Causes and main symptoms of the disease

All factors of the appearance and growth of prostate adenoma by doctors are not fully established. The results of scientific research suggest that the main reason is the middle and advanced age of men. The risk of developing a prostate tumor rises sharply after 40-50 years. In men at this age, testosterone production naturally decreases and estrogen secretion increases, which is one of the conditions for the development of the disease. After 70 years, prostate adenoma is diagnosed by almost anyone who complains to a urologist.

Genetic predisposition is another factor contributing to the onset of the disease. If one of the patient's relatives was ill with prostate adenoma, it is not surprising that his diagnosis also reveals a similar ailment.

The risk group also includes people with overweight. Obesity leads to metabolic disorders and abnormal endocrine regulation. Adenoma of the prostate is affected, and lovers of unbalanced nutrition with a predominance of salty, fatty and spicy foods. Starting an adenoma can produce severe or prolonged hypothermia.

The same studies have proved that excessive male sexual activity or lack of sex, alcohol abuse, smoking and infectious diseases affect the occurrence and development of prostate adenoma to a much lesser extent, but they should not be completely discounted.An improper lifestyle and neglect of care of one’s health can equally be the basis for the appearance and growth of prostate adenoma.

This ailment makes itself felt unpleasant symptoms, among which:

  • frequent urination
  • intermittent and sluggish stream of urine, weakening of its pressure,
  • frequent urination, especially at night,
  • the need to immediately empty the bladder after urge,
  • pain during urination,
  • urinary incontinence when the bladder is completely full.

Prostate adenoma forms slowly, passing through three stages of its development. On the first, there are minimal violations of the urination process: a slight increase in speed and a weak stream of urine, a slight weakening of the function of the bladder. The duration of this phase in each patient is individual and takes 1-12 years.

The second stage of the disease is characterized by more pronounced symptoms, namely: the urine stream becomes intermittent, immediately after each visit to the toilet the patient has an unpleasant feeling that the bladder is not completely empty. This happens because urine begins to stagnate in it, and this leads to inflammation of the mucous organ. Urination is difficult, accompanied by sharp pains in the pubic area, lower back, a burning sensation.

The second stage of prostate adenoma without treatment almost always goes into the third when urinary retention becomes chronic. At the same time, fluid may be released from the filled bladder involuntarily, in small portions, and blood may be present in it. Nearby organs, especially the kidneys, also suffer greatly. The general condition of the patient only worsens.

Echoes of BPH: what is it?

By the concept of echoes of benign prostatic hyperplasia, doctors mean what the apparatus examines with ultrasound.

In our case, they include:

  1. Enlarged prostate up to 20 cubic centimeters.
  2. Changes in the tissue of the prostate gland, which is manifested in scarring of the affected cells and heterogeneity of the organ itself.
  3. The formation of calcifications, edema, fibrosis as a result of a prolonged inflammatory process in the prostate.

Methods for diagnosing pathology

Prostate adenoma, the diagnosis of which is the basis of treatment, has some symptoms that distinguish this disease from others. It is on the basis of these signs that one can judge the damage to the body by this disease. Nevertheless, it is quite difficult for a person who is not knowledgeable in this field of medicine to make a correct diagnosis, which indicates the need for mandatory treatment in a medical institution.

Proper consultation of a urologist can not only charge the body with a cheerful mood to fight the disease, but also help to prescribe the right treatment. A medical examination for the presence of adenomas in the body should be carried out when the slightest signs of this pathology appear.

The initial methods for diagnosing this pathology are to conduct a digital rectal examination of the prostate by a doctor.

Thanks to this method, the doctor will be able to identify the following parameters of this body:

  • consistency
  • density,
  • dimensional characteristics.

In addition to digital rectal examination, the patient must be prescribed an ultrasound study of the structure of the prostate. Prostate adenoma, the diagnosis of which is of great importance, in most cases affects the stronger sex in adulthood, therefore, during this period they need to be more attentive to their own health.

The treatment of an adenoma is necessarily carried out by a urologist.

With the help of this specialist, the following types of diagnostics are performed:

  1. Preliminary inspection.
  2. Finger research.
  3. Ultrasound of the prostate.
  4. TRUS (transrectal examination of an organ through the rectum).
  5. Urodynamic method for studying urine tests (measuring its flow, as well as identifying the degree of violation of the urinary process).
  6. Identification of the number of prostate-specific antigens that are contained in the bloodstream.

All these diagnostic methods contribute to an accurate diagnosis of the pathology existing in the body. In most cases, doctors use all these methods in combination to get the most accurate picture of the development of adenoma in the male body.

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The initial diagnosis of such a common disease among men as prostate adenoma is based primarily on a patient survey, during which the accompanying symptoms are determined.

Disease complications

An important role in the treatment of the disease is the diagnosis of prostate adenoma. Having discovered any, even the most insignificant, symptoms of prostate adenoma, it is necessary not to postpone to undergo a complete examination of the pelvic organs. If the presence of a tumor in the prostate gland is not detected in time and the appropriate treatment is not started, then the development of a number of serious complications will not be long in coming. What can be expected afterwards?

Prostate adenoma is often accompanied by urolithiasis, which develops as a result of urinary disorders due to constant incomplete and irregular discharge of the bladder. This happens due to squeezing of the urethra by the enlarged prostate, which leads to stagnation of urine in the bladder cavity and the gradual deposition of mineral formations in it - sand, and eventually stones. If the process is too started, the operation cannot be avoided.

The presence in the urine of blood or the development of a patient with hematuria is another complication of the disease that any man can encounter. This is not only unpleasant, but also dangerous to health. In the event of a symptom such as extensive bleeding, an emergency operation is performed.

The third, last, stage of prostate adenoma in patients is often accompanied by acute urinary retention, along with severe intoxication of the body. However, this condition can occur at earlier stages of the disease. Such a symptom requires urgent treatment, otherwise everything ends in death. In such cases, to normalize urination, the doctor inserts a catheter into the bladder through the urethra, which removes excess urine. And this is the only option of salvation.

Among the frequent complications of prostate adenoma, the development of various inflammatory processes in the excretory system, leading to a number of independent diseases, can be noted. This leads to the formation of:

At the last stages of prostate adenoma in men in polyclinics, diagnosis often also reveals renal failure. It is expressed by symptoms such as bloating, fetid stool, apathy, bad breath, hypothermia. Without treatment, renal failure leads to the imminent death of the patient.

Laboratory diagnostics

Blood and urine tests for uncomplicated BPH should be normal. With their help, inflammatory processes, dysfunction of the kidneys or liver, and hemocoagulation disorders are diagnosed.

  1. An increased number of white blood cells, red blood cells or bacteria reveals the presence of an inflammatory disease in the patient in the genitourinary system. A high concentration of salts in the collection of urine can be detected by the presence of stones in the urinary tract.
  2. Biochemical analysis characterizes the work of the kidneys, reveals renal failure. Fluctuations in creatinine and urea concentrations will indicate kidney dysfunction. If an imbalance of calcium, potassium and sodium or a low content of hemoglobin and red blood cells is observed, this can also indicate a decrease in kidney function.
  3. Hematuria indicates urolithiasis.
  4. Deviation of blood coagulability from the norm is present with renal dysfunctions and chronic pyelonephritis.
  5. PSA analysis helps to detect a malignant tumor process in time, as well as select patients for a prostate biopsy. The analysis is submitted before undergoing a digital rectal examination, since after it the PSA content may increase.

Conclusion

The key to success in any treatment is timely and accurate diagnosis of the problem area. Prostate adenoma is not a cross on the health of a man, but just that ailment that can be easily cured if, at the very beginning, when determining any of the symptoms and signs inherent in it described above, turn to a qualified specialist.

Features of urodynamic research

Determining the nature of the urinary process, as well as other characteristics of urine, are equally important in diagnosing adenoma.

Urodynamic studies are carried out thanks to such methods as:

These methods allow you to identify the true cause of disorders of the urethra.

Thanks to the results of such studies, a urologist can:

  • make an assessment of the health of the lower urinary departments,
  • determine the true cause of the symptoms,
  • recognize the degree of disruption of the bladder and related organs,
  • identify the characteristic features of the resulting pathological changes.

The use of uroflowmetry today is a prerequisite for obtaining the most accurate diagnosis of the pathology existing in the body.

This urodynamic examination of patients is prescribed primarily when patients complain about changes in the nature of urination. Treatment of adenoma with such a diagnostic method becomes much simpler and more effective.

Thanks to uroflowmetry, doctors can accurately measure urine flow to determine the true rate of urination. To date, this method is used using special electronic equipment. Electronics for uroflowmetry has improved so much today that this technique can be safely carried out even at home. Only this method is suitable for home use, and the rest require the supervision of an appropriate specialist.

Most of the urodynamic studies are carried out in a clinical setting, where special equipment and around-the-clock monitoring of medical personnel are located. For these purposes, separate rooms are specially equipped in hospitals - rooms where all the necessary equipment and related tools are in working mode. Each patient undergoes an urodynamic examination individually, which allows you to get the most reliable results and make an accurate diagnosis of the existing disease in the body. Remember, only the correct diagnosis allows you to identify the true cause of the pathology that occurred in the body and determine the nature of the treatment.

Adenoma (it is also officially called hyperplasia) of the prostate by urologists is recognized as one of the most common lesions in men who have overcome the 50-year threshold (in 30-40% of cases in patients 55-60 years old, in 75-90% of cases after 65 years).The disease occurs when changes occur that affect the tissues of the prostate, in particular, benign proliferation of glandular tissue, which extends up to the neck of the bladder. The consequences of untimely detection of the problem can be quite serious, therefore, methods should be "remembered" for men to "recognize" the symptoms and signs of prostate adenoma.

Prostate adenoma or hyperplasia appears mainly in men who have survived the age of 40-50 years

The main methods of diagnosing the disease

The initial step in the diagnosis of prostate adenoma is a detailed survey of the patient. It allows you to determine what the patient complains about. First of all, the doctor notes the age of the patient. The time of onset of symptoms, their severity, as well as a series of tests, make it possible to differentiate prostate adenoma from other urological diseases.

Rectal digital examination is the next stage of diagnosis. With its help, the size and density of the prostate is determined, and a benign tumor is distinguished from prostate cancer. Adenoma often appears in the center of the organ, while cancer affects the prostate mainly in the peripheral zones.

Despite the fact that this method is unpleasant for most men, it is one of the key points used for the correct diagnosis of prostate adenoma. Finger research is carried out as follows. The doctor puts on gloves and carefully inserts the index finger into the rectal region and gropes the prostate through its front wall. Normally, this organ is small in size and has a soft consistency, but with prostate adenoma it enlarges and becomes dense, which is explained by inflammation of the tissues. At the same time, his soreness is noted. With prostate cancer, sharp pain and a special dense body texture are also noted.

A general blood test is uninformative and cannot help determine the adenoma, therefore, the diagnosis of prostate adenoma also involves such a research method as determining the level of blood content of a patient with a prostate-specific antigen. This protein is a significant tumor marker, the detection of which in the blood serum confirms the presence of the disease. The test is typical for the modern diagnosis of prostate adenoma and monitoring the development of hyperplasia and prostate cancer. The PSA method is indicated for all patients older than fifty years.

Diagnosis of prostate adenoma does not do without determining the presence or absence of residual urine in the bladder, as well as its actual volume. In a healthy body, after urination, urine does not remain or it takes up no more than 10% of the amount of fluid before urination. With adenoma, it accumulates much more.

The main method for determining the amount of residual urine in patients is transabdominal ultrasound of the kidneys, prostate and bladder. The examination allows the patient to easily identify the number of milliliters of residual urine that is contained in his bladder in order to establish at what stage the prostate adenoma is. Ultrasound also determines the exact location and size of the tumor.

Another diagnosis of prostate adenoma using transrectal (through the anus) ultrasound allows you to more accurately assess the size and structure of the prostate. For this, the urologist introduces a special sensor through the rectum of the patient and conducts an examination to assess the condition of the organ.

Diagnosis of prostate adenoma with ultrasound can also reveal diseases of the genitourinary system associated with prostate adenoma, for example, stones in the bladder or kidneys, which complicates the diagnosis.

Sphincterometry

Investigate with a special apparatus, to which a tip is attached 1-2 cm long, with a diameter of 0.5-0.7 cm.After appropriate treatment of the external opening of the urethra, a sterile tip is inserted into the urethra to a depth of 1-1.5 cm and tightness is carried out by tightness (most conveniently a metal or rubber coupling). With a pear of a sphygmomanometer, air is slowly and evenly fed into the urethra. At the time of opening of the neck of the bladder, the pressure on the scale of the apparatus drops sharply. The highest rise characterizes the tone of the neck of the bladder and urethra. With an empty bladder, the minimum total tone is examined, with a full one, the maximum. Normally, these indicators are respectively 76.7-91 and 78-117 hPa. The degree of retention of urine also depends on the length, elasticity of the urethra and the condition of the muscles of its back. With prostate adenoma, urethral resistance increases, while the sphincter tone is reduced.

To assess the state of urodynamics of the lower urinary tract, urethral resistance and the effective cross-sectional area of ​​the urethra are important. The data of cystomanometry and radoisotopic uroflowmetry characterize the functions of the muscle emptying the bladder, vesicourethral segment and urethra.

Prostate ultrasound preparation

Depending on the choice of diagnostic method, preparation for ultrasound of the prostate should be carried out accordingly.

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General requirements in preparation for the procedure are:

  1. Before the examination, you must refrain from smoking.
  2. If ultrasound is done before noon, the patient should refrain from eating. In the event that the procedure is scheduled for afternoon hours, a light snack is allowed in the morning.
  3. Regardless of the method of examination, you must follow a diet for several days before the procedure.
  4. It is necessary to warn the doctor about taking medications for various purposes.
  5. Before the examination is not forbidden to have sex.

