Prostate Adenoma Symptoms, Treatment And Prognosis

// Published October 20, 2019 by James Washington

Prostate adenoma is a benign neoplasm of the tissues of the glandular organ. In urological practice, it is customary to talk about adenoma not as a neoplasm, but as a nodular proliferation (hyperplasia) of glandular cells as a result of a number of external and internal factors. Therefore, it is more correct to call prostate adenoma benign prostatic hyperplasia (BPH) .

Definition

Adenoma of the prostate gland (also benign prostatic hyperplasia) is a neoplastic process that results in the active division of the glandular cells of the described organ with the formation of a well-delimited rounded node. The disease is benign. Nodular neoplasms are not prone to malignancy (the acquisition of the properties of a malignant tumor).

Causes of Prostate Adenoma

To the end, the causes of the development of the disease are not clarified. However, despite this, we can talk about factors predisposing to the formation of pathology:

• • Age. There is a direct correlation between years and the likelihood of becoming a victim of prostatic hyperplasia. The older the patient, the higher the risk of getting sick. Over time, the prostate ceases to work as before, a change in the level of hormones, bad habits, all this accumulates for a long time and, as a result, results in a pathological proliferation of glandular tissues of the organ.

• • Hormonal imbalance. Excess testosterone leads to an increase in libido and activation of sexual function. Frequent sexual intercourse, nightly emissions (outside sexual intercourse) and other reproductive factors entail an increased synthesis of seminal fluid and prostate secretion. At some point, iron loses the ability to satisfy the body’s need for secret. The prostate responds by overgrowing its own tissues for more intensive synthesis of the necessary substance.

• • Frequent sexual intercourse (immediate cause described above).

• • Irregular sexuality. Paradoxically, it also affects the work of the prostate, causing its hyperplasia.

• • The effect of viral and infectious agents on the prostate gland. Especially when it comes to human papillomavirus (HPV). HPV causes excessive proliferative activity, promoting cell division.

• • The presence of inflammation in the prostate gland (prostatitis). Acts as a trigger (provoking factor).

There are other factors, the role of which, however, is not clear for certain: there are too few studies and sources.

• • Smoking. According to one theory, nicotine and tobacco cause stenosis of the great vessels that feed organ tissues. As a result, ischemia occurs, acute lack of blood leads to proliferation of the prostate gland.

• • Transferred sexually transmitted infections.

• • Burdened by heredity. The role of the genetic factor is also unknown. However, some studies indicate a direct relationship between burdened heredity and the risk of developing prostate adenoma. If there was a man in the family who suffered from hyperplasia, a descendant is likely to suffer 25%. Fortunately, it is not the disease that is inherited, but only the features of the reproductive system, including the predisposition to neoplastic processes.

• • Diabetes. Causes atherosclerosis of the vessels feeding the pelvic organs (more about type 2 diabetes).

• • Belonging to the Negroid race. For reasons not fully understood, Negroids suffer from prostate adenoma almost twice as often as white patients.

• • Improper nutrition and obesity. Affect lipid metabolism. Metabolic disorders, in turn, entail a decrease in the synthesis of male sex hormones. The reproductive system comes into disharmony.

Pathogenesis

The primary role in prostatic hyperplasia is played by male sex hormones – androgens. It was found that in patients with prostate adenoma the concentration of dihydrotestosterone exceeds the norm by at least 3-5 times. Both dihydrotestosterone and other substances (including female specific hormones) have a stimulating role on glandular tissue. At a certain point in time, iron simply can not cope with the function assigned to it due to overload. The only way to satisfy an induced need is to increase the volume of synthesizing tissue. This is how nodal neoplasms, known as prostate adenoma, are formed. Similar processes occur in the pituitary gland, thyroid gland.

Symptomatology

The clinical picture of the disease is extremely diverse. The specific manifestations depend on the stage of the pathological process, the general condition of the patient, the presence of concomitant diseases, etc. Depending on the severity of the clinical picture, there are three stages of adenoma:

1. Stage of compensation. Manifestations occur with an empty bladder.
2. Stage of subcompensation. Urination is severely impaired. After visiting the toilet room, a significant amount of urine remains in the bladder.
3. Stage of decompensation. Total bladder dysfunction.

Symptoms include:

• • Sense of insufficient emptying of the bladder even after going to the toilet. This is due, firstly, to the pressure of nodular growth on the walls of the bladder, and secondly, incomplete urine output.

• • Low urine pressure. As with prostatitis, the urination process is disturbed. The jet is weak or may weaken during the process itself.

• • Urine excretion in small portions (dropwise) already at the end of the urination process.

• • The need to make an effort to urinate. Abdominal muscles come into play.

• • Frequent urge to empty the bladder (the so-called pollakiuria). It appears day and night.

• • Imperative urge to empty the bladder. Characterized by urgency, the inability to restrain.

• • Oliguria. Decrease in daily urine output. It is observed in developed stages. It is explained by incomplete emptying of the organ.

Diagnostics

Diagnostic measures should be carried out only by the attending specialist (urologist or andrologist-andrologist). The examination process begins with a history and oral questioning of the patient for complaints. Rectal digital examination of the prostate is very informative . This uncomfortable manipulation for the patient allows you to evaluate the structure and size of the prostate. You simply can’t do without it. However, it is not enough to establish the mere fact of nodal growth of the prostate gland. To verify the diagnosis and differential diagnosis, a series of instrumental studies is shown:

• • Ultrasound examination of the prostate gland . It is necessary to assess the presence of neoplasms, their size, shape, structure. Also makes it possible to determine calcifications in the structure of nodes.

