Prostate Adenoma In Men - Symptoms, Treatment, Consequences Of Surgery

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Symptoms and methods of treatment of prostate adenoma in men

Adenoma of the prostate is a benign tumor that forms from the stroma of the prostate or from the glandular epithelium. This disease is quite curable if it is diagnosed in a timely manner and treatment is started, using the doctor's recommendations. Unfortunately, not all men are responsible for their health, and often they come to the doctor's office with an advanced stage of the disease, the treatment of which is associated with great difficulties. Therefore, you should know the symptoms of pathology and the reasons leading to its development.

Synonyms for the disease are prostate adenoma, benign prostatic hyperplasia. The prostate gland is an organ consisting of lobules of glandular tissue and connective tissue, or stroma. The prostate produces a secretion that maintains normal sperm function.

The dynamics of the development of prostate adenoma is disappointing. According to the National Institute of Diabetes and Digestive and Kidney Diseases, up to 40 years of age, symptoms of enlarged prostate are rare, but already at the age of 51-60, almost 50% of men suffer from adenoma. After 80 years, 90% of older men have it. ^[1]

The incidence of adenoma depends on the race and dietary habits of residents of different countries. Representatives of the Negroid race suffer from this disease more often than others, and the inhabitants of China and the Land of the Rising Sun are somewhat less likely due to food saturated with phytosterols.

Content:

• What are the causes of prostate adenoma in men?
• The main symptoms of prostate adenoma
• What is the difference between prostate adenoma and prostatitis?
• Possible complications and consequences
• Diagnostics
• PSA rate for prostate adenoma
• Treatment of prostate adenoma in men
• What are the consequences of surgery for prostate adenoma?
• Embolization of prostate adenoma
• Ineffective treatments
• Prostate adenoma: what can and cannot be done?
• Prevention and prognosis

What are the causes of prostate adenoma in men?

The main cause of BPH (enlargement of the prostate gland) is low testosterone levels, and as a result, high estrogen levels. The closer the "male menopause" (the lower the testosterone), the higher the risk of prostatic hyperplasia. Of primary importance is the neuroendocrine regulation of the activity of the prostate - a decrease in the production of testosterone, the main male hormone, and an increase in the concentration of estradiol. This hormone is able to stimulate increased proliferation of prostate cells.

[Video] Dr. Berg - PROSTATE ADENOMA: What is the real cause of an enlarged prostate?

On the subject: How to raise testosterone levels in men?

Factors contributing to the development of prostate adenoma:

• Physical inactivity and associated excess weight - adipose tissue produces estrogens;
• Genetic predisposition - cases of adenoma in relatives;
• Hypertension;
• Improper nutrition - including fatty, fried foods with hot spices in the diet;

All other factors, such as insufficient sexual activity, the consequences of genital infections, bad habits, have not been confirmed in scientific studies.

The main symptoms of prostate adenoma

Obstructive symptoms of adenoma associated with urinary disorders:

• Feeling of an incompletely emptied bladder - normally in men, after urination, there is a feeling of an empty bladder;
• Sluggish urination - urine is excreted at a reduced rate;
• Intermittent urination in parts - normally it occurs without interruption;
• It is impossible to carry out urine flow without tension of the abdominal muscles;
• The exit of urine droplets at the end of urination - normally this symptom is impossible;
• Primary retention of urine flow - when the sphincter relaxes, urination seems to be delayed, occurs with a delay.

Irrigative manifestations - symptoms of irritation of the tissues of the bladder:

• Daytime pollakiuria - urination 15-20 times a day, normally 4-6 times with a drinking regime of 2.5 liters of liquid.
• Nocturnal pollakiuria (nocturia) - from 3 or more urinations at night, although a night's sleep is normally possible without urination at all.
• False urge - urge with no urination.

Irrigative symptoms occur due to the fact that urine accumulates in the bladder for a long time.