What is prostate adenoma

Prostate adenoma in men is a somewhat outdated term, it was replaced by the definition of BPH - benign prostatic hyperplasia. This definition “hides” the process of formation of tumor-nodes in a certain area of ​​the organ (the region of the transition zone), which mainly affects the male body, surviving the age of 40-50 years. The main problem with such a disease is that the growth and “creep” in the space of the tissues of an organ increases its size over time, which leads to the spread of education towards the urethra and to its compression. If at the initial stage this only leads to difficulty urinating, then subsequently the lesion will develop at least into inflammation in the cavity of the bladder, and maximum - to serious renal failure and intoxication of the body.

The cause of prostate adenoma is the occurrence in the male body of the process of "reconfiguration" of hormonal balance, inevitable when a certain age is reached. When the hormonal balance changes, the volume of testosterone (male sex hormone) abnormally decreases, the norm of the level of estrogen (respectively, female sex hormone) increases. Since this process usually coincides with the beginning of the extinction of sexual activity, it is obvious that for young people the risk of developing such a disease is extremely low.

In addition to the age and hormonal changes associated with the aging of the body, specialists do not identify other causes that make the likelihood of developing adenomas higher. However, although there is no exact confirmation, the influence of some factors may contribute to men's predisposition to the manifestation of the disease. In particular, such factors are:

  • bad habits (alcoholism, smoking),
  • improper nutrition (in particular, the abuse of salty and fatty foods with a minimum amount of plant components),
  • a lifestyle characterized by a lack of physical activity,
  • hereditary predisposition
  • overweight (due to improper diet or lifestyle).

Specialists cannot give a 100% complete answer to the question regarding what is prostate adenoma and for what reasons it begins to develop. However, they are quite well versed in what relates to the symptoms of prostate adenoma. Symptoms of hyperplasia should also be known to potential patients.

The first signs of prostate adenoma may be urgent (imperative) urination during the day

X-ray diagnostic methods

The following methods are used in the diagnosis of prostate adenoma: excretory urography, cystography, mixed cystography, urethrocystography, prostatotomography, prostatocystopneumography. In recent years, they began to use X-ray diffraction, which with the help of selenium plates allows you to get an image of the urinary tract and adenomas on paper. The use of electron-optical converters and video recording also allows you to obtain the necessary data.

Using X-ray research methods, you can determine the size, shape and direction of growth of the adenoma, to find out the anatomical and functional changes in the kidneys and ureters, which is very important for the diagnosis of complications of prostate adenoma, in particular bladder stones, diverticulums, prostate stones. For differential diagnosis between adenoma and bladder cancer, these X-ray methods are not enough. In such cases, biopsy data are needed.

In a survey picture of the urinary organs, you can sometimes see a shadow of the bladder if it contains urine. Against the background of this shadow, calculi are visible. X-ray negative calculi are determined by the defects of the shadow of the bubble. The localization of stones in the bubble makes it possible in some cases to determine the magnitude and direction of growth of the adenoma.

The data of excretory urography make it possible to find out the functional state of the kidneys and urodynamics of the ureters, to clarify the anatomical changes in them, to reveal diverticulums and non-contrast bladder calculi, trabecularity, neoplasms, and also the approximate dimensions of the adenoma. In renal failure, the diagnostic value of excretory urography data decreases. In these cases, they resort to retrograde contrast of the bladder - cystography and urethrocystography.

Cystography and urethrocystography with liquid or gaseous contrast agents for prostate adenoma can detect deviation, elongation, narrowing of the back of the urethra, size, shape and direction of growth of the adenoma, trabecularity, diverticulosis, X-ray negative bladder stones, and also neoplasms.

For the diagnosis of obstruction of the vesicoureteral segment, cystography is used. This study is performed under the control of video. In this case, it is possible to identify the symptoms of obstruction of the vesicourethral segment. In case of prostate adenoma, the neck of the bladder does not open well, during the mixes, the contrasted urine in separate portions or a blast stream enters the back of the urethra.The act of urination occurs mainly due to straining, that is, an increase in intra-abdominal pressure. Sometimes, on active micic cystograms, active or passive vesicoureteral reflux is defined on one or both sides. With good patency of the urethra, the bladder is emptied and gradually contracts. With an adenoma, when there is a violation of urination and residual urine is contained, there is no complete reduction. By the shadow of the remaining urine contrast, one can judge the degree of impaired muscle tone, which empties the bladder.

Prostatography and prostatocystopneumography are used to more accurately determine the size, shape and direction of growth of the adenoma, especially in the part inaccessible to palpation. Prostatography is used before transurethral electroresection, since indications for this type of treatment are determined on the basis of data on the size and direction of growth of adenomas.

How to identify prostate adenoma? - This question is often asked by male patients to the attending physician. Of course, great importance is attached to the method for determining this disease, since it is not only the diagnosis that depends on it, but also the treatment model chosen subsequently. What methods does modern medicine offer today to detect prostate adenoma?

Transabdominal method

There are several methods for conducting ultrasound diagnostics of the prostate gland, the most painless is transabdominal diagnosis (brief designation - TAUSI). This type of study is prescribed for the initial examination of a presumably healthy patient. With the help of TAUZI, it is possible to determine the approximate dimensions of the prostate, to identify violations in the state of the bladder. Also, this type of research is often carried out simultaneously with ultrasound of the abdominal organs.

A transabdominal examination is done non-invasively in the suprapubic part. This method eliminates the occurrence of pain, since the ultrasound probe moves along the abdominal wall without penetration. However, the accuracy of the examination is slightly lower than when diagnosed transrectally, especially if the patient has a large fat layer.

TAUSI is used for acute hemorrhoids, anal fissures, during the recovery period after rectal surgery, as well as for problems with blood coagulation.

Contraindication to this diagnostic method is the presence of fresh sutures and bandages in the abdomen.

The advantage of the examination is that it does not require complicated preparation for ultrasound of the prostate in men. When the attending physician decided to diagnose transabdominally, it is enough for the patient to follow the simple rules of nutrition the day before and a special drinking regimen on the day of the procedure.

Directly in the ultrasound room, the patient should prepare for such actions: expose the suprapubic zone of the abdomen and take a lying position on the back on the couch. The doctor usually does the decryption and analysis of the data obtained immediately.

In order for the results to be more accurate, it is necessary to exclude factors that can provoke spasms in the abdominal cavity.

Additional methods for diagnosing the disease

For accurate diagnosis of prostate adenoma, diagnostics of the kidneys and the degree of patency of the urinary tract, the patient undergoes excretory urography. The meaning of this radiological method of research is that the patient is injected with an intravenous contrast medium and monitored by the kidneys on x-rays. The survey results allow you not to miss the time of onset of renal diseases and their complications.

Diagnosis of prostate adenoma using an uroflow meter is another non-invasive research method that a doctor can prescribe to a patient.It allows you to control the speed of the outflow of urine from the patient's compressed bladder during urination. To do this, he urinates in the reservoir of a special device, which gives an automatic conclusion about the nature of the functional disorders of urination. Based on the test results, the doctor prescribes the treatment of the disease, in particular, makes a conclusion about the need for surgery. Uroflowmetry is especially relevant for men of age who are not suitable for other diagnostic methods.

Diagnosis of prostate adenoma is also an accurate determination of the degree of abnormal narrowing of the urethra (cystoscopy). For this purpose, a special elastic catheter is inserted into the urethra with a video camera at the end and a backlight.

Clinical manifestations

Any diagnostic process begins with a medical history. The patient first notes the frequent nightly rising, desire to urinate again, difficulty urinating, sluggish flight of the stream, the need to wash drops of urine from the shoes (a symptom of “wet shoes”). If the disease develops for more than one year, a man indicates frequent urination for a whole day, a feeling of fullness of the bladder.

Some patients find out about their illness with a sudden cessation of urination. This situation is called acute urinary retention. It can provoke the use of alcohol, stones in the bladder, prolonged ignoring of signs of ill health.

Symptoms of Hyperplasia

The first signs of prostate adenoma, due to the location of the organ and the spread of neoplasms in its tissues to the urethra, are:

  • Significant increase in urination at night,
  • urgent (imperative) urges during the day,
  • difficulty starting the bladder emptying process,
  • noticeable weakening of the urine stream,
  • the allocation of a few drops of urine after the completion of the act of urination.

The manifestation of an adenoma by the listed and some other signs occurs in several stages. The development of the disease proceeds rather slowly, everything can go unnoticed if neoplasms in the tissues of the gland are not localized in close proximity to the urethra. By location (and, consequently, by the intensity of the symptoms), the lesion is classified as follows:

  • an intravesical adenoma (intravesical), expanding towards the neck of the bladder, due to which it deforms and clogs the urethra,
  • retrotrigonal adenoma (prevesical), in which protrusion of the neoplasms occurs on the sides of the prostate gland, that is, their minimal contact with the bladder,
  • intratrigonal adenoma (subvesical), the increase in size of which is directed towards the intestine and only slightly affects the bottom of the bladder.

Each of the listed varieties is quite dangerous, since it affects, to one degree or another, different parts of the urinary system (bladder, lower or upper urinary tract). Nevertheless, in the case of a subbubble formation, the patient’s good state of health remains long enough, while the intravesical form may have sufficiently pronounced symptoms at an early stage.

If cancer is suspected

An important task in diagnosing prostate adenoma is to determine whether a neoplasm has a benign or malignant nature, since the symptoms of these diseases (adenomas and cancer) are similar. In such cases, an organ biopsy is prescribed. To do this, under local anesthesia, a tissue sample is taken from a suspicious site and sent for histological examination. It is carried out in a special laboratory. Examining the patient’s tissue cells under a microscope makes it possible to confirm with confidence or completely exclude prostate cancer from him.Often a biopsy is prescribed to patients after 50-60 years.

The refinement method for the diagnosis of malignant neoplasms is MRI, which allows you to get visual information about the state of the tissues of the prostate gland, nearby lymph nodes, seminal vesicles, as well as the size and location of the tumor, the presence of metastases.

Special diet

General recommendations for dieting in preparation for ultrasound of the prostate are reduced to the fact that the subject should exclude all products that provoke gas formation.

2-3 days before the date of the survey, it is forbidden to eat the following foods:

  1. Butter and yeast flour products.
  2. Foods high in coarse fiber.
  3. Legumes.
  4. Vegetables and fruits without heat treatment.
  5. Dairy products.
  6. Carbonated and alcoholic drinks.

The patient should make a diet that will include cereals, low-fat first courses with any boiled meat and other products that do not cause flatulence. In some cases, the doctor may prescribe medications to reduce swelling, for example, Espumisan.

Lower urinary tract examination

It is carried out after an examination of the prostate. Its purpose is to determine the patency of the urethra and the volume of residual urine. A catheter, which is a soft tube, is inserted into the urethra. Extreme caution is required, since the integrity of the mucous membranes can easily be violated. Displacement of the urethra, as well as lengthening of its posterior part indicate prostate adenoma.

Catheterization of the bladder allows you to determine at what stage the disease is, the tone of the muscle responsible for urine output, as well as associated pathologies (stones, tumors and others) are detected. With constant urinary retention in patients with a flaccid abdominal wall, you can visually, as well as with a manual examination, determine a spherical tumor formation, slightly protruding in the suprapubic region.

An external examination of the stretched organ reveals a flat surface, as well as quite expressive contours. Pressing the bladder with the fingers causes and intensifies the urge to empty it.

During catheterization of the bladder, the urine flow rate is determined. A good head pressure indicates normal muscle tone. If the flushing fluid or urine is sluggish along the catheter, excreted in drops - this indicates that the organ has partially lost its contractility. If the fluid does not leak at all, this indicates a complete loss of muscle function.

Using catheterization after urination, learn about the amount of urine remaining. It depends on the tone of the muscle, carrying out the withdrawal of urine from the bladder. If more than 100 ml of liquid is detected, then incomplete emptying is present. The same can be determined by ultrasound. The data obtained help to establish the stage of prostate adenoma disease. Diagnosis using a catheter eliminates a disease such as urethral stricture.

In some cases, catheterization is contraindicated. For example, patients with aseptic (sterile) urine. Such patients are very susceptible to urinary infections and instrumental examination poses a certain danger to them. Therefore, if it is impossible to do without the use of a catheter, antibiotics are taken along with the procedure.

Disease treatment

There is an opinion that the treatment of the disease is not complete without surgery, but this is not always the case. Early and timely diagnosis of prostate adenoma allows the attending physician to prescribe appropriate conservative treatment to his patient, however, it all depends on the stage of prostate adenoma.

If the disease is at the initial stage, drug therapy shows excellent results.Such treatment is prescribed for patients with mild symptoms, minor violations of the urination process without involvement in the pathological process of the bladder, upper urinary tract and the presence of complications.

Combined drug therapy for patients with prostate adenoma consists in prescribing them:

  • alpha adrenergic blockers,
  • 5-alpha reductase inhibitors.

This combination of drugs has a powerful effect on the disease, stops the growth of the tumor, improves the condition of patients, and returns the lost function to the affected organ.

Positive results along with traditional methods of treating prostate adenoma show methods such as:

  • phytotherapy,
  • diet,
  • prostate massage,
  • balloon dilatation and stenting of the urethra.

In the terminal stages of the disease, the doctor prescribes surgery. Variants of surgical cure for pathology can be:

  • transurethral resection,
  • transurethral vaporization,
  • laser removal
  • cryodestruction
  • open adenomectomy.

Timely diagnosis of prostate adenoma provides an opportunity at the initial stages of the disease to stop the development of the tumor with the help of simple folk remedies - tinctures, decoctions, collections of medicinal herbs. They include datura, bird highlander, thyme, leaves of wild strawberry and blackberry, plantain, Ivan tea, chamomile, St. John's wort.

It is also possible to reduce prostatic hyperplasia by various combinations of available medicines from the arsenal of traditional medicine, including: onions and garlic, walnut kernels, horse chestnut, pumpkin and sunflower seeds, bearberry, aloe, sea buckthorn and fir oil.

