All about prostate adenoma


Prostate adenoma can appear already at the age of 40-50 years. According to the WHO (World Health Organization), there is an increase in the disease, ranging from 12% in men aged 40-49 years to 82% in 80 years. After 80 years, prostate adenoma is found in 96% of cases.

Studies have led to the result that prostate adenoma is more common in the Negroid race, and less so in the inhabitants of Japan and China. This is due to the peculiarities of nutrition in Asian countries, which contains a large number of phytosterols, which have preventive properties.

Anatomy of the prostate gland

The gland is located in the pelvis between the rectum and the pubic symphysis. It is shaped like a chestnut. Gland weight in men from 19 to 31 years old is approximately 16 grams. Iron normally has a dense elastic consistency. The prostate gland consists of the right and left lobes. The shares are connected by an isthmus. The isthmus of the prostate is adjacent to the bottom of the bladder and partially protrudes into the bladder lumen.

Through the prostate gland passes the urethra. It enters the gland at the base and exits from it anterior to the apex. The prostate gland is supplied from the lower cystic and rectal arteries. The veins of the prostate gland form a plexus around it.

Why does prostate adenoma occur?

The causes of prostatic hyperplasia are not fully understood. Scientific studies have linked this disease with the age of a man (the older a man is, the more often they become ill with prostate adenoma). At a young age, men very rarely develop prostate hyperplasia.
With age, there are changes in the neuroendocrine regulation of the prostate gland (after 40 years, in men, testosterone production decreases, and estrogen secretion increases).

There are several factors that increase the risk of developing prostate adenoma:

    Genetic predisposition (someone from the family was sick with this disease)
    Overweight (leads to impaired metabolism and endocrine regulation)
    Unbalanced diet (eating excess salty, spicy, fatty foods).

Studies have not shown the effect - sexual activity, smoking, alcohol consumption, infectious diseases on the development of benign prostatic hyperplasia.

Symptoms of prostate adenoma

Symptomatic picture of the disease depends on the stage of the disease.
There are three stages of the disease.
  Stage 1 is characterized by the occurrence of complaints with full emptying of the bladder (compensation stage).
  Stage 2 is characterized by a significant disruption of the bladder in which a significant amount of urine remains after urination (the stage of subcompensation).
  Stage 3 develops complete bladder dysfunction with the phenomenon of paradoxical ischuria (drop-by-drop urine from an overflowing bladder).

All symptoms of the disease can be divided into obstructive (associated with obstruction of urine) and irritative (irritation symptoms).

Obstructive symptoms:

    The sluggish urine stream — the rate at which urine is excreted — is lowered.
    Initial (primary) urinary retention - urination does not occur immediately after sphincter relaxation, but after a certain delay.
    It is necessary to strain the abdominal muscles - in order to urinate the patient has to significantly strain the abdominal muscles.
    Intermittent urination - that is, urination in parts (normally, urination occurs without interruption until the bladder is completely empty).
    Urine drop by drop at the end of urination (normally this does not happen)
    Feeling of incomplete emptying of the bladder (normally, after urinating, men feel that the bladder is completely empty).
Irritative symptoms appear due to instability of the bladder and appear during the accumulation and subsequent finding of urine in the bladder.

Pollakiuria daytime - the increased number of urination in the daytime. Normally, the amount of urination is 4 to 6 per day, if a person drinks no more than 2.5 liters of fluid per day and is not treated with diuretics. Pollakiuria can reach up to 15-20 urination per day.

Nighttime pollakiuria or nocturia - frequent urination at night. Normally, a person can sleep at night without emptying the bladder. Nocturia appears up to 3 times or more.

False urination to urinate - a condition in which the urge is present, and urination does not occur.
An important role in the appearance of symptoms is played by dysfunction of the detrusor (bladder muscle, expelling urine). Normally, a detrusor contraction occurs when the bladder neck is fully opened. In prostate adenoma, the detrusor becomes unstable. This is due to the increased activity of the detrusor in relation to the adrenergic effect. This phenomenon occurs, as a rule, against the background of weakening of the contractile ability of the detrusor.

Prostate giperplazicheskie nodes cause a violation of the blood supply to the bladder neck, which, along with a reduced threshold of excitability of the detrusor leads to its dysfunction.

What is dangerous prostate adenoma?

