BPH is a disease that starts in men in adulthood and is characterized by benign enlargement (hyperplasia) of the paraurethral glands.
Adenoma of the prostate can occur at age 40-50 years. According to the who (world health organization) is the accumulation of disease, ranging from 12% for men aged 40-49 years at 82% in 80 years. After 80 years of BPH occurs in 96% of cases.
Studies have led to the result that the adenoma of the prostate in blacks more common, and the inhabitants of Japan and China often. This is due to the dietary habits of Asian countries, which is a large number of phyto-sterols, which are preventive properties.
Is gland, which is located in the pelvis between the rectum and the pubic Symphysis). This is a form that is reminiscent of the chestnut tree. The weight of the gland in males from 19 to 31 years of age, approximately 16 grams. Iron is usually photoelasticity consistency. The Prostate gland consists of right and left lobes. The interest is connected with the isthmus. In the isthmus of the prostate, which is adjacent to the bottom of the bladder and partly in the lumen of the bladder.
Through the prostate passes the urethra. Enters the gland at the base and it goes out anteriorly from the apex. The Prostate is supplied with blood, which is at the bottom of the cystic and the intestinal arteries. The veins of the prostate form a plexus around it.
The causes of BPH are not fully understood. Scientific studies have linked the disease as men age (the older the man, the more often fall ill with adenoma of the prostate). In the youth men rarely develop hyperplasia of the prostate.
With age, changes occur in the neuroendocrine regulation of prostate cancer (after 40 years of age and in men the production of testosterone decreases, and secretion of estrogen increases).
There are several factors that increase the risk of developing BPH:
The conducted research did not evidence the impact of sexual activity, Smoking, alcohol consumption, infectious diseases in the development of benign prostatic hyperplasia.
The symptomatic picture of the disease depends on the degree of disease.
There are three stages of disease
Stage 1 is characterized by the occurrence of complaints in the complete emptying of the bladder (stage of compensation).
Stage 2 is characterized by significant disturbance of the bladder after urination, which is a significant amount of urine (in the stage of subcompensation).
Stage 3 developing a complete dysfunction of the bladder with the occurrence of paradoxical ischuria (selection by drops of urine from the full bladder).
All the symptoms of the disease can be divided into obstructive (related to obstruction in urine output) and signs of irritation.
Obstructive symptoms are:
BPH can be complicated:
Disease diagnosis always begins with a medical history. In 1997 in Paris at the meeting of the International Committee on issues of hyperplasia, was accepted as a standard diagnostic algorithm of patients with BPH. This algorithm included the total score of all symptoms with a simple questionnaire, called the (IPSS) and the rating scale of quality of life (QQL). For the assessment and QQL IPSS use the points. IPSS 0-7 points means a slight manifestation of symptoms. With 8-19 points – moderate symptoms, and 20-35 severe symptoms.
Also, this algorithm includes completing the voiding diary (frequency and volume), palpation (digital examination) of the prostate and the various instrumental methods of diagnosis.
Palpation of the prostate (digital rectal examination of the prostate).
Palpation of the prostate allows you to determine the size, consistency, tenderness of the prostate (in the presence of a chronic prostatitis).
Ultrasound. With the help of ultrasound determine the level of an enlarged prostate. Assessment of the direction of the growth nodes, the presence of calcifications. Ultrasound also allows us to estimate the size of the kidney, the presence in them of various changes, concomitant urological diseases.
CONSCIENCE – transrectal ultrasound. This study allows us to study the structure of the prostate, its exact dimensions, as well as to identify signs of chronic prostatitis or prostate cancer. Transrectal ultrasound examination allows to determine the development of BPH in the very early stages.
Often in patients with very severe hyperplasia of the prostate determination of the foci of calcification. The presence in the Central zone of the prostate calcification tells about the end of the (5) stages of development of the disease.
