Adenoma of the prostate gland. Stage of development and possible complications.
Adenoma of the prostate or benign prostatic hyperplasia is the formation of a tumor around the urethra in the prostatic division, with violation of the outflow of urine.
This disease is the most common among males aged over 50 years. Therefore, experts recommend that men older once a year to visit a urologist for passing the appropriate examination.
According to the structure and location of the tumor there are three types of adenomas:
- The tumor penetrates through the urethra inside the bladder, modifying the internal sphincter and disrupting its function.
- For uniform compaction of the prostate under the pressure of the adenoma is formed, the delay of urine in the bladder and impaired urination.
- The tumor increases from the side of the rectum, slightly disturbed urination, but the loss of contractility of the prostatic Department of the urethra cannot completely empty your bladder.
The value of benign tumors does not always correspond to the stage of disorders of urine outflow. Basically it depends on the direction of growth of the prostate. With the sprouting of a large adenoma paraurethral glands at the side in the direction of the rectum clinical manifestations of the disease may be completely absent.
At the same time a small adenoma, growing out of the back of the group of glands hanging over the urethra in the form of a valve can cause delay urine output.
3 stages of development of BPH
Newborn boy weight of the prostate is only a few grams. In puberty it gradually increases and by age 19, reaches a weight of 20 grams. Normally, the structure and weight of the body remains unchanged for 25 years; 20% of men in older age, especially after 50 years there is a dysfunction, and the rest of the growth of the paraurethral glands, expressed in varying degrees.
Studies hormonal men suffering from BPH, have identified some patterns that complement the ideas about the pathogenesis of the disease. Scientists have discovered that the content of testosterone in normal prostate and changed the same, but the level of dihydrotesterone last exceeded in 5 times.
Stage of development
The prostate cancer has 3 stages:
Is characterized by complete elimination of urine from the bladder due to compensatory changes of the bladder muscle (detrusor), its growth and the absence of significant changes in the functional state of the kidneys and upper urinary tract.
At this stage, patients may observe small changes in the dynamics of the act of the outflow of urine. Urination to become lessintense, free and more frequent. Urination starts to disturb at night.
A day at the initial stage of urination could be no apparent change in frequency, but some men say that the act of the outflow of urine does not occur immediately, but over time, especially in the morning after waking up from sleep. Further increases the frequency of daytime urination and significantly decreases the volume of urine.
Also for the first stage is characterized by the emergence of imperative (imperative) urge to urinate, in which the patient can hold the muscle contraction of the bladder, and forced to quickly empty it.
Is characterized by several stages of changes in the urinary bladder, kidneys and upper urinary tract. The bladder with the excretion of urine is not completely emptied and remains in it up to 200 ml residual urine. In the future, its amount increases and reaches a few hundred milliliters.
In the second stage (dystrophic changes in the detrusor (the bladder muscle), he is no longer able to expel the urine, and as a result, the bladder increases in volume. For complete emptying of the patients have greatly strain the muscles of the diaphragm and abdomen during the act of the outflow of urine, which can cause the increase in intravesical pressure. The flow of urine is performed in bursts, in waves, multiphase with small rest periods.
As a result of increased intravesical pressure, squeezing estuaries ureters and the loss of elasticity and muscle structures there is a violation of passage of urine through the upper urinary tract and their extension. The failure of the compensation mechanism facilitates the transition of the disease from the second to the third stage, final.
Characterized by decompensation of the function of the upper urinary tract, bladder, and renal insufficiency.
At this stage, the bladder ceases to contract and emptying becomes impossible. The bladder wall is strongly stretched, it is full of urine and it can specialist identified visually or with pressure on the lower abdomen.
Round shape the top edge of the bladder resembles a tumor, which reaches the level of the navel. The patient feels a constant desire to empty the bladder: it does not pass, the abdomen appear strong, not subsiding pain. During urination, the urine in small portions or drops very often.
Continuous constant urine retention can cause a weakening of the urge to urination and pain. Patients begin to see the periods of day and night involuntary permanent separation of urine drops. Such a condition doctors call "incontinence".