They bring a noticeable improvement in prostate adenoma and bee products: honey, morbidity, propolis. They are used both orally and they are made from medicinal candles.

The initial diagnosis of such a common disease among men as prostate adenoma is based primarily on a patient survey, during which the accompanying symptoms are determined.

Stage 1 signs

Symptoms of prostate adenoma progress in 3 consecutive stages. At the 1st (compensated) stage, the signs of the disease are not noticeable, they include weakness of the stream, increased urgency, especially at night, strong pressure in the urethra, difficulty in starting and in the process of urination. Sometimes the bladder emptying procedure is painful, and blood impurities are noticeable in the urine. Additionally, the patient feels:

At the 1st (compensated) stage, sometimes the procedure for emptying the bladder is painful, there is severe pain in the groin, giving off to the testicles

  • severe pain in the groin, extending to the testicles,
  • a feeling of strong and almost constant pressure in the bladder,
  • the need to make an effort to start urinating,
  • a feeling of fullness of the bladder,
  • rarely - erection malfunctions.

Echo signs as the results of ultrasound examination already at this stage demonstrate that nodules (one or several) have formed in the prostate, enlarged so as to affect the patency of the urethra. Problems with getting rid of urine lead to overflow of the bladder and congestion, as a result of which inflammation develops, and since the walls of the bladder weaken and lose their tone, incontinence becomes a possible scenario. Although such formations are benign and do not give metastases, it is easier to treat them at this stage than at subsequent stages, and the consequences can be much less.

Men who contacted a urologist in a timely manner and started treatment can cope with the symptoms characteristic of the first stage of BPH quite easily, and after one course of drug exposure they usually return to their usual lives.

Bladder filling

Filling the bladder before examination transabdominally is a mandatory procedure. This is done to get a clearer picture of organs. With an empty bladder, an empty space is formed in the abdominal cavity that impairs visibility.

The volume of fluid and the amount of time that you must withstand before the procedure depend on the objectives of the study.

If the goal is to determine the causes of infertility or dysfunction of the genital organ, the amount drunk is about 1 liter 2-3 hours before admission.

When diagnosing difficulties with residual urination, the patient should drink more than 1 liter of fluid half an hour before the appointed time. It is also necessary to have some water in hand in case of insufficient filling of the bladder. You should go into the office with a feeling of light urge to urinate. If the desire to urinate is too strong, then pressing the sensor on the wall of the abdomen may cause painful sensations and increased urges.

Instrumental examination methods

Most often, an ultrasound examination of the prostate is prescribed. This method allows you to measure the volume of the prostate (normal - 28 cm³, 1 stage of adenoma - 50 cm³, 2 stages - 55 cm³, 3 stages - 60 cm³ or more), visualize hypo- and hyperechoic areas, the presence of cysts or stones, residual urine volume .

To clarify the diagnosis (benign or malignant), a prostate biopsy is performed. The study is carried out after cleansing the rectum with a special gun. To obtain reliable results, tissue sampling is performed from several points.

Before tissue collection for the study, you need to prepare:

  • cleanse the intestines (enemas or laxatives are used for this)
  • 30 minutes before the procedure, drink an antibiotic or inject it parenterally (intravenously, intramuscularly) to prevent infection of injection sites,
  • shave the perineum, especially the inner surface of the buttocks, so that the hair does not interfere with the doctor.

In difficult cases, computed tomography of the pelvis or magnetic resonance imaging is prescribed. Such studies are necessary to determine the nature of the pathology of the pelvic organs, the presence of malignancy, the germination of metastases.

2nd stage of prostatic hyperplasia

Signs of the 2nd stage of prostatic hyperplasia (subcompensated) are more noticeable and wider than in the previous stage. The volume of residual urine is growing, overflowing the bladder, stagnating in it, which inevitably provokes inflammation. The smooth muscle structure of the walls of the bladder wears out and atrophies, the outflow of urine deteriorates even more, which makes the urination process more difficult - to urinate, you have to strain your stomach and take breaks. At this stage, one of the complications (in addition to the main unpleasant symptoms of prostate adenoma in men) is the likelihood of developing an inguinal hernia, as well as prolapse of the rectum. Manifestations of the disease are becoming more painful.

Pictures of ultrasound diagnostics show the presence of gross fold-like formations on the gland, which serve as barriers between the ureters and the bladder. Folds stop the flow of urine through the urinary system, which causes stagnation, inflammation, and its foci eventually begin to spread to all parts of the system - kidneys, ureters, bladder. The course of the disease at this stage at any time can lead to complications, especially if the patient himself contributes to this by abusing bad habits, staying in stressful situations, undergoing hypothermia and ignoring the instructions of the attending physician.Under such conditions, the ailment goes so far that treatment with medications alone is no longer enough, especially if there is an absolute delay in urine excretion, which cannot be dealt with without catheterization in a hospital setting.

At the decompensation stage, treatment of prostate adenoma is only surgical, since otherwise a fatal outcome is likely

Transrectal method

The transrectal method - abbreviated as TRUS, is the most accurate of all prostate ultrasound techniques. This is due to the physiological location of the organ in the pelvis. With TRUS, structural changes in the prostate gland, benign tumors that cannot be detected by palpation or with TAUS, can be detected. Also, a transrectal ultrasound is prescribed for a biopsy. It is done invasively through the rectum.

That is why many men have a negative attitude to this method, experiencing psychological discomfort. This method is notable for its thorough preparation for ultrasound of the prostate. Excessive nervousness can lead to spasm of the muscles of the anus and the appearance of pain. Therefore, doctors recommend taking a mild sedative before a visit.

If the patient has hemorrhoids, only the period of exacerbation will become a ban on the procedure. TRUS is not prescribed for removal of the end sections of the intestine, in the presence of cracks in the anus.

Transrectal ultrasound is prescribed for overweight patients when it is impossible to conduct a more comfortable TAUSI.

As before TAUZI, a few days before the examination of the prostate is transrectal, it is necessary to follow a non-slag diet, in which there will be no stagnation of feces and gas formation. It is especially important to exclude alcohol and carbonated drinks from the diet. If the intestine is not cleaned, the sensor may take its contents for prostate neoplasms. Eat later than 6 o’clock in the evening on the eve of the day of the examination is impossible. On the day of admission, it is allowed to drink water or unsweetened tea drink. The bladder is filled as in the diagnosis transabdominally.

If the procedure is prescribed unscheduled, it is necessary to use a special condom, which is worn on the sensor.

While in the office, the patient must do the following:

  1. Bare the lower body and lie sideways on the couch, with your back to the doctor. The legs should be bent at the knees and pulled to the stomach.
  2. When introducing the sensor into the end section of the intestine, through the sphincter, it is important to achieve the greatest relaxation in order to avoid pain.

The doctor carefully examines the images of the organ. The results of the analysis will be immediately.

Preparation for a planned transrectal ultrasound of the prostate necessarily includes a procedure for cleaning the intestines by enema or taking laxatives.

Laboratory methods

The urologist directs for the delivery of a general and biochemical analysis of blood, a general analysis of urine and according to Nechiporenko, spermograms. A blood is drawn for a blood test for PSA (prostate-specific antigen). This substance is produced by the tissues of the prostate and partly enters the bloodstream, partly in the gland itself.

An increase in gland by 1 cm³ gives a quantitative increase in PSA concentration by 0.3 ng / ml, tumor growth by 1 cm³ gives a marker increase by 3.5 ng / ml.

For the timely detection of the disease, age-related standards for tests for prostate adenoma have been developed. A graduation of laboratory results was needed because one standard was previously set for everyone, and what was not a disease for an elderly person was regarded as a pathology.

Quantitative indicators of the normal level of PSA in different age groups of men are as follows:

  • 2.5 ng / ml or less - for people from 30 to 50 years old,
  • 3.5 ng / ml or less - from 50 to 60 years,
  • 4.5 ng / ml or less - from 61 to 70 years,
  • 6.5 ng / ml or less - from 71 years and older.

Exceeding these indicators may indicate a pathological process in the body. A PSA level of 10 ng / ml indicates prostatic hyperplasia. Exceeding this quantitative threshold suggests the development of a malignant tumor of the organ.

Urologists evaluate not only the PSA level, but also the ratio of the total and free fractions of the substance. Normal numbers are 1:10. Violation of the ratio in the direction of the general indicator indicates malignant growth of cells in the gland.

The increase in PSA per year should not exceed 0.75 ng / ml, otherwise prostate cancer should be sought.

To obtain a reliable result, it is important to properly prepare for the study:

  1. exclude the use of alcoholic beverages for a week,
  2. do not eat spices 3-4 days before the study,
  3. do not donate blood within 4 weeks after a prostate biopsy (in some sources - 2 weeks). The most correct result will still be obtained after 4 weeks, since the formation of full-fledged connective tissue in places of invasion occurs in 21 days,
  4. avoid intercourse or masturbation 3-4 days before the test,
  5. do not go to prostate massage 7 days before the biopsy,
  6. after a digital examination of the prostate, donate blood no earlier than 7 days later,
  7. exclude heavy physical exertion, especially cycling a week before the examination.

All of the above factors can distort the result, and then additional examinations will be required.

The gold standard for the differential diagnosis of benign and malignant changes is a biopsy of the gland tissue and histological examination of the material.

The study of the composition of the juice of the prostate gland is another important indicator for prostate adenoma in the diagnosis of pathological abnormalities. The secret is an increased level of white blood cells, rarely malignant cells.

Stage 3 - the male body is at risk

At the stage of decompensation, as the 3rd stage is called, the signs of prostate adenoma in men become as noticeable and difficult as possible. It is almost impossible to carry out the urination process, the bladder almost always feels crowded, its walls are stretched, as can be seen in the ultrasound images. In a certain period, all pain associated with urination disappears, which is associated with the loss of (partial) sensitivity of the bladder. The state of relief passes quickly, but in the subsequent pains come back accompanied by uncontrolled separation (incontinence) of urine.

Neither the patients themselves nor the doctors have problems with how to determine prostate adenoma at this stage - the fastest and most effective treatment becomes the biggest difficulty during this period. This is very important, since at the 3rd stage, the body begins to suffer from intoxication with nitrogen processing products, which not only exacerbates the current symptoms, but generally leads to a deterioration in the condition of the body. In this case, the treatment of prostate adenoma "perceives" only surgical, as otherwise a fatal outcome is very likely.

BPH: symptoms as the first stage of diagnosis

Hyperplasia or adenoma, on the one hand, is a benign lesion of the prostate, which means that in the early stages it can be cured quite quickly and in full. However, on the other hand, this condition is still a disease, that is, in any case and at any stage that has a negative effect on the state of health. That is why the correct diagnosis and optimally-quickly carried out therapeutic effects are so important.

With prostate adenoma, the symptoms and treatment are interconnected: the more fully and more accurately the patient will describe his symptoms to the doctor, the less difficult it will be for the specialist to make the correct diagnosis and prescribe treatment.Naturally, just asking a patient does not help to exclude the danger of chronic prostatitis from the “suspects” (and the signs of prostatitis are similar to symptoms of hyperplasia) or prostate cancer — other diagnostic methods will help to clarify this, including:

Diagnostic methods will help clarify the diagnosis to the doctor, including ultrasound diagnosis of the pelvic organs

  • palpation of a diseased organ,
  • Ultrasound diagnosis of the pelvic organs,
  • Ultrasound examination of the bladder,
  • fluoroscopy
  • urodynamic research
  • blood test for prostate-specific antigens.

But it is a man’s turning attention to the signals of his body that helps prevent the most serious consequences.
Actually therapeutic measures to combat benign hyperplasia (aka prostate adenoma) are:

  • drug (conservative) exposure by the use of 5-a-reductase inhibitors and / or a1-blockers at the first stage of the disease,
  • surgical intervention associated with the removal of damaged organ tissues in the absence of drug treatment results and in the late stages of the development of the lesion.

An important part of treatment is diet and normalization of an optimal healthy lifestyle, as well as the rejection of bad habits and strict adherence to the prescriptions of the urologist.

In the modern world, everyone is able to turn to the Internet to find out about any disease: what it is, how it manifests itself, how it is treated, and how serious the consequences are. In the case of prostate adenoma, the symptoms and treatment in many sources are described in sufficient detail and accurately to give readers a general idea of ​​the disease. Nevertheless, in order to avoid the likelihood of “acquiring” irreversible health problems, comprehensive information about this disease should be obtained exclusively from a urologist who is familiar with the clinical picture and medical history of a particular patient.

Prostate adenoma is a disease characterized by an enlargement of the prostate gland due to the proliferation of its own tissues. In medical practice, this disease is often called benign prostatic hyperplasia. Despite the fact that this tumor of the prostate gland is benign, nevertheless, many unpleasant symptoms accompany this disease, which significantly reduce the quality of life.

The danger of benign prostatic hyperplasia lies in the ability of this tumor to transform into malignant. In addition, under certain conditions, the course of the disease can be accompanied by a number of serious complications that require surgical intervention. One of the side effects of an enlarged prostate gland is squeezing the urethra, which leads to many problems with urine diversion.

Cleansing enema

Bowel cleansing with enema is carried out in several ways:

    Standard water enema using Esmarch mug. Using a special tip, about 2 liters of water is introduced into the intestine a little warmer than room temperature. This will cause a strong desire to empty, and the feces will be washed in a stream. It is carried out twice for the best effect. The first procedure is carried out on the eve of the day of the examination, approximately 12 hours before it. The second stage is prescribed 1.5–2 hours before TRUS. This method is not entirely convenient at home and on your own. Therefore, if possible, you should contact the treatment room. Clinics specializing in urology offer their patients to carry out all preparations stationary.

  • Oil enemas are a less complicated option. For enemas in this way it is necessary to have: a rubber bulb, a substance for lubrication, vegetable oil.
    1. Preheat the oil to an acceptable temperature.
    2. Collect pear fluid and enter it into the intestines.
    3. Wait for the effect, it takes about 30 minutes to get the effect.

