Diseases of the prostate adenoma, male reproductive system.
Adenoma of the prostate is a disease that occurs as a result of enlargement of the prostate gland, leading to blockage of the lower urinary tract.
The manifestation of adenoma depends mainly on the localization of the nodes in the prostate gland, and not on the size of the gland itself. Most quickly, blockage of the urinary tract occurs when the nodes are located in the middle lobe of the gland.
The reasons for the development of adenoma of the prostate are a sedentary lifestyle, irregular sex, vibration (this disease is common among drivers, cyclists), drinking alcohol (especially beer).
All these factors lead to a slowdown in blood circulation in the lower trunk and in the pelvic organs, including the prostate gland. Due to the slowing down of blood circulation, edema of the prostate gland occurs, which favors the entry and consolidation of infection in it. The triggering factor of adenoma is infection. Infection in the prostate gland can enter through the urethra, through the bloodstream, through the lymphatic tract.
Every man after 45 years of age should be examined by a urologist at least once a year and at least once every two years to perform a blood test for PSA antigen (prostate tumor marker).
Adenoma of the prostate is an old name for the disease. The new name is benign prostatic hyperplasia.
The name change is fundamental to understanding the essence of the problem.
The word adenoma means that it is a tumor. In fact, this is an increase in the mass and volume of the prostate gland, which occurs in people after 40-50 years old and is caused by certain hormonal changes in the male body. By the age of 70, the vast majority of men have some degree of prostatic hyperplasia. Strictly speaking, this is the physiological state of the prostate gland in a certain age period. Moreover, if benign prostatic hyperplasia does not cause narrowing of the urethra and does not cause disturbances in the outflow of urine from the bladder, then it does not require treatment.
The compensated stage of prostate adenoma is characterized by:
- increased urge to urinate, especially at night,
- delayed onset of urination,
- a sluggish stream of urine.
However, at this stage, the bladder is still completely empty, and there are no significant changes in the upper urinary tract.
At the second stage, as a result of the increasing difficulty in the outflow of urine from the bladder, a compensatory thickening of its muscular wall gradually develops, which is accompanied by the presence of residual urine after natural urination in the amount of 100 ml or more. A patient in this stage of the disease begins to have a feeling of incomplete emptying of the bladder, he urinates in several stages with a sluggish thin stream.
In the first and second stages of prostate adenoma, cases of acute urinary retention, provoked by alcohol or hypothermia, are sometimes noted. However, the performed catheterization leads to the restoration of urination.
The third stage of prostate adenoma is characterized by loss of muscle tone in the bladder. This is manifested by retention or urinary incontinence, which is expressed in the form of involuntary flow of urine drop by drop when the bladder is full.
Diagnosis of adenoma of the prostate is carried out by a urologist:
- Digital rectal examination of the prostate gland;
- Prostate-specific antigen (PSA) – a moderate increase is typical for prostate adenoma, – a sharp increase – for prostate cancer. A free PSA / total PSA ratio of less than 15% with a serum PSA concentration in the range of 3-10 µg / L indicates an increased likelihood of prostate cancer;
- Cystoscopy is indicated to exclude bladder tumors;
- X-ray methods.
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
When treating patients with prostate adenoma, it is recommended to avoid hypothermia, prolonged sitting, spicy food, alcohol and significant amounts of fluids, especially at night.
Shown are walks in the fresh air, exercise therapy with an emphasis on exercises for the muscles and organs of the pelvic floor and thighs. Sexual life in such patients should continue and be rhythmic.
Medicinal and physiotherapy treatments
For drug therapy of prostate adenoma, the following are used:
- hormonal drugs
- 5-alpha reductase inhibitors
- polyene antibiotics
- tissue preparations.
The choice of the drug, the course of treatment, its duration are determined depending on the clinical picture and on the severity of the symptoms of the disease. The duration of the course also depends on whether it is an independent method of treatment or is carried out in order to prepare the patient for surgery.
Hormone therapy is carried out with drugs that block the synthesis of testosterone (male hormone) by the testes at the level of the brain or prevent the action of male hormones on the prostate gland. The first group includes zoladex, buserelin, depostat, the second – flutamide, casodex, androkur and megestrol. However, at present, drugs in this group are used to a limited extent due to frequent adverse reactions (erectile dysfunction, decreased libido, gynecomastia) and their high price.
5-alpha reductase inhibitors are widely used. These are drugs such as finasteride (proscar) and episteride. The drugs are well tolerated by patients, however, among the adverse reactions are erectile dysfunction, decreased libido and a decrease in ejaculate volume.
Herbal preparations – permikson, tadenan (trianol), kharzol, peponene, speman, optimal and the domestic drug tykveol. Their anti-inflammatory and anti-edema effect is especially pronounced. The efficiency of Permixon reaches 70%. However, treatment with phytopreparations is long-term – at least one year. Phytopreparations do not affect sexual function.
Recently, alpha-blockers have also begun to play an important role in the treatment of prostate adenoma. Mainly used are prazosin, alfuzosin, doxazosin, terazosin, tamsulosin. The safety and efficacy of treatment with these drugs has been proven for their long-term (more than 6 months) use. Pronounced improvement and favorable dynamics are already evident in the first 2–4 weeks of their use. If the positive effect is not achieved within the specified time frame, then the further use of these drugs is futile. Among the adverse reactions: malaise, weakness, dizziness, headache, heart palpitations, therefore, treatment with alpha-blockers should be started with minimal doses. The most effective and least toxic drug is tamsulosin.
Non-surgical methods also include treatment methods when a local physical factor is applied to the prostate gland, which partially causes its death, wrinkling and, as a result, a decrease in size.
These treatments include:
- cryotherapy of prostate adenoma (freezing);
- thermotherapy for prostate adenoma (warming up);
- ethanol ablation of prostate adenoma (introduction of alcohol into the prostate gland).
It should be noted that each method of treatment has its own strict indications for the appointment.
Most of the operations for prostate adenoma are currently performed in a low-traumatic way without incision of the skin using special equipment.
Surgery to remove adenoma of the prostate is performed, as a rule, under anesthesia of the lower torso without turning off consciousness. A special operating system is inserted into the urethra up to the prostate gland, with the help of which, under the supervision of the surgeon’s eye, that part of the prostate gland that interferes with the free outflow of urine from the bladder is removed. Removal of prostate tissue is performed using an electrical loop that is passed through the operating system. In the postoperative period, a catheter is left in the bladder for some time. If the course is favorable, the patient is discharged for outpatient treatment in 5-7 days.
The most common complications of prostate adenoma include:
- inflammation of the urethra
- inflammation of the bladder
- inflammation of the epididymis
- kidney inflammation
- renal failure.
Prolonged, often occurring urinary retention leads to overstretching and degeneration of the walls of the bladder, gaping of the mouth of the ureters and, as a result, to anatomical changes.
The prognosis for timely treatment of prostate adenoma is favorable.