However, bladderremains crowded in the urine. Thus, there is a simultaneous combination of incontinence and retention of urine – "paradoxical retention of urine".
In the third stage in men with BPH is an expansion of the upper urinary tract, kidney dysfunction etc Patients complain of lack of appetite, thirst, weakness, dry mouth, constipation, nausea and vomiting. The disease is accompanied by changes in the mental sphere: anxiety, apathy, depression, unpleasant urine smell from the mouth, hoarseness and increases the dryness.
Without timely medical care-stage renal disease becomes terminal, increases the water and electrolyte balance and the patient may die.
Possible complications of this disease
- In I and II stages of the disease even in the absence of dysuria, may suddenly occur on the total delay of the outflow of urine. Reasons for the occurrence of this violation can be a violation of proper nutrition, for example, drinking alcoholic beverages, spicy, salty foods, constipation, hypothermia, etc. may Also manifest itself and the increase in swelling adenomatous tissue.
- Another complication of BPH is hematuria (blood in urine). It is expressed slightly and could only be detected by examination of the urine sediment with the aid of special apparatus.
- The most common complication of the disease is the formation of stones in the bladder.
- The most serious and dangerous complications of the disease are infectious: urethritis, vesiculitis, adenoma, prostatitis, pyelonephritis, and epididymitis epididymoorchitis.
Need for prevention
The most fundamental in the prevention of the disease is the normalization of lifestyle:
- sufficient physical activity;
- proper nutrition (with the exception of alcohol, spicy, salty, fatty foods, etc.);
- maintaining a healthy weight;
- regular sexual activity.
Medical history, examination of the prostate and PSA to diagnosti
Diagnosis is divided into two stages.
The first stage
It is history (i.e., patient interviews), which allows most accurately determine the nature of complaints, the period of their emergence and the changes that have occurred since the outbreak to seek medical help.
The establishment of dynamics of development of symptoms and their nature is important, because through this the doctor can establish the differential diagnosis of prostatic adenoma from other diseases of the prostate in the early stages of diagnosis.
Most patients complaining of urinary incontinence, namely:
- the need to urinate during night time;
- frequent urge to urinate;
- weak pressurejet;
- difficulty urinating;
- a feeling of incomplete emptying of the bladder after the act of the outflow of urine;
- some men may experience infringements of sexual function, etc.
During diagnosis doctor considers all the symptoms. Violation of the outflow of urine may be due and other diseases, for example prostatitis chronic. For the differential diagnosis of benign prostatic hyperplasia, chronic prostatitis, are also important pain, that is characteristic only of prostatitis.
Adenoma of the prostate obstructs the urethra, it can cause a thickening of the bladder muscles. This process for awhile can support the function of urination. The last stage of the disease is characterized by the full development of urinary incontinence and a complete lack of urgency in tension of the walls of the bladder.
In patients with pronounced impaired urination, in addition to the signs of benign prostatic hyperplasia also may be other complications, such as hydronephrosis, pyelonephritis, urolithic disease, developing due to incomplete removal of urine and its latency.
The second stage
This digital transrectal examination of the prostate. With this method your physician can determine the size and consistency of the prostate, and also to differentiate adenoma from prostate cancer. For benign prostatic hyperplasia characterized by a Central increase, while prostate cancer in most cases develops in the peripheral parts of the gland.
Of instrumental methods of diagnostics specialists often prescribe ultrasound examination of the prostate. This method allows to determine the location of the adenoma and the size of benign tumors. Most often the patient is prescribed a comprehensive ultrasound examination of the genitourinary system.
Besides adenomas can be detected and other related diseases, e.g., bladder stones, kidney stones, hydronephrosis, etc. All of these complications complicate diagnosis and worsen the patient's condition.
Currently, an increasingly popular way of diagnosis is to become the immunological determination of prostate specific antigen (PSA). This method is a specific protein, the concentration of which in blood increases in different inflammatory and neoplastic lesions of the prostate.