    This method is more gentle than enema with water and is convenient for home use.

    Also, for preparing bowel cleansing, modern ready-made microclysters are suitable. They differ in almost instant impact. It should be used according to the manufacturer's instructions.

    Before choosing any of the above methods, it will be correct to consult with your doctor in order to take into account the individual characteristics of the patient's body.

    Before entering the enema instrument, a lubricant must be applied.

    In especially serious cases, to completely empty the intestines, the doctor may prescribe a hydrocolonoscopy. This procedure is carried out inpatiently under the supervision of medical personnel.

    What to do if PSA is increased?

    Any laboratory parameters that are outside the normal range in apparently healthy patients are always checked and a second blood test is prescribed. In this case, it is important to analyze whether all points in preparation for the analysis were met.

    If the second result shows an increase in PSA levels, you should consult your doctor. An increase in the concentration of prostate-specific antigen may indicate prostatic hyperplasia, an organ tumor, or inflammatory pathology.

    The doctor prescribes a further examination and, based on the data obtained, treatment.

    Laxative

    Another way to prepare the intestines for TRUS of the prostate without enema is by taking laxatives. They allow you to improve intestinal motility, thereby accelerating the movement of feces. The type and methods of their administration are selected by the attending physician. Typically, such drugs should be taken on the eve of the examination.

    The most prescribed drug is Fortrans Powdered Laxative. The bag is diluted with water, the resulting solution is drunk one glass every quarter hour. In a bowel cleansing procedure using a laxative, the patient should eat semi-liquid food. It is advisable to complete the process 4–5 hours before transrectal ultrasound examination of the prostate.

    It is also possible to use glycerin suppositories before TRUS, in the absence of natural urge to empty the intestines. As a rule, it is injected into the rectum a couple of hours before the examination. This method of preparing the intestine for ultrasound of the prostate is acceptable in the absence of diseases, the progression of which is possible after using a suppository.

    The main causes of prostate adenoma

    Many doctors believe that benign processes of proliferation of prostate tissue are part of the natural mechanism of aging of the male reproductive system. This assumption is not without reason, because this disease is diagnosed mainly in men older than 50 years. The older the man, the higher the risk of developing prostate adenoma. Statistics show that approximately 90% of men over 75 have one form or another of this ailment. With prostate aging, adenoma and prostatitis are common. The aging processes of the male body mainly originate from changes in the hormonal background. In order to understand the causes of benign prostatic hyperplasia and the symptoms characteristic of the course of this disease, it is necessary to consider the anatomy of this organ.

    This organ is located between the pubic symphysis and the rectum. In normal condition, it looks like a chestnut. The prostate gland has 2 lobes connected by an isthmus. The urethra is located between the lobes. In young men aged 18 to 30 years, this gland is of limited size and weighs about 16 g.In older men, hormonal changes are observed that trigger compensatory phenomena that provoke an increase in the size of the prostate gland. The reasons for the development of prostate adenoma have not yet been fully studied, but clinical observations have highlighted the main predisposing factors and the mechanisms of their influence on the process of disease formation.

    1. Genetic predisposition. In most cases, men who show the first signs of prostate adenoma at the age of 50 have a family history of this disease. The mechanism of transmission of predisposition to prostate damage is not fully understood, but nevertheless some features of the course of the disease make it clear that the hereditary continuity of this aging process occurs in many men. As a rule, in men from the same family, the first manifestations of prostate adenoma begin at the same age, and the course of the disease is complicated by the same pathologies.
    2. Hormonal changes. The initial stage of development of pathology in the prostate gland falls on the period of a natural decrease in the level of sex hormones and the onset of aging of the male reproductive system. The relationship between the development of benign prostatic hyperplasia and a decrease in the level of sex hormones can be traced very clearly. The thing is that rare cases of development of prostate adenoma in people under 30 years of age are observed precisely against the background of hormonal disruptions.
    3. Overweight. In men suffering from various forms of obesity, the risk of damage to the prostate gland and the development of prostate adenoma increases significantly. The thing is that adipose tissue not only causes serious diseases of the endocrine system and metabolic disorders, but also interferes with normal blood circulation in the pelvic organs, which primarily affects the prostate.
    4. Unbalanced diet. The abuse of spicy, fried, salty and fatty foods is a predisposing factor for the appearance of problems with the prostate gland. Observations show that men who clearly monitor the balance of nutrients and their diet, much later experience the onset of symptoms from prostate adenoma. In addition, it is worth noting that men who have lived all their lives in rural areas and have consumed self-grown products are not only less likely to suffer from prostate adenoma, but also do not face serious complications in the presence of this disease.
    5. Passive lifestyle. A prolonged lack of motor activity leads to a gradual weakening of the muscles of the small pelvis, which, in turn, is reflected in all organs located in this area.

    There is an opinion that smoking, alcohol abuse, the presence of chronic infectious diseases of the genitourinary system may be predisposing factors for the development of pathologies in the prostate, but clinical studies have not yet confirmed that prostate adenoma is a consequence of an improper lifestyle. It is believed that these adverse factors affect the rate of general aging of the body.

    How is prostate adenoma manifested?

    All available symptoms can be divided into irritative and obstructive. Irritative symptoms develop as a result of irritation resulting from an enlarged prostate, while obstructive symptoms are related to urinary excretion problems.

    With the development of prostate adenoma, obstructive symptoms appear first.

    1. Sluggish stream of urine. In this case, we are talking about reducing the speed of urine diversion due to squeezing in a certain place of the urinary canal, due to proliferation of tissues with prostate adenoma.
    2. Initial retention of urine outflow. This process is also called primary urinary retention and is characterized by a delay in the beginning of urine excretion after relaxation of the sphincter.This delay continues for several seconds.
    3. The need for abdominal involvement during urination. With the development of this symptom, the patient has to make significant efforts to start urinating.
    4. Intermittent urination. If the outflow of urine occurs in parts, this is considered a pathology, since under normal conditions the stream should be continuous until the bladder is completely empty.
    5. The last portion of urine leaves drop by drop.
    6. Constant sensation of incomplete emptying of the bladder. This pathology is observed due to the lack of complete emptying of the bladder. To completely empty the bladder, a man needs to visit the toilet many times.
    1. Nocturia. This pathology is manifested by an increased frequency of the appearance of urge to urinate at night.
    2. Daytime Polacciauria. With the development of this deviation in patients with prostate adenoma, the number of urinations increases. From the norm, 4 to 6 times the number of trips to the toilet increases to 16-20.
    3. False urination. Such a deviation from the norm is characterized by a frequent desire to empty the bladder, but there is no outflow of urine.

    Constant accumulation in the urine in the bladder with prostate adenoma and problems with its outflow leads to stretching of the walls of the bladder and impaired detrusor function. Detrusor is a muscle that contracts while squeezing urine out of the bladder. When this muscle is stretched, complete bladder emptying does not occur.

    Ultrasound of the prostate

    After conducting a digital examination, the patient is sent for ultrasound diagnosis. Ultrasound is often performed transrectally. This allows the specialist to obtain the most reliable information about the structure and condition of the prostate, seminal vesicles.

    The patient does not experience any inconvenience during this diagnostic procedure. The sensor with which the internal research is carried out is small, up to 2 cm in diameter. Therefore, discomfort is almost not felt. The patient lies on his left side, bending his legs and pressing them to his stomach.

    Also, ultrasound diagnostics can be performed externally, through the wall of the abdominal cavity. But this method is only indicative, as it gives an approximate idea of ​​the picture of the disease. The patient should come to the procedure with a full bladder, and an enema the night before.

    Ultrasound helps a specialist to determine with maximum accuracy the structure of the prostate gland, size, density, uniformity, the presence of neoplasms. In a patient with prostate adenoma, an increase in the organ and adenomatous nodes is observed.

    Changes in the shape and nature of the nodes, blurring and fuzzy contours, rapid growth, changes in density indicate a malignant lesion.

    Prostate Biopsy

    Is biopsy necessary for prostate adenoma? This diagnostic measure is not required or necessary to detect a benign mass in the tissues of the prostate gland. However, after passing tests for PSA, in the case of revealing its increased content and uncertain results of a digital examination, the urologist can refer the patient to perform a prostate biopsy. This will make it possible to exclude the presence of a malignant process in the patient.

    A sample of prostate tissue is obtained using a biopsy needle. The procedure can be carried out by different methods, but in most cases, the prostate tissue is taken rectally, through the membrane of the rectum.

    In addition, in accordance with individual indications, the patient can be sent to other types of studies, for example, radioisotope diagnostics, excretory urography, and others.

    The main stages of development of prostate adenoma

    Symptoms of the disease do not appear immediately, but as if flow into each other.Over time, problems become more and more noticeable. The course of prostate adenoma can be divided into 3 stages: compensated, subcompensated and decompensated.

    1. Compensated Stage. This stage is characterized by the absence of pronounced symptoms and problems with the outflow of urine, since the narrowing of the urinary canal is compensated by the significant tension of the walls of the bladder during urination. The only symptom of this stage is discomfort in the bladder after it is completely empty, which is observed for several minutes.
    2. Subcompensated stage. This stage is accompanied by the appearance of inflammatory processes of the walls of the bladder and the initial signs of impaired urine outflow. When urinating, a significant amount of urine remains in the bladder, which subsequently leads to a number of characteristic symptoms.
    3. Decompensated stage. This stage is manifested by serious disorders caused by the destruction of the bladder. At this stage, the patient cannot urinate normally, but with a full bladder, urine is excreted dropwise.

    The main types of complications of prostate adenoma

    With an unfavorable course, this disease can be accompanied by a number of dangerous symptoms, most of which require special or surgical intervention.

    1. An acute form of urinary retention. The development of this pathology is accompanied by a complete cessation of outflow of urine. As a rule, similar complications of the course of prostate adenoma are observed after severe stress, hypothermia and other adverse conditions that occurred at the third stage of development of benign prostatic hyperplasia. The inability to empty the bladder can lead to overflow and rupture of the walls. In order to avoid the most negative consequences, the patient must immediately consult a doctor for qualified assistance. To carry out the outflow of urine, catheterization of the bladder is performed.
    2. The formation of stones in the bladder. Incomplete emptying of the bladder carries the risk of accumulation of mineral deposits. From mineral deposits, over time, sand is first formed in the cavity of the bubble, and then stones of different sizes. Stones in the bladder are dangerous because under certain conditions they can leak into the urethra, which leads not only to block the outflow of urine, but also to injure the walls of the canal. Surgery is usually required to remove stones.
    3. Inflammatory processes. Benign prostatic hyperplasia is a kind of springboard for infection of the tissues of the genitourinary system. Most often with prostate adenoma pyelonephritis occurs, that is, inflammation of the renal parenchyma, as well as cystitis - an inflammatory process in the bladder.
    4. Hematuria This pathology develops against the background of varicose veins in the neck of the bladder due to an enlarged prostate. The main symptom of this pathology is the appearance of red blood cells in the urine. The blood in the urine is not always visible with the naked eye, since the doses of blood entering the urine can be different. Urine acquires a red tint only if significant bleeding has occurred.

    As a rule, complications of prostate adenoma develop only against the background of a prolonged lack of proper treatment or ignoring the disease by the patient himself. Often the complications are temporary, that is, for example, to eliminate the acute form of outflow of urine, one catheterization may be enough to relieve spasm, after which the function of the bladder and urethra resumes.

    Methods for diagnosing prostate damage

    Diagnosis of benign prostatic hyperplasia is carried out on the basis of a collected medical history, maintaining a patient urination diary, palpation and instrumental types of research. All these research methods allow you to determine the degree of prostate damage, which in the future will allow you to prescribe an adequate treatment. It is worth considering in more detail the main methods for detecting prostate adenoma.

    1. Palpation rectal examination of the prostate. This study allows you to determine the size, texture, soreness and other parameters of the damaged prostate.
    2. Transrectal ultrasound. This research method allows you to determine the presence of nodes and calcifications. In addition, this tool allows you to determine the size and direction of growth of the prostate with an accuracy of a millimeter. The benefits of using TRUS include the ability to detect prostate adenoma on very early lines.
    3. Uroflowmetry. This study allows you to identify abnormalities in the processes of urine excretion.
    4. Determination of urine remaining in the bladder. This test is done immediately after emptying the bladder. An ultrasound scan is used to identify the amount of urine remaining.
    5. Cystography.
    6. Cystonanometry Allows you to set the pressure inside the bladder.
    7. CT scan.

    Carrying out these studies allows you to establish an accurate clinical picture of the course of the disease. Further, based on the data obtained, conservative or surgical treatment can be prescribed.

    Diagnosis of prostate adenoma

    Of course - quality and justified - this is the key to the lock of the closed door, behind which there is a path to real recovery from prostate diseases in men (if the patient sincerely wants this recovery). Here's what you need to know about your problem in the normal course of the disease.

    • Ultrasound of the prostate, bladder,. This analysis is described in detail in a separate article on the site. In case of prostate adenoma disease, all indicators are important, but one must be aware that a significant excess of the amount of residual urine from the norm is the main prerequisite for surgery. The maximum norm of residual urine is 50 ml. Tip. Its value in most cases is steadily decreasing when conducting well-being health-improving measures. In case of excess urine, based on well-being and mood, objectively determine your capabilities (predisposition to diet, physiotherapy exercises), and only after deliberation make a decision on further surgery.
    • A physical diagnostic method in the form of palpation of the prostate. Allows you to examine only that part of the prostate that is adjacent to the rectum, that is, it can not be fully based. A reliable result after it can be given only by a urologist (andrologist) of high qualification.
    • What is PSA analysis done for? PSA analysis - a blood test for a specific prostatic antigen. Limit indicators: up to 49 years - 2.5 nanograms per milliliter, up to 59 years - 3.5 ng / ml, up to 69 years - 4.5 ng / ml, 70 years and older - within 6.5 ng / ml. A significant excess of the norm (10 ng / ml and above) gives rise to suspicion of prostate cancer and subsequent prostate biopsy. The PSA level is unstable, practice confirms that its slight excess decreases when maintaining a healthy lifestyle.
    • How is a prostate adenoma biopsy done? A prostate biopsy is used to detect prostate carcinoma by collecting a portion of the prostate tissue with a special needle. It is a very painful procedure and provokes a partial growth of a prostate tumor. As usual, there are contraindications. In practice, the author often met users of the methodology for treating prostate adenoma, when a biopsy was prescribed by a doctor for them unreasonably.Tip: a prostate biopsy is an analysis that can not be rushed to conduct at PSA boundary values. If you are predisposed to activity and restrictive nutrition, postpone the diagnosis for a couple of weeks and decide on a similar study after re-passing the PSA analysis.