• • TRUSES (a kind of ultrasound) (more here) . It is considered more informative, since it provides detailed information about the state of the prostate gland.

• • CT / MRI The most informative study (especially with contrast), which makes it possible to distinguish between a malignant process and a benign one. Due to its high cost and low availability, it is rarely prescribed.

• • Cystography. Contrast minimally invasive bladder examination. Allows you to determine the deformation in the urinary tract.

• • Cystomanometry The method needed to measure pressure inside the bladder. Identifies problems with urination.

• • Detection of residual urine. Conducted by ultrasound immediately after emptying the bladder.

• • Uroflometry Needed to evaluate the characteristics of a urine stream.

For diagnostic purposes, the patient is offered a simple questionnaire. Each question suggests a monosyllabic answer of “Yes” or “No.” Moreover, the degree of positive or negative value is ranked on a scale from 0 to 5. Questions are standard:

A value above 7 points is in favor of the current process. The questionnaire is necessary to assess the subjective sensation of the patient and should be evaluated only in conjunction with the data of objective studies.

Treatment

Therapy is symptomatic. In most cases, observation is indicated in dynamics with the simultaneous administration of drugs. Surgical intervention is indicated only with a heavily ongoing process.

Drug treatment

Alpha adrenoreceptor blockers have been shown. They lead to a decrease in the tone of the smooth muscles of the muscles of the urinary system and, as a result, lower resistance during the passage of urine. Trade Names:

• • Terazosin;

• • Prazosin;

• • Doxazosin;

• • Alfuzosin.

The dosage is determined by the doctor, based on the stage of development of the disease. The course of treatment is long and is about six months. The therapeutic effect is achieved by 3-4 months of drug administration. In the absence of a clinically significant effect, a change in treatment tactics is indicated.

5 alpha reductase inhibitors have also proven themselves well. These drugs normalize hormonal levels, eliminating the immediate cause of hyperplasia. They stabilize the size of neoplasms of the prostate gland and reduce the adenoma in size. The main drawback of these drugs is their side effects (they are severe, like all hormonal drugs).

The presence of a diverticulum of the bladder is an indication for surgery

• • urinary retention;

• • recurrent urinary tract infection;

• • hematuria (blood in the urine) due to adenoma;

• • renal failure;

• • urolithiasis disease;

• • the presence of a significant diverticulum.

Surgery

The tactics of surgical treatment are determined by the doctor. In previous years, preference was given to open surgery with the formation of an incision and direct access to the prostate gland. Less radical, endoscopic methods of intervention are currently being practiced. Among the techniques:

• • Stent implantation. It is necessary for normal drainage of the bladder. It is considered a temporary measure.

• • Dilatation (expansion) of the urinary tract by mechanical means.

There is a whole group of endoscopic methods:

• • Thermal degradation. It involves the destruction of affected prostate tissue by high temperature.

• • Microwave thermotherapy.

• • Laser exposure (vaporization or coagulation).

• • Electrosurgery of the prostate gland. Less radical method, not even involving partial tissue resection.

• • Electrovaporization of prostate tissue.

• • Classical endoscopic (transurethral) surgery with adenoma removal.

At the moment, they do not resort to open operations.

Treatment with folk remedies

It is used only as a palliative measure designed to alleviate the patient’s condition. Phytotherapy can be a good help in therapy. The most effective recipes:

• • Bee killing. Helps reduce swelling and inflammation. To prepare the product, take 2 tablespoons of raw materials, pour half a liter of water. Boil for 2 hours. Take a tablespoon twice a day.

• • Linseed oil. Take 2 tablespoons throughout the day.

• • Fresh onion. Eat onion per day.

• • Tea from caraway seeds.

• • Salt treatment of prostate adenoma (Professor Okulov). A controversial but relatively safe treatment. Pour a teaspoon of salt without a slide with 100 ml of warm water. Soak a bandage or gauze with saline. Squeeze the fabric. Put it on the crotch in the form of a bandage. Leave for a few hours. Reduces pain.

Diet

It is important to eat foods high in zinc:

• • Mushrooms.

• • Seafood.

• • The eggs.

• • Red meat.

• • Herring.

• • Peas.

• • Bran.

• • Nuts.

• • Buckwheat.

• • Sesame.

• • Offal.

There are no strict prohibitions. It is also important to consume more foods rich in selenium. It:

• • Sea kale.

• • Sesame.

• • Brazilian nut.

• • Pistachios.

• • Legumes.

• • Olive oil.

• • Shrimp

Complications

• • Acute urinary retention. A condition that can lead to rupture of the bladder or acute renal failure.

• • Hematuria (the appearance of blood in the urine).

• • The formation of stones in the bladder.

• • Inflammatory processes of the excretory system.

Preventive measures

• • Rationalization of physical activity (morning exercises for men’s health).

• • Healthy eating

• • Regular sex life (no frills).

• • Normalization of body weight.

• • Wearing loose underwear.

Hyperplasia (adenoma) of the prostate gland is a disease that requires increased attention. In most cases, the process can be reversed or stopped by conservative methods. However, in extreme cases, surgical treatment is required. The patient should be attentive to their own health. At the first suspicions, you should not hesitate to visit a urologist. So a man will be able to maintain health.

• Health