An important role in the onset of symptoms is played by impaired functioning of the detrusor, the muscle responsible for the expulsion of urine. Normally, it contracts when the bladder neck opens, but with adenoma, the detrusor is unstable. This is due to the effect of adrenergic drugs, the concentration of which changes its activity, weakening the contractile ability. Foci of hyperplasia disrupt the normal functioning of the bladder due to a pathologically weakened blood supply.

Also, the symptoms of the disease depend on what stage it is at:

1st stage	Negative sensations appear when the bladder is empty
Stage 2	The functioning of the bladder is impaired, which cannot completely empty after urination
Stage 3	Paradoxical ischuria develops, when urine is almost not excreted when the bladder is full, the functioning of the bladder stops

What is the difference between prostate adenoma and prostatitis?

These states are often confused, replacing concepts that are different from each other. Adenoma of the prostate is an enlargement of the tissues of the prostate gland, or hyperplasia. Prostatitis is an inflammation of the prostate gland.

	BPH	Prostatitis
Age features of occurrence	After 40-45 years, young men practically do not occur	Age of highest sexual activity - 20-42 years
Causes of occurrence	Manifestations of androgynous insufficiency, manifested during the "male menopause"	Hypodynamia; Frequent or too rare sexual intercourse; Decreased immunity
Processes in the prostate gland	Formation and growth of nodes that compress the urethra	Inflammatory process in the tissues of the prostate
Treatment features	Conservative therapy with drugs, in an advanced stage - surgery (ectomy of hyperplasia nodes)	Therapy with anti-inflammatory and antimicrobial agents, analgesics

Learn more: Prostatitis in men - why is it dangerous? Symptoms and Treatment

Possible complications and consequences

If you postpone a visit to a doctor when the first symptoms of prostatic hyperplasia appear, a small problem can turn into a life-threatening condition that is fraught with complications.

Complications of prostate adenoma:

• Acute urinary retention. Complication appears at 2 or 3 stages of the disease due to compression of the urethra by a hypertrophied prostate gland. Provoking factors - stress, acute respiratory infections, hypothermia, alcohol consumption, prolonged sitting, fatigue, untimely emptying of the bladder.

  Symptoms of acute retention are a full bladder, inability to urinate fully, severe pain radiating to the penis, to the lumbar region. The complication is dangerous by the development of acute renal failure, hydronephrosis, coma, therefore, the patient must be taken to the hospital without delay for bladder catheterization.

• Inflammation of the urinary tract. Stagnant processes in the bladder lead to the growth of bacteria. They provoke the development of cystitis, urethritis, pyelonephritis. Prevention of complications - timely treatment of prostate adenoma.
• Urolithiasis disease. Incomplete emptying of the bladder leads to the appearance of microliths, stones, or mineral deposits in it. They can cause a blockage of the bladder, urinary retention. Treatment is surgery during the removal of the adenoma.
• Hematuria. The appearance of erythrocytes in the urine, which is caused by varicose veins of the bladder neck. Types of hematuria - macroscopic and microscopic form. In the first case, the urine turns red, in the second, the diagnosis is made by laboratory examination of urine. The complication is differentiated from stones and tumor processes in the bladder.

Diagnostics

The general standard for the collection of anamnestic data was adopted in 1997 by the International Committee on Prostatic Hyperplasia. Symptoms are assessed using the IPSS questionnaire and the QQL. The results obtained and the severity of the symptoms of the disease are evaluated in points:

• 0-7 - minor;
• 8-19 - moderately expressed;
• 20-35 - severe manifestations.

The urologist, with the help of the patient, fills in the urination diary, which takes into account the volume of urine and the frequency of urination, conducts various diagnostic methods:

• Palpation of the prostate. A urologist or surgeon conducts a digital rectal examination of the prostate gland to determine its size, consistency, soreness, differentiation from chronic prostatitis.
• Ultrasound (ultrasound examination of the kidneys and prostate). With the help of this study, the degree of prostatic hyperplasia, the size and direction of the growth of adenomatous nodes, and the presence of calcifications are determined. Ultrasound of the kidneys helps to determine their size, the presence or absence of pathological changes, urological diseases.