Prostate adenoma can be complicated by:
    Acute urinary retention is a serious complication of the disease, characterized by the inability to urinate. This complication most often appears in the second or third stage of the disease. Usually acute urinary retention develops after hypothermia, overwork, or prolonged sitting in a sitting position. This complication is treated with a bladder catheterization.
    Inflammatory processes that have developed against the background of prostate adenoma. Most often, cystitis (inflammation of the bladder) and pyelonephritis (an infectious disease affecting the renal pelvis and kidney parenchyma) can develop. Prevention of these complications is the timely treatment of prostate adenoma.
    Bladder stones are mineral deposits that appear due to incomplete emptying of the bladder. Prevention of this complication is the elimination of incomplete emptying of the bladder. If the stones nevertheless appear, it is necessary to carry out surgical treatment of prostate adenoma with the simultaneous removal of stones.
    Hematuria - the appearance of red blood cells in the urine. Hematuria occurs due to varicose veins of the bladder neck. Hematuria can be macroscopic (urine red) and microscopic (can only be established laboratory). When this complication occurs, it is necessary to exclude stones and bladder tumors.

Diagnosis of prostate adenoma

Diagnosis of the disease always begins with the collection of anamnesis. In 1997, in Paris, at the meeting of the International Committee on Prostate Hyperplasia, the standard algorithm for diagnosing patients with prostate adenoma was adopted. This algorithm includes the total assessment of all symptoms using a simple questionnaire called (IPSS) and the scale of assessment of quality of life (QQL). For scores IPSS and QQL use points. IPSS 0-7 points means insignificant symptoms. At 8-19 points - moderate severity of symptoms, and 20-35 - severe symptoms.
Also, this algorithm includes the filling of the urination diary (frequency and volume), palpation (digital examination) of the prostate and various instrumental diagnostic methods.

Palpation of the prostate (digital rectal examination of the prostate)

Palpation of the prostate allows you to determine the size, consistency, pain of the prostate (in the presence of chronic prostatitis).
Ultrasound. Using ultrasound to determine the degree of prostate enlargement. Evaluate the direction of growth of nodes, the presence of calcifications. Ultrasound also allows you to assess the size of the kidneys, the presence of various changes in them, concomitant urological pathologies.
TRUS - transrectal ultrasound. This study allows a detailed study of the structure of the prostate, to obtain its exact size, as well as to identify signs of chronic prostatitis or prostate cancer. TRUS allows you to determine the development of prostate adenoma at very early stages.
Quite often, in patients with severe prostate hyperplasia, calcification foci are determined. The presence of calcifications in the central zone of the prostate indicates the final (5) stage of development of the disease.

Uroflowmetry is a method used to measure various characteristics of a stream of urine. This method should be carried out not less than 2 times in the conditions of filling the bladder (150-350 milliliters) and in the event of a natural urge to urinate. To evaluate the results, a uroflow flow curve is used, on which the maximum urine flow rate is noted. A flow rate greater than 15 milliliters / second is considered normal. Also estimated is total urination time. Normally, for a urine volume of 100 milliliters - 10 seconds, for 400 milliliters - 23 seconds.
Studies have shown that there is a dependence of urination indicators on age. It is normally considered that the flow rate decreases by 2 milliliters / second every 10 years. This decrease in speed is due to the aging of the bladder wall.
The determination of residual urine after urination is of great importance for determining the stage of the disease, as well as for determining indications for surgical treatment. Residual urine is determined by ultrasound immediately after urination. Recently, uroflowmetry is combined with residual urine determination.
Cystomanometry is a method with which help determine the pressure inside the bladder. This method allows you to measure intravesical pressure at different stages of filling the bladder, as well as during urination.

In a healthy person, the initial urge to urinate occurs when there are 100-150 milliliters of urine in the bladder, and the pressure is 7-10 centimeters of water column. When the volume of the bladder is filled to 250-350 milliliters, the urge to urinate increases sharply. In this case, the normal intravesical pressure is 20-35 centimeters of water column. This reaction of the bladder is called the normoreflex.
Increased intravesical pressure (above 30 centimeters of water column) with a bubble volume of 100-150 milliliters indicates hyperreflexogenicity (the detrusor reflex is increased). Conversely, reduced pressure (10-15 centimeters of the water column) when filling the bladder to 600-800 milliliters indicates detrusor hyporeflexia. The detrusor's reflexogenicity makes it possible to evaluate its reserve function, and the relationship between volume and pressure characterizes the elastic properties of the detrusor.
Cystomanometry carried out during urination allows you to determine the vesicourethral urethral patency and contractile ability of the detrusor. Normally, the maximum intravesical pressure during urination is 45-50 centimeters of water column. If the pressure is increased, it indicates the presence of an obstacle when emptying the bubble.