    This is the main list of measures in the absence of complications and concomitant diseases. All of them are almost everywhere available for execution.

    The main methods for diagnosing prostate adenoma

    · History data collection.

    Rectal digital examination.

    · Ultrasound examination of the kidneys of the bladder, assessment of the volume of residual urine.

    · Application of the IPSS-QoL Questionnaire (BS).

    Ultrasound of the prostate gland (transrectally).

    · Analysis of serum PSA content.

    According to modern requirements, the purpose of diagnosis is not only the recognition of prostate hyperplasia and the identification of complications, but also the identification of factors that increase the risk of further development of the disease.

    We go on an ultrasound of the prostate: preparation for the study and its conduct

    Unfortunately, many men suffer from prostate diseases. Therefore, the question of the study of the prostate gland was and remains very serious.

    There are various ways to diagnose this organ, but ultrasound is considered the most painless and effective.

    Preparation for ultrasound of the prostate is an integral and very important part of the diagnostic process.

    Why do I need to properly prepare for an ultrasound examination?

    The principle of ultrasound is based on ultrasonic echolocation. The sensor is aimed at the walls of the prostate and begins to emit sound waves.

    When they collide with the tissues of an organ, they are reflected (create an echo) and converted into a digital image on a computer. The specialist can easily distinguish the response of healthy, denser tissues from the affected areas.

    The procedure is very simple and painless. The sound beam passes through the liquid and gives a high-quality image on the monitor. If it enters the airspace, the picture is distorted.

    These risk factors today are:

    · The total score for the IPSS questionnaire is greater than 7.

    · The volume of the pancreas is more than 30 cm3 (it is estimated using ultrasound transrectal method).

    · Excessive volume of residual urine determined by ultrasound - more than 200 ml.

    · The value of Qmax (maximum rate of urination) is below 12 ml / s (this value is estimated using uroflowmetry).

    · PSA value from 1.4 ng / ml.

    That is, if the patient has symptoms of pancreatic hyperplasia (more than 7 points according to the results of the survey), the maximum rate of urination is reduced, an increase in the pancreas is observed or PSA in the blood serum rises, the risk of the need for surgery is significantly increased - 4 times compared with patients who there are no similar clinical manifestations. Each of the indicators described above is of great diagnostic value and should be taken into account when determining the treatment regimen for patients (in some cases, it can be preventive).

    What else can not be done to patients before the procedure

    There are practically no contraindications to the study, but the doctor should definitely say about the medicines you take and the operations and studies you have done, such as irrigoscopy and colonoscopy.

    This diagnosis uses the input of a contrast component, which can distort the result of ultrasound.

    It's all. No more training is required.

    How to prepare for TRUS?

    This study compares favorably with the previous one, since it makes it possible to evaluate in detail the structure of the pancreas, its vessels and vesicles. A transrectal examination involves the mandatory cleansing of the intestines from feces, since it interferes with the proximity of the sensor to the prostate and violates the overall picture of the examination.

    Preparation includes 2 main points:

    • 2 hours before the study, you must definitely do an enema.If there is no natural urge, you can use a ready-made form such as Microlax or apply glycerin suppositories. These procedures are usually done on their own at home. If for any reason this is not possible, notify the doctor so that he takes the necessary measures in a timely manner. Remember that an empty bowel makes the TRUS procedure meaningless,
    • the next point is to fill the bladder. Why, one hour before the diagnosis, you need to slowly (portionwise) drink 2-3 glasses of water. You can not urinate until the end of the study.

    In addition, prepare for the procedure should begin in a day or two. Food provoking gas formation is necessarily excluded from food. Reception of Espumisan or Mezim will not interfere. At this time, you need to try not to smoke.

    Although the procedure is performed on an empty stomach, people with diabetes can eat a little white bread or chicken, drink tea without sugar.

    Contraindications

    Prostatitis is afraid of this remedy, like fire!

    It is only necessary to apply.

    Carrying out TRUS does not have any particular contraindications.

    However, there are conditions that require the procedure to be postponed to a later date:

    • cracks in the rectum (PC),
    • hemorrhoidal cones. Although they are not a contraindication, a doctor should be warned about this,
    • poor blood coagulation
    • acute diarrhea and paraproctitis,
    • rectal surgery (its various resections),
    • PC bleeding
    • psychical deviations.

    Results of a study for prostatitis and other diseases

    After 40 years, the vast majority of men begin to have problems with the prostate gland. Prostatitis is not just the most common male problem. It would seem that a man is in his prime, and should enjoy life and get the most out of sex, but prostatitis changes everything! The easiest, cheapest and most effective way to get rid of prostatitis.

    If the patient complies with all the recommendations for preparation for diagnosis, decoding the result will not cause difficulties for the doctor.

    If the prostate is normal, then the values ​​will be as follows:

    • size (front and rear) - 1.5-2.5 cm,
    • transverse - 2.6-4.3 cm,
    • longitudinal - 2.5-4.0 cm
    • prostate volume - 25 cc,
    • residual urine - 15 ml.

    Small deviations from these indicators are allowed, which is not a sign of a disease and may depend on the design features of ultrasound machines. Ultrasound diagnostics of the prostate reveals many pathologies of the organ: adenoma, oncology, or the inflammatory process.

    So an adenoma, for example, is a benign formation and is usually diagnosed in men after 40 years. Pathology may not have clinical manifestations and only ultrasound can reveal it. Pancreatic adenoma is nodular or diffuse.

    In the first case, nodules form in the structure of the gland, which over time increase in size and disrupt normal urination.

    This is clearly seen on an ultrasound scan, as the beam reflects well from areas of high density. With a diffuse form, the organ is enlarged entirely, since adenomatous nodules grow everywhere and narrow the urethra.

    Ultrasound examination makes it possible to diagnose or suspect prostate cancer. In the process of ultrasound, nodular seals of various shapes are detected. This often happens in men after 55 years. To confirm the diagnosis, a puncture of the neoplasm is taken in patients.

    Related videos

    Video on how to prepare for an ultrasound of the prostate:

    So, an ultrasound of the prostate gland is deservedly considered a valuable method for examining both the prostate itself and its seminal vesicles. The diagnosis itself is simple and painless.

    The only requirement for the patient is a thorough preparation for the procedure.TRUSI is the most informative study, although it gives a man minor inconvenience, but allows you to examine the gland in detail.

    • Eliminates the causes of circulatory disorders
    • Gently relieves inflammation within 10 minutes after administration

    3 types of pathology are distinguished by such a criterion as structure and localization:

    1. through the urethra, the tumor descends into the bladder. As a result, the deformation of the internal sphincter develops, and the functioning of the organ is disrupted,
    2. the tumor grows in the direction of the rectum. There are slight malfunctions in urination. At the same time, the reduction in the proportion of the urethra worsens, as a result, urinary may not be completely released,
    3. there is a uniform growth of the prostate. In this case, no signs are observed. This type of adenoma is the most favorable.

    Clarifying diagnostic methods are used when:

    · The results of the initial examinations contradict each other,

    · There is a need to differentiate BPH from other pathologies,

    · Planned surgical procedure,

    · The previous course of treatment for prostate adenoma did not give positive results and it is necessary to find out the cause of the treatment failure.

    Conservative treatments for prostate adenoma

    The treatment of benign prostatic hyperplasia requires an integrated approach. First of all, a blocker of alpha adrenergic receptors can be prescribed by a doctor with prostate adenoma. These drugs help reduce the tone of the smooth muscle structure of the bladder, as well as prostate tissues, which helps to reduce pressure on the urethra and greatly facilitates the process of urination. There are many drugs that belong to this group, but only a doctor who sees the clinical picture should deal with the selection of a specific remedy.

    In addition, alpha reductase inhibitors can also be prescribed that help block the conversion of testosterone to dehydrotestosterone. In addition to these medications, antiexudative and anti-inflammatory drugs can be prescribed. Drug therapy is quite effective and can reduce the size of the prostate gland and eliminate the most unpleasant symptoms. Among other things, in addition to drug therapy, diet and physiotherapy can be prescribed.

    Physiotherapy for benign prostatic hyperplasia is a set of exercises aimed at improving blood supply and rigidity of the muscles located in the pelvic area. Proper nutrition also plays an important role in the treatment of prostate adenoma, as it allows you to compensate for the lack of nutrients and improve the functioning of the genitourinary system.

    Surgical treatments for the prostate

    Surgical treatment of benign prostatic hyperplasia can be performed both with emergency indications and in a planned manner. Indications for emergency surgical intervention may be the following pathologies and deviations:

    • urinary retention
    • renal failure
    • bladder stones
    • often recurring infection
    • large diverticulum in the bladder.

    There are several types of surgery on the prostate and bladder, which can achieve an excellent effect and reduce the risk of complications in the future. The type of operation is selected by the doctor depending on the individual parameters of the course of the disease. As a rule, prostate adenoma after surgery is no longer felt for a long time.

    Among the reasons for visiting a urologist, one of the most common is prostate adenoma. This disease is an overgrowth of glandular tissue and is benign in nature.If you identify it at the initial stage of development and start treatment in a timely manner, you can do with drug therapy. In advanced cases, the elimination of adenoma is possible only surgically.

    To determine in the early stages, you need to know the main symptoms of this urological disease. Especially attentive to the state of your body should be men who are at risk. In this article you will find answers to all questions related to the symptoms, causes and diagnosis of prostate adenoma.

    When should I see a doctor?

    The most common disease in men is prostate adenoma. Most often, this pathology affects people aged 40-60 years. The main provocateur is usually a change in the hormonal background. Also, the disease can develop against the background of weight gain or the progression of atherosclerosis.

    In men who have crossed the sixty-year threshold, benign adenoma is often diagnosed. A doctor should be consulted if:

    1. Painful urination.
    2. Pain syndrome in the lower abdomen.
    3. Abnormalities detected during rectal examination.
    4. Deviations in urine analysis.
    5. Deviations in blood tests and spermograms.
    6. Renal failure.
    7. Infertility

    Only due to timely ultrasound of the prostate can stop the development of anomalies at an early stage. Found in the later stages, the disease is very difficult to treat.

    In addition, relatively new methods are used:

    · Echo-urodynamic research.
    · Transrectal echo dopplerography.
    MRI
    · Mixed multispiral cystourethrography.

    We will tell in more detail about modern methods of imaging in the diagnosis of BPH.

    Doppler ultrasound very informative in terms of diagnosis of pancreatic malignancies. This examination method shows better results than simple ultrasound. Its specificity is 85%, and sensitivity reaches 65%. In addition, risk factors determined by Doppler ultrasound (the possibility of intraoperative bleeding) make it possible to determine the course of surgical interventions taking into account the position of overly vascularized sites. It is also possible to assess the need for preoperative therapy (5α-reductase inhibitor) in order to reduce the aforementioned risk.

    Echo-urodynamic method used to assess the contractile ability of the detrusor. In addition, it is possible to visualize the prostatic section of the urethra and bladder neck during urination. This diagnostic method is used if it is necessary to differentiate benign hyperplasia from other conditions of the prostate associated with impaired urination (strictures, urethral stones, detrusor hypotension).

    Cystourethrography with a multispiral tomograph - An informative method for visualizing the lower urinary tract at the time of the urinary process. This technique accurately determines the anatomical changes in the urinary tract (for example, after surgical procedures). Therefore, it is often used before repeated surgeries.

    MRI necessary, first of all, for the diagnosis of malignant tumors with the determination of their stage. In addition, the data obtained with MRI give an accurate picture of structural changes in the pancreas, help to assess its growth and size (which makes it easier for doctors to plan surgical interventions). However, MRI also has its drawbacks - first of all, the impossibility of a good visualization of the lower urinary tract.

    So, the use of modern methods for examining patients with BPH makes it possible to diagnose hyperplasia, to identify the features of its development in a particular patient, based on which an individual treatment regimen is developed.If necessary, surgical intervention for hyperplasia, there is the possibility of a more rational planning of operations (including repeated).

    A man may complain:

    • frequent urination,
    • outflow of urine is getting worse
    • at night, the frequent occurrence of false desires.

    At the first stage of the pathological process, the bladder is completely empty; there are no morphological changes in the tissues. Further, interruptions in the outflow of urine are noted. The patient has a weak stream of urine, bowel movement is carried out in 2-3 stages. At the final stage, the muscle tone of the bladder disappears. The patient suffers from urinary incontinence, but it is excreted drop by drop, despite the overcrowding of the organ.

    Diagnosis of prostate adenoma is performed according to the standard algorithm:

    1. Palpation of the prostate helps to establish the size and tenderness of the pathology, as well as what its consistency is.
    2. An ultrasound examines how much the prostate has enlarged, and in which direction the nodes grow.
    3. Transrectal ultrasound - makes it possible to conduct a detailed study of the structure of the prostate, determine the exact size, and note whether the cancer has developed.
    4. Uroflowmetry is a method that gives an idea of ​​the various characteristics of a urine stream. It is carried out at least 2 times.
    5. It is very important to determine if there is residual urine. Without this, it is difficult to establish at what stage the disease is, as well as whether there are indications for surgery. The presence of residual urine can be determined by ultrasound, carried out immediately after emptying of the urine.
    6. Cystomanometry is a modern technique that allows you to establish what pressure is inside the bladder.
    7. Cystography - involves research through contrast.
    8. Computed tomography or nuclear magnetic resonance - the ability to study the pathological process in detail.

