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Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is benign prostatic hyperplasia. Benign prostatic hyperplasia is one of the most common urological diseases in men in adulthood.

According to the latest statistics, at the age of 40, 50% of men have changed in the prostate gland associated with its enlargement (hyperplasia), and after 80 years, every man has a prostate adenoma.

The prostate in normal state and with inflammation.

The development of this disease of the prostate gland (prostate adenoma) is associated with hormonal disorders of the body, which are observed in almost all men after 40-45 years (the so-called male menopause or andropause). However, at present, many key mechanisms of the occurrence of prostate adenoma remain unclear, which does not allow the development of sufficiently effective measures to prevent this disease.

The gradual enlargement of the prostate gland with adenoma leads to compression of the urethra passing through it and disruption of the normal outflow of urine from the bladder. Depending on the stage of the disease and the size of the prostate gland, Benign prostatic hyperplasia can cause from a slight decrease in the flow rate of urine to the development of a complete urethral block and the inability to empty the bladder, which is an emergency condition requiring urgent medical attention.

 

Benign prostatic hyperplasia symptoms

The first manifestation of prostate adenoma associated with an enlargement of the prostate gland and impaired outflow of urine include the following:

  • sluggish stream of urine
  • intermittent flow of urine at the end of urination
  • increased urination time
  • the need to tighten the abdominal muscles to empty the bladder completely

This symptomatology of prostate adenoma grows slowly and often goes unnoticed. However, as the prostate grows, the tension of the bladder and abdominal muscles becomes insufficient to overcome the block caused by prostate adenoma - residual urine begins to accumulate in the bladder.

If there is a lot of residual urine, there is a feeling of incomplete emptying of the bladder, and other benign prostatic hyperplasia symptoms appear, caused by functional disorders and a decrease in free volume in the bladder:

  • frequent urge to urinate
  • inability to hold urine for long when the urge appears
  • need to urinate at night

In the later stages of prostate adenoma, urine is excreted drop by drop against the background of an overflowing bladder, the urge to urinate disappears.

 

Benign prostatic hyperplasia diagnosis

If you suspect a prostate adenoma, the determination of the PSA (prostatic specific antigen) level of the blood is shown, as well as TRUS (transrectal ultrasound) of the prostate gland. The latter technique allows not only to assess the size of the prostate but also to clarify its structure and exclude other pathology of this organ.

The prostate gland in prostate adenoma, increasing in size and squeezing the urethra, leads to disruption of urodynamics (excretion of urine from the kidneys through the ureters, bladder, and urethra) at all levels of the urinary system. Violation of the normal passage of urine leads to its stagnation, which is one of the main factors in the occurrence of urolithiasis.

Also, stagnation of urine with prostate adenoma leads to inflammatory processes in the urinary organs (chronic cystitis and pyelonephritis).

 

Benign prostatic hyperplasia treatment

Any degree of enlargement of the prostate gland in prostate adenoma can cause acute urinary retention - a condition requiring urgent medical intervention aimed at restoring the outflow of urine.

Currently, there are a fairly large number of surgical and medical treatments for prostate adenoma. The main treatments for BPH are:

  • open adenomectomy (removal of the prostate gland)
  • TUR (transurethral resection) of the prostate gland - removal of the part of the prostate that narrows the urethra using special instruments inserted through the urethra
  • balloon dilatation of the prostate gland (expansion of the narrowed area by inflating a balloon inserted into the urethra)
  • placement of prostatic stents in the narrowing area
  • transrectal hyperthermia of the prostate and other methods of physiotherapy
  • drug therapy, including hormonal drugs, inhibitors of prostatic enzymes, adrenergic blockers, fortifying agents.

All of these methods of treating prostate adenoma have both advantages and disadvantages. Therefore, for the most effective treatment of prostate adenoma, an individual approach to each patient is required to select the most effective treatment tactics.