Cystography is a method of examining the bladder with the use of contrast. There is a descending and ascending cystography. Downward cystography involves the movement of contrast from top to bottom. This method allows to determine the filling defect in the area of ​​the bladder neck. In the picture, this filling defect is seen as a tubercle. Rising cystography allows you to determine the deformity of the urethra in the prostate.
Computed tomography and magnetic nuclear resonance - these studies provide more detailed information (correlation with neighboring organs) about prostate adenoma.

Prostate adenoma treatment

 Drug treatment

Alpha blockers adrenergic receptors. These drugs reduce the tone of the smooth muscle structures of the bladder neck and prostate, which leads to a decrease in urethral resistance during urination.
Such drugs as prazosin, alfuzosin, doxazosin, terazosin are used. These drugs must be used for a long time over 6 months. The therapeutic effect is observed after 2-4 weeks of use of these drugs.
    Prazosin 4-5 milligrams per day in 2 doses
    Alfuzosin 5-7.5 milligrams per day in 2 doses
    Doxazosin 2-8 milligrams per day once
    Terazosin 5-10 milligrams per day once
Special indication: if a positive effect cannot be achieved in 3-4 months, it is necessary to change the tactics of treatment.
5 alpha reductase inhibitors. This group includes finasteride and duasterid. Their action is to block the conversion of testosterone into dihydrotestosterone at the prostate level. These drugs do not bind to androgen receptors and do not have side effects characteristic of hormonal drugs.
The optimal dose of finasteride is 5 milligrams per day. With this type of treatment, a decrease in the prostate is observed after 3 months by 20%, and after 6 months by 30%.

Phytopreparations treatment

Phyto treatments have been used by people since ancient times. Recently, these drugs have become very popular in Europe, Japan and the United States.
Permixon is a French drug from the fruits of the American dwarf palm, which has an inhibitory effect on 5 alpha reductase. It also has a local antiproliferative and anti-inflammatory effect.
Studies have shown that prolonged use of the drug (for 5 years) leads to a significant decrease in prostate volume and residual urine volume, and also relieves the symptoms of the disease. Permixon is characterized by good tolerance and lack of side effects.
Prostamol Uno is a preparation made from the fruits of Sabal palm. The drug has anti-inflammatory, anti-exudative (prevents the accumulation of pathological fluid), anti-androgenic effect (due to inhibition of 5 alpha reductase). The drug does not affect the level of sex hormones, does not change the level of blood pressure, does not affect sexual function.
Phyto preparations are treated with prostatic hyperplasia of the first and second degree.

Surgical treatment of prostate adenoma

Surgical treatment can be carried out on an emergency or in a planned manner. A planned operation is performed only after a complete examination of the patient.
Surgical treatment (elective surgery) is carried out only if there are absolute indications:
    Delay urination (inability to urinate at least after a single bladder catheterization)
    Massive and repetitive hematuria (the presence in the urine of red blood cells), which occurs due to prostate adenoma
    Kidney failure that develops due to prostate adenoma
    Bladder stones due to prostate adenoma
    A urinary tract infection that recurs many times due to prostate adenoma.
    The presence of a large diverticulum in the bladder
Also, surgical treatment of prostate adenoma is indicated in patients who have significantly increased the average proportion of the prostate or those who have a large amount of residual urine in the bladder.
Emergency surgery is an operation that must be performed within 24 hours from the time the complications develop. In such an operation, an adenomectomy is performed (removal of the prostate).

Emergency surgery is shown:

    With bleeding in a life threatening patient
    With acute urinary retention

Preparation for surgical treatment of prostate adenoma

    A general blood test is carried out to determine anemia (a reduced amount of hemoglobin and red blood cells), leukocytosis (talking about any inflammatory process).
    Before surgery, it is necessary to check the function of the kidneys using a biochemical blood test. In the presence of renal impairment, creatinine and blood urea will be elevated.
    Blood clotting studies are necessary to rule out the risk of thromboembolism or bleeding, both during and after surgery.
    ECG (electrocardiogram) - in order to exclude possible complications of the heart during surgery.

Methods of surgical treatment:

 Transurethral endourological treatment of the prostate is a surgical method in which special endoscopic equipment is used. The operation is performed transurethrally (that is, in the cavity of the urethra). The endoscope through the urethra is carried out directly to the prostate, then the hypertrophied portion of the prostate is removed. This method of surgical intervention has several advantages over open surgery:
    The absence of soft tissue damage when accessing the prostate, which speeds up recovery time after surgery.
    Well controlled hemostasis (stop bleeding), which significantly reduces the risk of bleeding after surgery.
    It allows patients with concomitant diseases to be operated on.
Transurethral electrovaporization (evaporating) of the prostate - this method of treatment is similar to the endourological method and differs from it only by using a roller electrode. When the electrode touches the tissues of the prostate, the tissue burns out with drying and coagulation. This treatment method significantly reduces the risk of bleeding during surgery. This treatment is most effective for small and medium sized prostates.
Electrical incision of prostate adenoma - this method of treatment differs from other methods in that in this case the prostate tissues are not removed, but only make a longitudinal dissection of the tissues of the prostate and bladder neck.
Most often, this method of treatment is used in the following cases:
    Young patient age
    Small prostate size
    Intra vesical (in the lumen of the bladder) growth of prostate adenoma