    In addition to these methods, the patient should keep a diary of urination, which fits the frequency and volume of urine.

    Instrumental diagnosis of prostate adenoma

    The main indications for biopsy with prostate adenoma are clinical data indicating the possibility of combining this disease with prostate cancer. The presence of palpable signs suspicious of prostate cancer, or an increase in PSA levels above 10 Ig / ml (with PSA values> 0.15) makes a prostate biopsy necessary. The list of indications for biopsy in patients with prostate adenoma can be expanded. The growing interest in drug therapy and the increasing role of conservative methods of treatment dictate the need for more active measures aimed at identifying hidden cancer, especially since 20-40% of malignant neoplasms of the prostate at an early stage are not accompanied by an increase in PSA levels. In addition, in some cases, a prostate biopsy can help predict the results of conservative treatment.

    An endoscopic examination of the lower urinary tract in patients with prostate adenoma is an optional method. Urethrocystoscopy is indicated in the presence of hematuria, even anamnestic, or suspected bladder neoplasm according to x-ray or ultrasound of the prostate. In some cases, pronounced changes in the detrusor as a result of its hypertrophy, trabecularity, diverticulosis, or the formation of calculi do not exclude the presence of a bladder tumor. This is an indication for endoscopic examination. In addition, the result of some alternative treatments for prostate adenoma, such as thermotherapy, focused ultrasound thermal ablation, radiofrequency transurethral thermal destruction, inteostial laser coagulation, transurethral needle ablation, balloon dilatation, stenting, depends on the anatomical configuration of the prostate that justifies the use of an urethrocystoscope in preparation for this procedures.The need for endoscopic examination is determined in each case, based on the clinical situation.

    An important place in assessing the functional - the state of the kidneys and upper urinary tract is occupied by dynamic radioisotope methods. Dynamic nephroscintigraphy and radioisotope renography make it possible to evaluate the filtration and secretory functions of the kidneys, urine transport along the upper urinary tract, perform radioisotope UVM and determine the amount of residual urine.

    X-ray research methods have recently been leading in the diagnosis and determination of treatment tactics for patients with prostate adenoma. However, recently the outlook on the role of these methods has undergone changes, which is reflected in the recommendations of the International Advisory Committee on Prostate Adenoma, according to which excretory urography is classified as optional methods, and it should be performed by individual patients according to the following indications:

    • urinary tract infections currently or in history
    • hematuria
    • current or history of urolithiasis:
    • history of genitourinary tract surgery.

    An X-ray examination usually begins with a survey of the organs of the urinary system, on which calculi can be detected in the projection of the kidneys, ureters, or bladder. Excretory urography allows you to clarify the condition of the upper urinary tract, the degree of expansion of the pyelocaliceal system and ureters, to identify concomitant urological diseases. However, the performance of excretory urography in renal failure is impractical due to low information content.

    Cystography is a valuable diagnostic tool for prostate adenoma. On the descending cystogram, an image of the bladder with a filling defect in the neck area in the form of a hill due to an enlarged prostate is determined. Diverticulums, stones, and neoplasms of the bladder may also be visible. In case of compression of the intramural sections of the ureters by hyperplastic tissue and deformation of their juxtavesical segments during sub- or retrotrigonal growth, a characteristic radiological symptom of “fish hooks” can be observed. Sometimes, to obtain clearer images of the bladder, ascending cysto- and pneumocystography or Kneise-Schober combined cystography is performed with the simultaneous administration of 10-15 ml of RKV and 150-200 ml of oxygen. However, the scope of these studies is currently limited by the diagnosis of concomitant neoplasms of the bladder, since the configuration, direction of growth and size of the prostate with greater efficiency can be recorded by ultrasound.

    On retrograde urethrocystograms with prostate adenoma, elongation is observed. deformation and narrowing of the prostatic urethra. The most common indication for using this method is the need for differential diagnosis of prostate adenoma with other diseases. symptoms of infravesical obstruction: stricture of the urethra and sclerosis of the bladder neck. In addition, urethrocystography can be used to measure the length of the prostatic urethra from the bladder neck to the seminal tubercle, which is sometimes necessary when planning treatment with thermal methods, balloon dilatation or prostatic stenting.

    CT complements the diagnostic data on the prostate obtained by ultrasound, and provides extensive information on its topographic and anatomical relationship with neighboring organs. This is of great importance in the differentiation of prostate adenoma from cancer, it allows you to get accurate information about the spread of the malignant process outside the capsule and the involvement of regional lymph nodes.The picture of prostate adenoma on CT is represented by homogeneous masses with clear even contours. The most important signs of organ changes during cancer development are blurred gland contours, asymmetric enlargement, heterogeneity of the structure with areas of increased density and rarefaction, and an increase in regional lymph nodes. But the method does not allow to differentiate at an early stage cancer with prostate adenoma and chronic prostatitis.

    Recently published data on the use of MRI in diseases of the prostate. One of the advantages of the method is a more accurate determination of the anatomical structure, configuration, and size of the organ due to image acquisition in three spatial dimensions. Another advantage is the ability to assess tissue characteristics and identify zonal anatomy of the prostate. MRI allows you to clearly identify the central, peripheral and transient areas of the prostate, to measure and compare their sizes. and also determine the volume of hyperplastic tissue. The accuracy of the study is increased by using special transrectal emitter coils. The results of MRI in typical cases make it possible to presumably judge the morphological structure of the prostate and stromal-epithelial ratio. In the case of glandular hyperplasia, the image approaches the density of fatty tissue in density, and with the predominance of the stromal component, a higher density is characteristic. This is important in determining the tactics of treatment, especially conservative.

    The vast majority of men of advanced and senile age (80-84%), complaining of frequent and difficult urination, a sluggish stream of urine and imperative urination, with the detection of enlarged prostate by digital rectal examination and ultrasound, the diagnosis of prostate adenoma is not in doubt. However, in 16-20% of patients, symptoms of impaired lower urinary tract function are not associated with prostate adenoma. In this case, differential diagnosis is carried out with obstructive and non-obstructive processes of another etiology, which are characterized by similar clinical symptoms.

    Ultrasound allows you to get extremely important information about the condition, size of the kidneys and thickness of the parenchyma, the presence and degree of retention changes in the pyelocaliceal system, concomitant urological diseases, as well as the condition of the bladder and prostate.

    With prostate adenoma, ultrasound scans determine the enlargement of the prostate of varying degrees, which in the form of a rounded formation with smooth contours partially closes the lumen of the bladder. At the same time, the size and configuration of the prostate, the orientation of the growth of the nodes, changes in the echostructure, the presence of calculi and calcifications are evaluated. During the study, it is necessary to determine the volume of the bladder when there is a urge to urinate, pay attention to the evenness of its contours, ultrasonic signs of detrusor hypertrophy and trabecularity. The method allows with high reliability to exclude the presence of diverticula, stones and neoplasm of the bladder. But the diagnostic capabilities of transabdominal ultrasound are limited to obtaining only a general idea of ​​the prostate. In most cases, the method does not detect specific signs of prostate cancer. especially in the early stages. There may be an error in measuring the volume of the prostate and hyperplastic tissue.

    BPH - This is the presence of benign growth of the prostate gland located around the urethra.

    To understand the essence of prostate adenoma, you need to turn to anatomy.

    Prostate - The male genital organ, which has the shape of a chestnut and is located in the perineum between the external sphincter of the urethra and the bladder. Part of the urethra passes through the thickness of the prostate gland.These features cause the appearance of the main symptoms in diseases of the prostate gland.

    Under certain conditions, the tissue of the prostate gland begins to grow actively - to hypertrophy. The tissue changed in this way was called adenoma. This tumor is benign, i.e. it grows slowly without causing metastases. But when a growing adenoma compresses the urethra and glands located in its thickness, signs of the disease appear.

    Why does prostate adenoma occur and who is at risk?

    BPH - One of the most common diseases among older men.

    During the study, it was found that prostate adenoma occurs in 25% of men aged 40-50 years, in 50% - in 50-60 years, in 65% - in 60-70 years old, in 80% - in 70-80 years old , more than 90% - over the age of 80 years. However, the symptoms of the disease and, accordingly, the diagnosis of prostate adenoma are very different. The reason for this is the different intensity of symptoms in different men. Symptoms of problematic urination concern about 40% of men with this disease, but only 20% of them seek medical help.

    There are no exact data on the causes of prostate adenoma. Most scientists believe that the most likely factors leading to prostate cancer are age-related changes and the normal secretion of male sex hormones.

    Data on the hereditary tendency to the disease are not confirmed, only the predisposition to the early development of prostate adenoma is inherited.

    According to other theories, the growth of prostate adenoma is affected by sexual activity, overweight, alcohol consumption and smoking - factors that significantly contribute to the occurrence of prostate adenoma.

    What is the danger of prostate adenoma

    BPH Is a benign tumor, i.e. Adenoma cells alone are not able to grow and form metastases. The main danger of this ailment is its complications.

    The most common complications of prostate adenoma include:

    • Urinary tract infections (pyelonephritis, prostatitis, cystitis) - often occur with prostate adenoma and are associated with incomplete emptying of the bladder, which becomes the optimal medium for the multiplication of microbes. The infectious inflammation that occurs in the form of complications creates even greater inconvenience in the life of a man.
    • Stone formation is a frequent companion of prostate adenoma. Sometimes the identification of kidney stones becomes the only sign of the presence of the disease.
    • Acute urinary retention is the most common complication of adenoma. Its occurrence is promoted by the use of alcohol and certain medications. In this case, urination does not occur due to complete blockage of the urethra due to edema of the gland. This complication requires immediate medical attention.
    • Renal chronic failure - manifests itself in the long course of the disease and can lead to death in prostate adenoma.

    All cases of mortality in prostate adenoma are associated with the development of complications and untimely treatment of the disease. In this case, death occurs mainly due to three reasons - sepsis, renal failure and complications after surgery.

    It should be remembered that with prostate adenoma, the number of symptoms of the disease increases with age, and the frequency of complications is similar to other diseases. Such complications can be prevented if you consult a doctor in advance and begin a course of treatment.

    Prostate Adenoma: Diagnostic Methods

    In most cases, the diagnosis of prostate adenoma is not difficult.At the initial examination, the doctor takes into account the complaints of the man and conducts a rectal digital examination of the prostate gland. To clarify the diagnosis, as well as determine the degree of violation of urination and the size of the adenoma, uroflowmetry and ultrasound are used.

    Ultrasound of the prostate allows you to determine the size of the adenoma and prostate, the presence of stones and nodular formations. Also, the results of ultrasound are necessary to select a method of treatment. Also, studies are carried out on the condition of the bladder, ureters and kidneys.

    Uroflowmetry is a method that allows you to reliably determine the level of difficulty urinating. In this study, a man needs to urinate, and special equipment will determine the time of urination and the flow rate of urine, i.e. will allow in a qualitative form to fix the existing violations.

    Also, a PSA blood test is mandatory. With its help, differential diagnosis of prostate cancer and prostate adenoma is carried out. The norm is considered to be a level not exceeding 4 ng / ml. If this diagnosis gives controversial data, a prostate diopsy is prescribed to confirm the final diagnosis.

    Also, sometimes X-ray research methods are used (cystography, excretory urography), which allow to assess the effect of an enlarged prostate on the urinary tract. To exclude diseases of the bladder and urethra that have similar symptoms, and in preparation for the operation, the cystoscopy method is used - examination of the bladder and urethra using a special tool.

    Prostate Adenoma: Treatment Methods

    The only treatment that can save the patient from prostate adenoma is surgery. But at the initial stages of the disease and in the presence of contraindications to surgical intervention, drug therapy is prescribed to reduce the progressive symptoms of the disease. Due to the low efficiency, physiotherapeutic non-surgical methods are not widely used.

    In 1993, the International Committee for the Treatment of Prostate Adenoma proposed the I-PSS Symptom Scale, which was based on a summary assessment of the severity of urination disorders. If on this scale the total score is less than 8 - the disease does not require treatment, with 9-18 points conservative drug therapy is prescribed, from 18 points and above - surgical removal.

    There are different methods of surgical treatment of prostate adenoma:

    Transurethral resection or TUR is a widespread method, because such an operation is performed through the urethra without incisions. However, it can be used only with an adenoma mass of up to 60 g and up to 150 mg of residual urine in the bladder. Also, this method is not allowed to be used in patients with renal failure.

    Adenomectomy (open prostatectomy) is a popular method of surgical treatment of prostate adenoma due to the least number of contraindications. It is relevant to use with a prostate mass of over 40 g and a residual urine of 150 ml or more. Do not interfere with the operation and various complications of the pathology.

    Laser ablation, laser destruction and TUR vaporization of the prostate gland - are used for those recommendations that TUR. These methods are considered more gentle, blood loss during surgery is minimized, therefore, it is possible to carry out an operation with a tumor mass of more than 60 g and practice it on young patients for whom it is important to maintain sexual function.

    The surgeon chooses the method of operation depending on the severity of the signs of the disease, the general condition of the patient, the amount of residual urine, the size of the prostate adenoma.Today, doctors prefer minimally invasive methods (laser destruction, TUR, etc.), because such operations are performed without incisions and do not force the patient to remain under general anesthesia for a long time, they are performed under spinal anesthesia. As a result, the postoperative rehabilitation period of the patient is reduced and his quality of life is improved.

    Treatment of prostate adenoma: minimally invasive methods

    Unlike other medical areas in urology, many surgical interventions are performed without open access. Many special tools have been developed that allow for manipulation without cuts. Many of them can be carried out in a dressing room under local anesthesia. The use of such technologies can significantly reduce physical and psychological postoperative trauma. Blood loss is minimized. Treatment with the minimally invasive method does not require long-term rehabilitation, patient stay in the hospital, removal of sutures. All this makes these methods more preferable, especially among young patients for whom it is important to quickly restore performance and quality of life.