• TRUS - transrectal ultrasound examination of the prostate. Helps to establish the true size and structure of the prostate gland, to differentiate adenoma from prostatitis or oncological process. The study identifies prostatitis at the very beginning of its development, even before the onset of significant symptoms.

  Calcification foci in the central zone of the prostate gland, identified as a result of TRUS, indicate the 5 (final) stage of the disease.

• Uroflowmetry - measurement of the characteristics of the stream of urine. The research method is carried out 2 or more times with a full bladder (200-230 ml). The uroflow curve records the time during which urination occurs, the maximum flow rate. The rate of urination is 100 ml in 10 seconds, up to 100 ml in 23 seconds, the rate of flow is 15 ml / sec. The rate of urine flow depends on the age of the man, decreasing every 10 years by 2 ml / sec.
• Determination of residual urine. An important diagnostic indicator for determining the indications for surgery, for determining the stages of the disease. It is combined with uroflowmetry, performed after urination using ultrasound.

• Cystomanometry. A method for determining the pressure inside the bladder during urination and at different stages of its filling. Normally, when 100-150 ml of urine accumulates in the bladder, the pressure is 7-10 mm Hg, with 250-300 ml - 20-35 mm Hg.

  Deviations from the norm towards an increase in intravesical pressure up to 30 mm Hg. talk about an increase in the detrusor reflex. When lowering it to 10-15 mm Hg. when filling up to 600-800 ml, detrusor hyporeflexia (decreased reflex) occurs. Both of these indicators characterize the properties of the detrusor, its elasticity and reserve functions.

  Deviation from the norm over 45-50 mm Hg. talk about an obstacle to normal urination.

• Cystography. This method uses a contrast agent to examine the bladder. With descending cystography, the contrast agent moves from top to bottom, which allows you to determine the pathology of the bladder neck, which prevents its filling. In ascending cystography, the movement of the contrast agent helps to determine the deformation of the urethra in the area of the prostate gland.
• CT and MRI. Computed tomography and magnetic-nuclear resonance imaging help determine the structure of the adenoma, its volume and stage, the presence of complications, and the oncological process.

PSA rate for prostate adenoma

PSA, or prostate-specific antigen, is an enzyme normally produced by prostate cells to dilute semen. Part of the PSA enzyme enters the systemic circulation. With prostate adenoma, the concentration of PSA in the blood increases, with malignancy of the tumor, the level of the enzyme becomes even higher.

PSA rate depending on age:

• up to 50 years - less than 2.5 ng / ml;
• from 50 to 60 years old - less than 3.5 ng / ml;
• from 60 to 70 years - less than 4.5 ng / ml;
• over 70 years old - 6.5 ng / ml

An enzyme concentration of more than 10 ng / ml is evidence of an increased likelihood of malignant degeneration of the tumor. Each gram of a benign tumor increases the PSA level by 0.3 ng / ml, and each gram of malignant neoplasm increases by 3.5 ng / ml. The dynamics of the increase in the level of the enzyme in the blood with prostate adenoma - no more than 0.75 ng / ml during the year. With a more pronounced growth, there is a suspicion of malignancy of the tumor.

There are the following forms of prostate-specific antigen, determined in laboratory studies:

• Free PSA circulating in free form,
• Associated PSA (due to other proteins).

When the concentration of free antigen is less than 15%, its total amount has a risk of oncological transformation of the prostate tumor. The same suspicions are caused by the increased density of PSA (more than 0.15 ng / ml / cm ³). It is determined by dividing the level of enzymatic protein in the blood (in ng / ml) by the volume of the prostate (in cm ³⁾.

If the course of the malignant process is suspected, a biopsy of the gland tissues and their histological examination are performed.

Treatment of prostate adenoma in men

Drug treatment

The use of drugs cannot relieve a man of prostate adenoma. Their action somewhat slows down the growth of the tumor and minimizes the symptoms of the disease.