Surgical treatments using a laser

There are two main areas of laser therapy:
    Laser vaporization
    Laser coagulation
Moreover, treatment with these methods can be carried out by contact or contactless method. For contactless (remote) endoscopic laser coagulation, fiber-optic fibers with a special tip guide the laser beam at an angle to the longitudinal axis of the fiber. Non-contact technique differs from the contact of a lower energy density in the tissues of the prostate.

The advantage of evaporation over coagulation is the ability to remove the prostate under visual control. The evaporation procedure can take from 20 to 110 minutes.
There is also a method for interstitial laser coagulation of the prostate. This method involves placing the tip directly into the prostate tissue. During the operation, change the location of the tip several times. The average operation time is 30 minutes.
Transurethral microwave thermotherapy is a method for using the effect of high temperatures on prostate tissue. The threshold of temperature tolerance (tolerability) of prostate cells is 45 degrees Celsius. This method involves the use of temperatures from 55 to 80 degrees Celsius. This temperature is created by using unfocused electromagnetic energy, which is conducted to the prostate using a transurethral antenna.
Transurethral radiofrequency thermal destruction - this method involves the use of hard temperature effects (70-82 degrees Celsius). This method also uses electromagnetic energy.

The main advantage of thermal destruction is its high efficiency in the treatment of prostate adenoma with marked sclerotic changes and calcification of the prostate. This procedure lasts about an hour on average.
Balloon dilatation - a method based on the mechanical expansion of the prostatic urethra.

Urethral stents (internal drainage systems)

With the help of implantation of a urethral stent solve the problem of bladder drainage. Most often, stents are used in the second or third degree of the disease (when obstructive symptoms are strongly pronounced).

Prostate adenoma prevention

    Daily mobility and sports (but without undue stress). Physical activity reduces the risk of congestive processes in the pelvis.
    Healthy food, which involves the exclusion from the diet of acidic, salty, sharp smoked products. Mandatory presence in the diet of fruits and vegetables, as well as vitamins of all groups.
    Fighting obesity (improves metabolism throughout the body).
    To exclude wearing tight things in the crotch area: panties, pants.
    Exclude casual sex as a means of preventing genital infections.

Frequently asked Questions

 Is it possible to use any physiotherapeutic methods for the treatment of prostate adenoma?

The following physiotherapeutic methods of treatment cannot be used:
    Any type of prostate warming
    Electromagnetic waves
    Various vibratory procedures
All of the above physiotherapy methods aggravate the course of the disease.
In prostate adenoma, electrophoresis is most often used to deliver the drug directly to the tissues of the prostate.

Can massage be used as a treatment method?

Massage is only effective for chronic prostatitis (inflammation of the prostate). For the treatment of prostate adenoma, massage is contraindicated.

What foods should be eaten?

The daily use of raw pumpkin seeds significantly increases the effect of treatment, especially in the early stages of the disease.

Are there exercises to do with prostate adenoma?

Exercises should be performed at least 5-10 times per session.
    In the supine position with the buttocks torn off the floor, the anus should be pulled in.
    In a position on all fours take turns pulling the legs back, then to the side. Simultaneously with stretching the legs, it is necessary to stretch the opposite hands forward (that is, if stretching the left foot back means simultaneously stretching the right hand forward).
    Lying on your back, tighten your knees bent at the knees, and then lower in turn either to the right or left of the body.

What is the difference between prostate adenoma and prostatitis?

Prostate adenoma is a disease in which its benign enlargement occurs. Prostatitis is an inflammatory process in the prostate gland.

What are the PSA rates for prostate adenoma?