    The oldest endourological method for treating prostate adenoma is transurethral resection of the adenoma. After this kind of surgery, there are far fewer complications than with open surgery. However, taking into account the technical capabilities of the method, there are a number of limitations: the amount of residual urine cannot exceed 250 ml, and the mass of adenoma is 60 g. TUR is not used if the patient has renal failure.

    During transurethral resection, the tissue of the prostate adenoma is excised from the inside with a special instrument, and its remains are removed from the bladder using a special balloon. The main problem in this case is the stopping of bleeding. Typically, the blood is stopped by coagulation, but sometimes such measures are not enough and additional tissue must be excised. With such manipulations, the risk of damage to the urethra, bladder and other organs located in close proximity increases significantly. Among others, a complication called TUR syndrome, which occurs when there is heavy bleeding with the absorption of a large mass of hypotonic or isotonic fluid, is of particular danger (used to stretch tissues and fill the bladder during surgery).

    At present, a new method of removing prostate adenoma is becoming popular - using a laser. In this case, no incisions are also performed, access to the organ is performed through the urethra. This method has more features and causes fewer complications than TUR adenomas.

    The laser was first used by urologists in 1960. But the first attempts to treat adenomas with a laser had fewer restrictions, which was why they were accompanied by severe urethral edema after surgery. As a result, the patient experienced an increase in the period of catheterization of the bladder, which seriously affected the quality of his life.

    Today, there is a completely new type of laser that does not cauterize adenoma tissue, but vaporizes them. Modern urological lasers operate on the principle of selective (selective) laser evaporation, used to remove pathological tissues. The combination of laser parameters - radiation, pulse and wavelength patterns - allows you to achieve results that are not comparable with other methods: tissue damage is excluded. Compared with TUR, laser coagulation and other methods, their alternative in the form of laser selective evaporation is a convenient and painless procedure that reduces the likelihood of complications.

    To understand the principle of selective laser evaporation of tissues, you need to turn to the physical side of the technology. Since soft tissues contain a large amount of water, for complete excision of the tissue, laser radiation must be well absorbed by water. Also, in order to successfully stop the bleeding that has occurred, hemoglobin absorption of blood is required. The laser system has the advantage that it is able to provide the highest degree of absorption with both hemoglobin and water at a constant wavelength. The laser beam pattern provides efficient focusing and beam delivery to adenoid tissue. Due to this, the operation can be performed under local anesthesia, and the patient experiences a minimum of discomfort and side effects.

    The use of the method of laser evaporation of prostate adenoma has fewer restrictions compared to traditional TUR, which is explained by minimal blood loss and the lack of need for general anesthesia. Therefore, it becomes real to carry out the operation at a young age, when it is necessary to maintain sexual function, and with an adenoma mass of 60 g.

    Prostate Adenoma - Treatment

    The use of the laser evaporation method virtually eliminates complications that may occur after TUR, and the operation itself has significant advantages:

    ideal for men taking anticoagulants,

    does not affect the function of the bladder and sexual function of the patient,

    insignificant load on the organs of the cardiovascular system,

    prevention of retrograde ejaculation as a preventive procedure,

    does not require a blood transfusion,

    perfect control in case of unforeseen bleeding.

    Basic research methods

    Ultrasound of the prostate allows you to determine the presence of neoplasms, as well as to clarify the density, structure and homogeneity of this organ. Ultrasound of the prostate is performed transrectally and transabdominally. In the first case, the sensor is placed on the skin of the abdominal wall. This diagnostic method is most often used only on the recommendation of a doctor. At the request of the man himself, this research method is practically not used.

    Ultrasound of the prostate requires the participation of a filled bladder. Therefore, during preparation for the examination, a man should drink at least 1 L. liquid. Unfortunately, this method of ultrasound of the prostate cannot be called informative.

    Transrectal ultrasound involves the installation of a small sensor in the rectum. Doctors use this diagnostic method much more often. It is transrectal ultrasound that allows you to establish an accurate diagnosis. Preparation for this research method involves conducting cleansing enemas. This procedure must be done 2-3 hours before the study.

    Transabdominal examination

    This examination method is carried out after filling the bladder. Drink only high-quality non-carbonated water. You can not urinate after filling the bladder for two to three hours before the procedure.

    An abdominal ultrasound of the prostate adenoma is performed as follows:

    • the patient lays on the couch face up,
    • the doctor carefully lubricates the desired abdominal wall and installs the sensor,
    • then the specialist scans the gland in the transverse and longitudinal planes.

    Then the patient is allowed to empty the bladder.

    Features of transrectal ultrasound

    Preparation for this research method involves not only filling the bladder, but also using glycerin suppositories or microclysters. This is necessary to free the rectum.

    Transrectal ultrasound of the prostate adenoma is performed as follows:

    • the patient lays down on the fetal position, pulling up her knees,
    • the specialist puts on a disposable condom on the sensor,
    • after that, the sensor is inserted into the rectum.

    It is important to consider that the sensor is most often made of latex.If there is an allergic reaction to this material, the patient must notify the doctor in advance.

    An ultrasound examination is not prescribed if a person has had surgery on the large intestine before. Hemorrhoids are not a contraindication, but before undergoing an examination, you need to notify the doctor about its presence.

    After examination, a small amount of blood may be observed in urine. If its amount increases, you must urgently seek help from a doctor.

    Treatment of prostate adenoma in men

    Specialists of the European Association of Urology have developed recommendations for the treatment of patients with benign prostatic hyperplasia. The goal of treating prostate adenoma, according to these recommendations, is:

    · Slowing down the hyperplastic process in the pancreas.

    · Improving the quality of life of patients with impaired urination.

    · In some (few) cases, prolongation of life of patients with complicated course of the disease.

    Patients diagnosed with prostatic hyperplasia are treated with both conservative and surgical methods. A conservative approach involves drug therapy or is reduced to dynamic monitoring of the patient's condition. In this case, the patient should regularly visit a medical institution. The intervals between examinations should be equal to about a year. A simple observation of the patient is permissible only when the symptoms are mild and do not cause the patient significant discomfort, and when there is no absolute indication for surgical intervention.

    Typically, treatment for patients with BPH involves drug therapy. In recent decades, many new drugs have been developed to treat this disease. Therefore, the number of surgical operations for BPH has significantly decreased today.

    Medicines used in modern medical practice to treat prostate adenoma give a good result with minimal side effects. So the drugs are divided into three groups.

    Examination of the prostate and bladder

    Ultrasound of the adenoma of the prostate and bladder is also carried out abdominally. Preparation again involves filling the bladder. 30 minutes before the study, the patient needs to drink 200 milliliters of tea or still water. The procedure is performed when the patient has a desire to empty the bladder.

    The ultrasound procedure of the prostate and bladder is as follows:

    • the patient lies face up
    • the doctor, changing the position of the sensor, examines the transverse sections of the organs,
    • after this, the study involves a thorough scan in the longitudinal direction (for the implementation of this procedure, the patient is turned on his side).

    At the end of this procedure, the doctor asks the client to empty the bladder. Then a second ultrasound of the prostate and bladder is performed. The doctor is interested in a change in the bladder after emptying, as well as the condition of its walls.

    Treatment of prostate adenoma with medication

    All of the aforementioned medications are able to relieve unpleasant symptoms and positively affect the objective indicators of urination.

    In addition, each of the drugs used can have effects that determine additional indications for their use in a particular case. For example, α1-blockers are characterized by increased speed of action - the result becomes noticeable after a few days. Also, after a series of studies, it was possible to find out that tamsulosin and doxazosin not only help with acute urinary retention, but also prevent postoperative ischuria (urinary retention). Doxazosin, alfuzosin, terazosin have a hypotensive effect, and therefore they are recommended for the treatment of patients prone to high blood pressure.And if a patient with prostatic hyperplasia suffers from coronary artery disease, the choice is made in favor of tamsulosin, which improves the performance of the heart.

    The use of 5α-reductase inhibitors not only leads to a decrease in the prostate (by about a third), but also helps to relieve macrohematuria in patients with pancreatic hyperplasia. In addition, these drugs can be used to reduce intraoperative blood loss (for this purpose they are prescribed during the preparation of the patient for transurethral pancreatic resection).

    PCPT results show that finasteride 5α-reductase inhibitor can reduce the likelihood of developing prostate cancer by about 25%. Another authoritative study (MTOPS) helped to find that a course of monotherapy with this drug reduces the risk of progression to hyperplasia by half. And if you combine it with an α1-blocker, then this risk is reduced by 67%. That is, the combination of the two drugs is shown not only to quickly eliminate problems with urination, but also helps to prevent complications associated with hyperplasia (such as acute urinary retention).

    Of the herbal products, Permixon and Prostamoluno with Serenoa repens extract were most studied. This extract helps to reduce the size of an enlarged pancreas (up to about 20%). The research results confirm the decongestant properties of the extract and its ability to reduce the inflammatory process. For this reason, its administration is indicated for patients with concomitant chronic prostatitis.

    Dietary recommendations

    Preparation for ultrasound of the prostate adenoma implies compliance with certain dietary recommendations. First of all, preparation for an ultrasound examination involves the rejection of meat and offal. You can not eat fish, chicken. Also, the patient should not eat sweets, legumes and soda water. The use of alcohol is strictly prohibited. Before the procedure, you can not drink even "harmless" kvass.

    It is allowed to eat fresh fruits, vegetables, seeds and nuts. Also, before an ultrasound examination, you can eat brown bread or special bread rolls. You can drink only herbal teas and decoctions. Rosehip broth is very useful. It can be alternated with freshly squeezed fruit and vegetable juices.

    What can cause the development of the disease

    Modern medicine does not accurately determine the causes of prostate adenoma. According to doctors, there are several factors, the presence of which allows you to identify a man at risk. The main one is age: after 40 years, the endocrine system undergoes rearrangement in the male body, which ultimately affects the hormonal balance. It is a change in the hormonal background that is considered today the main reason for the development of prostate adenoma.

    The likelihood of this disease increases after 50 years and continues to grow every year of life. Judging by the statistics, the risk of getting sick increases in overweight men who lead a sedentary lifestyle or abuse alcohol. The risk group also includes those who have a genetic predisposition.

    Protocol Decryption

    Normally, the size of the prostate does not exceed three centimeters. Volume - no more than 25 milliliters.

    Often during an ultrasound of the prostate, the presence of an inflammatory process is revealed. In this case, specific symptoms of prostatitis are observed, including painful urination and a significant decrease in potency. With prostate adenoma, a weakening of the stream and the presence of constant urges to empty the bladder are observed.

    The “appearance” of prostatitis on ultrasound of the prostate gland depends on the characteristics of inflammation and the development of the pathological process. In the acute form, there is a significant increase in the size of the investigated organ.Against this background, its echo density decreases significantly.

    If, during an ultrasound examination, a chronic form of the disease is established, the specialist detects the presence of sclerotic sites. This signals a sluggish course of pathology.

    An abscess is presented as a round lesion with reduced echogenicity. Often, such a lesion is characterized by a lack of blood supply. In addition, it is surrounded by a large and fairly bright vascular network.

    Symptomatology

    Determining prostate adenoma can be based on some of the main symptoms. Almost all of them are associated with impaired urination. The prostate gland, increasing in size, begins to exert pressure on the urethra, gradually blocking it completely.

    At the initial stage, the patient may experience some discomfort during urination: to empty the bladder, additional efforts must be applied, and the urine stream becomes sluggish and intermittent. The number of urges increases regardless of the amount of fluid drunk from 4-6 times a day to 10 or more, especially often the need to empty the bladder is observed at night.

    If you do not start treatment at this stage, the symptoms will intensify and become more painful:

    • the number of urges continues to increase,
    • prostate tissue compresses the neck of the bladder, and for the outflow of urine it is necessary to strain the muscles of the anterior abdominal wall,
    • there is a delay in urination, in which a few seconds elapse from the beginning of the process to the appearance of a stream, with the further development of the disease, this time period increases,
    • one of the unpleasant symptoms of the late stages of the disease is urinary incontinence, when the contents of the bladder continue to stand out between trips to the toilet.

    Stages of the disease

    The disease has three stages of development, which are characterized by a certain group of signs. At the first stage, the man has an increase in the number of urges, the need to additionally engage the abdominal muscles. On average, the duration of the first stage is about 10 years.

    At the second stage, the patient has unpleasant pain. The walls of the bladder are gradually stretched, while urinating in the folds there is a certain amount of urine. The further the disease progresses, the more fluid will remain in the folds of the bladder, even with strong muscle tension during urination. At the second stage, a malfunction of the kidneys can be observed.

    If the disease goes to the third stage, the patient practically stops the normal outflow of fluid from the bladder, and urine constantly in the body leads to intoxication of the body. This condition of the patient requires immediate medical attention.

    Features of the treatment of prostate adenoma

    In conclusion, it should be added that effective therapy for BPH suggests that patients will actively participate in the treatment process. Therefore, the patient needs to tell about all the features of his illness, inform him about the possible consequences, provide information about the different methods of treatment (with all their advantages and disadvantages).
    It is extremely important to fully inform the patient, because the matter concerns the quality of his life. And he has the right to decide on which of the possible methods the therapy will be carried out. That is, a treatment plan is developed taking into account the characteristics of the course of the disease in this patient and based on his personal wishes. Subject to all of the above principles, drug therapy usually leads to a noticeable improvement in the patient's condition.

    Further research in this direction is based on the latest achievements of scientific medicine and therefore has great prospects.

    Learn about modern diagnostic methods for such an insidious disease as prostate adenoma.

    Adenoma of the prostate gland is considered a benign neoplasm in which specific nodules form in the prostate. The gland increases in size and thus puts pressure on the urethra. Therefore, the patient has a violation of urination.

    Until now, doctors can not determine the exact cause of the disease. Today, doctors agree that prostate adenoma is a manifestation of male menopause. Key factors are the age and level of male sex hormones - androgens.