Uroflowmetry is a method that can be used to measure the different characteristics of the flow of urine. This method should be carried out not less than 2-fold in the sense of bladder filling (150-350 ml) and in the event of a natural urge to urinate. To evaluate the results using the Uroflowmetry curve, which represents the maximum flow of urine. Flow rate exceeding 15 ml/s is considered normal. Also the estimated total time of urination. The norm for volume of urine in a 100 ml – 10 seconds by 400 milliliters of 23 seconds.
Studies have shown that there is a dependence of the indicators of urination of age. Rule of thumb is that the speed of flow is reduced to 2 milliliter/second every 10 years. This reduction in speed is due to the aging of the bladder wall.
Determination of the residues of urine after urination, which is of great importance for determining the stage of the disease, and to determine indications for surgical treatment. The residual urine is determined by ultrasound immediately after voiding. Recently Uroflowmetry is combined with determination of residual urine.
Cystomanometry is the method by which it determines the pressure within the bladder. This method allows the measurement of the intravesical pressure at the various stages of bladder filling and during voiding.
In a healthy person starts the urge to urinate occurs when the bladder 100-150 ml of urine, the pressure is equal to 7-10 cm water column. When the bladder volume is filled up to 250-350 ml, the urge to urinate increases greatly. In this case, the normal intravesical pressure is 20-35 cm water column. This reaction is called the norm of the bladder reflex.
Increased intravesical pressure (above 30 cm water column) at the bubble scale of 100-150 milliliters to talk about hyperreflexivity (increased reflex of the detrusor muscle). On the contrary low pressure (10-15 cm water column), when filling the bladder to 600-800 milliliters speaks of the Hypo-a reflection of the detrusor muscle. Reflexogenic detrusor muscle allows you to evaluate your backup function, and the relationship between volume and pressure is characterized by the elastic properties of the detrusor muscle.
Cystography is the method to check the bladder with contrast. There are descending and ascending cystography. Descending cystography involves the movement of the difference from the top to the bottom. This method allows to determine the filling defect in the neck of the bladder. The picture shows the filling defect is visible as a bump. Ascending cystography allows to determine the deformation of the urethra in the prostate area.
Computed tomography and magnetic nuclear resonance , these studies provide more detailed information (correlation with neighbouring authorities) on BPH.
Blockers of alpha adrenergic receptors. These medications reduce the tone of smooth muscle structures of the neck of the bladder and prostate, resulting in reduction of urethral resistance during voiding. This medication should be used long-term more than 6 months. The therapeutic effect occurs after 2 to 4 weeks of use of these drugs.
Treatment of herbal medicines by people since ancient times. Recently these drugs have become very popular in Europe, Japan and the USA.
One of the French preparations from the fruit of the American dwarf palm tree, which has an inhibiting effect on 5 alpha reductase. The local also has antiproliferative and anti-inflammatory effect.
Research has shown that long-term use of the drug (in 5 years), leads to a significant reduction of prostate volume and residual volume of urine and relieve the symptoms. The tool is characterized by good tolerability and no side effects.
Another drug, made from the fruit Sabal palm trees, has anti-inflammatory, antiexudative (prevents the accumulation of pathological fluid), antiandrogenic activity (by inhibiting the 5 alpha reductase). The drug does not affect the level of sex hormones does not alter blood pressure, does not affect sexual function. Treatment of herbal medicines, which is carried out on the hyperplasia of the prostate of first and second instance.
Surgical treatment can be performed in an emergency or in a planned way. The selection operation is carried out only after an in-depth examination of a patient.
Adenoma of the Prostate – benign neoplasm, by definition. This does not invade neighbouring tissues and do not metastasize.
However, in time, BPH can become malignant. Develop prostate cancer. Usually the "first bell" that signals the development of malignant tumors is the increased blood level of prostatic specific antigen. Finally helps to confirm the diagnosis a biopsy.
Prostate cancer is in contrast to adenomas, which are able to germinate in the surrounding tissue and metastasize. Successful treatment largely depends on how early it was started.