A prostate-specific antigen (PSA) is a protein-enzyme that is produced by normal cells of the prostate gland. It enters the seminal fluid and dilutes it. Moreover, a small amount of prostate-specific antigen enters the bloodstream.
With benign prostatic hyperplasia, PSA is produced in an increased amount, with malignant tumors, its level in the blood rises even more.
The standards for PSA for men of different ages:
    up to 50 years - <2.5 ng / ml;
    50-60 years old - <3.5ng / ml;
    60-70 years old - <4.5 ng / ml;
    over 70 years old - 6.5 ng / ml.
Each gram of benign prostate adenoma increases PSA level by 0.3 ng / l, and each gram of malignant tumor - by 3.5 ng / ml. In prostate adenoma, the level of prostate-specific antigen almost never rises above 10 ng / ml. If this happens, then cancer is suspected.
In prostate adenoma, the PSA level in the blood rises annually by no more than 0.75 ng / ml. Faster growth is characteristic of malignant tumors.
A prostate-specific antigen can circulate in the blood in a free form (free PSA), or be bound to other proteins (PSA bound). Usually the level of free and total prostate specific antigen is determined in the laboratory. If free is less than 15% of the total - there is a risk of a malignant tumor.
The indicator such as PSA density is also important. In order to get it, divide the indicator of the level of prostate-specific antigen in the blood by the volume of the prostate gland. If the PSA density is more than 0.15 ng / ml / cm3, there is a risk of cancer.
In all cases, when, after a blood test for PSA, there is a suspicion of prostate cancer, the doctor prescribes a biopsy.

 What could be the consequences of surgery for prostate adenoma?

The probability of certain complications may be different, depending on the selected operation. Consider the possible effects of surgery on the example of open prostate gland removal and transurethral resection:
    Bleeding during surgery is the most severe complication. According to statistics, it occurs in 2-3 men out of 100. May require blood transfusions.
    Bleeding after surgery. At the same time in the bladder blood clots are formed, which violate the flow of urine. We have to perform a second operation, open or endoscopic.
    Urinary retention Occurs as a result of disruption of the muscles of the bladder or due to surgery.
    Infections of the urogenital system: acute prostatitis (inflammation of the prostate), acute pyelonephritis (inflammation of the kidney cups, pelvis and canalicular system), acute orchiepididymitis (inflammation of the testicle and its appendage). There are 5-22 men out of 100.
    Insufficient removal of prostate tissue during surgery. The remaining tissue can work as a valve and lead to urinary disorders, which do not go away for a long time, sometimes causing a man even greater anxiety than before the operation. Complication occurs in 2-10 men out of 100, re-surgery helps to cope with it.
    Retrograde ejaculation - a condition in which the sperm during sexual intercourse does not go out, but is thrown in the opposite direction, into the bladder. This complication is very common.
    Erectile disfunction. Erection problems occur in every tenth man who has undergone surgery for benign prostatic hyperplasia. Many scientists believe that the operation has nothing to do with it - violations of non-operated men are just as common.
    Constriction of the urethra. Develops after surgery about 3 out of 100 men. Requires endoscopic intervention.
    Urinary incontinence. This complication occurs in some men. If it is associated with a violation of the muscles of the bladder, it can pass on their own.

What is embolization of prostate adenoma?

Embolization is a modern method of treatment of benign prostatic hyperplasia, which began to be applied in 2009. The essence of the technique is that the doctor turns a special probe into the vessel feeding the adenoma, and inserts emboli through it - the smallest particles that block the blood flow. Adenoma ceases to receive blood and as a result decreases in size.
Embolization is often a good alternative to surgical intervention for benign prostatic hyperplasia. But it can be performed by no means in all hospitals - for this you need special equipment and trained medical specialists - endovascular surgeons.
After embolization, the prostate gland may decrease by half or more. In this case, the procedure avoids the complications that may occur during and after surgical interventions.

How is embolization of prostate adenoma carried out?

    The procedure is carried out in a special room (X-ray operating) under the control of radiography.
    Thanks to the use of anesthesia, the procedure is virtually painless. The man feels like being injected into a vein.
    The doctor makes a small incision in the radial or elbow joint and inserts a catheter into the radial or brachial artery, respectively.
    Under the control of radiography, the catheter is conducted into the aorta, the internal iliac artery, and finally into the vessel feeding the prostate adenoma.
    The doctor introduces emboli through the catheter - small particles that block the lumen of the vessel and disrupt the blood flow to the adenoma.
    In general, the procedure can last up to several hours. After embolization, many men can return home the same day and do their daily activities.
As a rule, embolization is prescribed when the size of prostate adenoma is 80 cm3 or more.

Is there a malignant prostate adenoma?

Prostate adenoma is a benign neoplasm by definition. It does not grow into neighboring tissues and does not metastasize.
However, over time, prostate adenoma can become malignant. Prostate cancer develops. Usually, the “first bell” that signals the development of a malignant tumor is an increase in the blood level of the prostate-specific antigen. The biopsy helps to finally confirm the diagnosis.
Prostate cancer, unlike adenoma, can grow into adjacent tissues and give metastases. The success of treatment strongly depends on how early it was started.