    According to statistics, about 50% of men after 50 years turn to andrologists and urologists with prostate adenoma. And almost 80% of men, sooner or later, but face this problem.

    How to identify the disease?

    It’s easy to diagnose prostate adenoma. For this, various diagnostic methods are used.

    Hello! I have prostate adenoma, the doctor insists on treatment and scares that everything can end badly 18 October 2013, 17:25 Hello! I have prostate adenoma, the doctor insists on treatment and scares that everything can end badly. Doctor, tell me, is it so serious, from adenoma, I, I think, do not die.

    The first thing a doctor does is interview a patient. The following symptoms that the patient can tell about the disease can indicate:

    • difficulty urinating
    • weak stream when urinating,
    • urinate dropwise
    • intermittent urination
    • the presence of blood in the urine (hematuria),
    • the inability to completely empty the bladder.

    Digital rectal examination

    This method is the most “ancient”, the simplest, and at the same time one of the most effective. Thanks to this method, the doctor can probe the gland, determine its density, assess the condition of the median groove between the prostate lobes, and also check the condition of other tissues around the gland.

    The value of this procedure lies in the cheapness, great information content, as well as the unnecessary additional tools. All that is needed is the experience of a research doctor.

    With prostate adenoma, a general urinalysis and blood biochemistry are indicated. These tests are standard for any disease, and such tests do not carry any specific information for prostate adenoma. However, the doctor needs information about the presence of certain inflammatory processes in the patient's body.

    Another laboratory test method is to check the level of PSA - a prostate-specific antigen - the most important diagnostic indicator for prostate adenoma. PSA is a protein secreted by prostate cells. The main function of PSA is to liquefy sperm after ejaculation. The American Urological Association recommends that all men older than 50 check their PSA levels.

    If a prostate adenoma is suspected, ultrasound is usually performed. In this case, two types of ultrasound are distinguished: simple, which is performed with a full bladder and transrectal, when the sensor is inserted into the rectum.

    Conventional ultrasound is usually sufficient for diagnosis. The doctor resorts to the transrectal method of research if all the previous research methods give an unclear picture of the disease.

    The endoscopic method, the essence of which is that a thin elastic catheter with a miniature video camera and a light source is inserted into the urethra. Using this method, you can evaluate the degree of narrowing of the urethra with prostate adenoma.

    Thanks to the method of urofluometry, you can study such a parameter as the rate of urination. The norm is urination at a speed of 15 ml per second.There are special urofluometers equipped with minicomputers, which automatically give the result in the form of numbers and graphs.

    Contrast excretory urography

    The essence of the method is that a special contrast agent is administered intravenously to the patient. After that, X-rays of the kidneys are made, with which you can assess the condition of the kidneys: the presence of inflammation, stones and other disorders that may be associated with prostate adenoma.

    Establishing diagnosis

    To confirm the diagnosis, a man needs to be examined. There are several ways to identify prostate adenoma. First, the patient is offered to undergo a rectal examination. With the help of palpation of the gland, it is possible to establish the size of the organ and its soreness. Next, a blood test for hormones is prescribed. To get an accurate idea of ​​the shape of the prostate adenoma and its size, as well as to examine the bladder for stones and residual urine, an ultrasound scan is performed. Uroflowmetry helps determine the rate of urine output.

    A comprehensive examination and questioning of the patient allows you to make an accurate diagnosis, determine the stage of development of the disease, prescribe the most effective treatment.

    Treatment methods

    If the disease is not started, drug therapy is applied to the patient. Medications relieve pain and facilitate fluid outflow. The duration of the course of treatment depends on the size of the gland, the condition of the patient, and can last a long time. This method is effective only at the initial stage of the development of the disease.

    If a man has serious disorders of the urinary system, treatment is possible only through surgical intervention. Today, there are several different ways to conduct operations. The choice depends on the volume of the prostate gland, the general condition of the patient, the presence of complications.

    When the first symptoms appear, you should not postpone a visit to the doctor or self-medicate. It should be remembered that the timely appeal to specialists and the implementation of their recommendations increases the chances of a quick recovery.

    BPH - This is the presence of benign growth of the prostate gland located around the urethra.

    To understand the essence of prostate adenoma, you need to turn to anatomy.

    Prostate - The male genital organ, which has the shape of a chestnut and is located in the perineum between the external sphincter of the urethra and the bladder. Part of the urethra passes through the thickness of the prostate gland. These features cause the appearance of the main symptoms in diseases of the prostate gland.

    Under certain conditions, the tissue of the prostate gland begins to grow actively - to hypertrophy. The tissue changed in this way was called adenoma. This tumor is benign, i.e. it grows slowly without causing metastases. But when a growing adenoma compresses the urethra and glands located in its thickness, signs of the disease appear.

    Preparations for the treatment of prostate adenoma

    Therapy of prostate adenoma is predominantly complex. If you respond to the problem in a timely manner, then the chances of avoiding the operation are high.

    Important! You can not self-medicate, you can only aggravate the situation.

    The most effective drugs for prostate adenoma are Prazosin, Alfuzosin, Doxazozin, Terazozin.

    Important! If after 3-4 months the result of treatment is not observed, the tactics should be changed.

    Indications for surgery may include:

    • urinary calculi
    • acute urinary retention
    • the development of renal failure,
    • infectious lesion
    • if there is a lot of residual urine,
    • hematuria.

    After the operation, the man is required to maintain bed rest for 4-5 days, only then he is allowed to sit down.The recovery process is long.

    With adenoma of the prostate is prohibited:

    • any warming up
    • electromagnetic waves,
    • Vibration related procedures
    • ultrasound.

    All of these methods can only aggravate the situation. But electrophoresis can be prescribed so that the drugs are delivered directly to the tissues.

    One of the most popular ways to treat pathology in men is ozone therapy. Ozone helps to establish blood flow in the pelvic organs, reduce pain, accelerate oxidation in the urinary system, and relieve the inflammatory process. The procedure is effective, painless, performed without anesthesia.

    An important point in the treatment of adenoma is a review of the diet. Due to the proper diet, the condition of the patient can be improved.

    Important! A menu should be developed by a doctor, focused on the individual characteristics of each patient.

    The essence of diet therapy is that foods with a high iron content are excluded. It is important to maintain a balanced diet and not provoke weight gain. At least 1.5 liters of water are recommended per day.

    Photodynamic treatment

    This method of therapy comes down to the effects of photodynamic light. The doctor introduces a medicine into the tumor, the effect of which is activated under the influence of irradiation of this area with a laser of a certain wave.

    A similar procedure helps fight tissue necrosis. When performing photodynamic treatment, modern medicine uses the Tukadom remedy.

    Among the most common recipes there are several:

    1. Dried St. John's wort, chamomile, nettle and oak bark, taken in equal proportions, are mixed. Every day, 2 large tablespoons of the mixture are brewed with 1 liter of boiled water and aged overnight. The filtered broth should be drunk completely in a day. Duration of admission is 3-4 months.
    2. 100 g of milk thistle and 200 g of parsley are mixed, poured with 3 liters of boiled water and left for a week in the pantry. Ready drug take 50 g three times a day.
    3. The bark and buds of birch are rich in zinc, which stops the growth of hyperplasia. These components, taken in equal volumes, are mixed and filled with alcohol at the rate of 2 tables. tablespoons - 400 ml. For several days, the composition should withstand the cool. The filtered drug is stored in the refrigerator. Every day you need to drink 1 teaspoon shortly before meals.

    Complications and Predictions

    Prostate adenoma can be successfully treated. But if you do not pay attention to the manifestations of the disease for a long time, then irreversible complications may develop, the most common is urinary retention. Such a problem requires surgical measures.

    Perhaps the development of the inflammatory process of the urinary organs - pyelonephritis, urethritis, cystitis. It provokes such complications of stagnation of urine and, as a result, the rapid multiplication of pathogenic microorganisms.

    Urolithiasis can provoke a blockage of the duct, which is fraught with serious urinary retention. Without emergency surgery, it will not be possible to solve the problem.

    Among the preventive measures, it is worth noting a few:

    • move as much as possible every day, play sports, but do not overdo it. Due to this activity, stagnant processes in the pelvic area will not develop
    • balanced diet,
    • fighting overweight
    • discard tight underwear.

    Prostate adenoma is a serious disease that requires immediate action. Self-medication is unacceptable. Only with timely recognition of pathology and proper treatment will it be possible to get rid of the disease and avoid an operative solution to the problem.

    - This is the proliferation of glandular tissue of the prostate, leading to a violation of the outflow of urine from the bladder. Characterized by frequent and difficult urination, including nighttime, weakening of the stream of urine, involuntary discharge of urine, pressure in the bladder.Subsequently, complete urinary retention, inflammation, and the formation of stones in the bladder and kidneys may develop. Chronic urinary retention leads to intoxication, renal failure. Diagnosis includes ultrasound of the prostate, a study of its secretion, and, if necessary, a biopsy. The treatment is usually surgical. Conservative therapy is effective in the early stages.

    General information

    BPH - benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. For pathology, a benign course is characteristic.

    Only a small proportion of patients seek medical help, however, a detailed examination allows you to detect symptoms of the disease in every fourth man aged 40-50 years and half of men from 50 to 60 years old. The disease is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 years and more than 90% of men over the age of 80 years. The severity of symptoms can vary significantly. Research in clinical andrology suggests that problems with urination occur in about 40% of men with prostate adenoma, but only every fifth patient in this group seeks medical help.

    Symptoms of prostate adenoma

    There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, persistent (imperative) urination, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and increased urination time, a feeling of incomplete emptying, urination with an intermittent flaccid stream, and the need for straining.

    Three stages of prostate adenoma are distinguished: compensated, subcompensated and decompensated. At the compensated stage, the dynamics of the act of urination changes. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia in stage I prostate adenoma does not cause anxiety in a patient who associates constant night awakenings with the development of age-related insomnia.

    During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after a night's sleep. Then the frequency of daily urination increases, and the volume of urine allocated for a single urination decreases. Imperative urges arise. A stream of urine, which previously formed a parabolic curve, is sluggish and falls almost vertically. Hypertrophy of the muscles of the bladder develops, due to which the effectiveness of its emptying is maintained. There is no or almost no residual urine in the bladder at this stage. The functional state of the kidneys and upper urinary tract is preserved.

    At stage II of prostate adenoma, the bladder increases in volume, degenerative changes develop in its walls. The amount of residual urine reaches 100-200 ml and continues to increase. Throughout the urination act, the patient is forced to intensively strain the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure. The act of urination becomes multiphase, intermittent, undulating. The passage of urine along the upper urinary tract is gradually disturbed. Muscular structures lose elasticity, urinary tract expand. Renal function is impaired. Patients are concerned about thirst, polyuria and other symptoms of progressive chronic renal failure. If the compensation mechanisms fail, the third stage begins.

    The bladder in patients with stage III prostate adenoma is distended, is full of urine, is easily detected by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is not possible even with intense tension in the abdominal muscles. The desire to empty the bladder becomes continuous. Severe pain in the lower abdomen is possible. Urine is often excreted in drops or in very small portions. In the future, pain and urge to urinate gradually subside. A characteristic paradoxical urinary retention develops (the bladder is full, the urine is constantly dripping out).

    The upper urinary tract is dilated, the functions of the renal parenchyma are impaired due to constant obstruction of the urinary tract, leading to an increase in pressure in the pyelocaliceal system. Clinic of chronic renal failure is growing. If medical care is not provided, patients die from progressive chronic renal failure.

    Prostate Adenoma Treatment

    The criterion for the choice of treatment tactics for this pathology for the andrologist is the I-PSS symptom scale, which reflects the severity of urination disorders. According to this scale, if the total score is less than 8, therapy is not required. At 9-18 points, conservative treatment is performed. If the total score is more than 18, an operation is necessary.

    Conservative therapy is carried out in the early stages and in the presence of absolute contraindications for surgery. To reduce the severity of the symptoms of the disease, 5-alpha reductase inhibitors (dutasteride, finasteride), alpha-blockers (alfuzosin, terazosin, doxazosin, tamsulosin), herbal preparations (extract of the bark of African plum or sabal fruit) are used.

    To fight infection, often joining with prostate adenoma, antibiotics are prescribed (gentamicin, cephalosporins). At the end of the course of antibiotic therapy, probiotics are used that restore the normal intestinal microflora. Immunity correction is carried out (alpha-2b interferon, pyrogenal). Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs into the prostate gland, so trental is prescribed to normalize blood circulation.

    The following surgical procedures for treating prostate adenoma are as follows:

    1. Adenomectomy . It is carried out in the presence of complications, residual urine in an amount of more than 150 ml, an adenoma mass of more than 40 g,
    2. TOUR (transurethral resection). Minimally invasive technique. The operation is performed through the urethra. It is carried out with a residual urine quantity of not more than 150 ml, an adenoma mass of not more than 60 g. Not applicable for renal failure,
    3. Gentle methods. Laser ablation, laser vaporization of the prostate. Minimum blood loss allows for operations with a tumor mass of more than 60 g. The listed interventions are the operations of choice for young patients with prostate adenoma, since they allow maintaining sexual function.

    There are a number of absolute contraindications to surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc.). If surgical treatment is not possible, catheterization of the bladder or palliative surgery is performed - cystostomy

    Among the reasons for visiting a urologist, one of the most common is prostate adenoma. This disease is an overgrowth of glandular tissue and is benign in nature. If you identify it at the initial stage of development and start treatment in a timely manner, you can do with drug therapy. In advanced cases, the elimination of adenoma is possible only surgically.

    To determine in the early stages, you need to know the main symptoms of this urological disease.Especially attentive to the state of your body should be men who are at risk. In this article you will find answers to all questions related to the symptoms, causes and diagnosis of prostate adenoma.

    Watch the video: Advances in Treatment of Enlarged Prostate Glands. El Camino Health (March 2020).

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