Pharmaceutical groups of drugs used in the conservative treatment of adenoma:

• Alpha blockers. They cause an expansion of the urethra by relaxing the smooth muscles of the urethra, which improves the outflow of urine, reduces urethral resistance. To obtain the desired effect, long-term medication is required - at least six months. The therapeutic effect of the drugs becomes noticeable after 2-4 weeks from the start of administration. Such drugs are used as Prazosin (4-5 mg / day), Doxazosin (2-8 mg / day), Alfuzosin (5-7.5 mg / day), Terazosin (5-10 mg / day). If no pronounced effect is observed in 3-4 months, a change in treatment tactics is required.
• 5-alpha reductase inhibitors. They are used to reduce the size of a large prostate, slow down its growth. The action of drugs in this group is based on the conversion of testosterone to dihydrotestosterone. Used such agents as Finasteride (5 mg / day), Dutasteride. These drugs do not have the side effects of hormonal drugs, as they are not associated with hormonal receptors. The expected effect of the application is a reduction in prostate volume by 20% after 3 months, by 30% - after 6 months.

Surgery to remove prostate adenoma

Surgical treatment of prostatic hyperplasia is carried out according to absolute indications after examination of the patient. In emergency cases, an unscheduled surgical intervention is performed.

Indications for emergency surgery:

• Acute urinary retention;
• Bleeding that is fatal.

Emergency surgery is performed within 24 hours after complications appear. The result is the removal of the prostate gland (prostate adenectomy).

Absolute indications for unscheduled surgery:

• Retention of urination, even after bladder catheterization;
• Renal failure due to prostate adenoma;
• Stones in the bladder caused by an adenoma;
• Frequent relapses of urinary tract infections, provoked by adenoma;
• Massive hematuria (the presence of red blood cells in the urine), caused by adenoma of the prostate gland;
• Large diverticulum in the bladder;
• A significant increase in the average lobe of the prostate gland;
• Large amount of residual urine in the bladder.

Before the operation, the patient undergoes an examination - he takes a general blood test to determine the number of leukocytes (a sign of inflammation), erythrocytes and hemoglobin (a sign of anemia). A general biochemical blood test allows you to assess the state of the kidneys by the level of creatinine and urea. A blood clotting test will help eliminate the risk of surgical and postoperative bleeding and thromboembolism. An ECG will prevent complications of cardiac activity.

Types of surgery to remove adenoma:

Open prostatectomy is a traditional abdominal surgery performed under general anesthesia. Indications - the mass of the gland is more than 60 g, the volume of residual urine is not less than 150 ml.

Tactics for prostatectomy in 2 stages:

• Removal of the prostate, the formation of a fistula up to the abdominal wall to drain urine into the urine bag.
• Restoration of the normal path for urination.

Transurethral endourological treatment - performed in the urethral cavity using endoscopic equipment. The endoscope is brought directly to the gland through the urethra, under its control, foci of hyperplasia are removed.

The advantages of the method:

• Soft tissues are not injured, which facilitates the rehabilitation period;
• Hemostasis is constantly under control, which reduces the risk of postoperative bleeding;
• Surgical intervention is possible even in patients with concomitant pathologies.

Complications may occur - retrograde ejaculation, urinary incontinence, urethral stenosis, sclerosis of the bladder wall.

Transurethral electrovaporization - used for small and medium-sized prostates. A roller electrode is inserted through the urethra, it burns out the hypertrophied tissues of the prostate, while simultaneously drying the operating field and coagulating the vessels. Reducing the risk of bleeding during evaporation of adenoma is a great advantage of the method.

Electro-incision of adenoma of the prostate - used for small intravesical adenoma. A longitudinal dissection of the bladder neck and gland tissues is performed.

Laser surgery - performed by contact and non-contact methods. The main directions of operations using a laser:

• Transurethral laser vaporization - a catheter is inserted through the urethra. The laser evaporates water from the tumor cells, they die, the size of the prostate is reduced. The operation takes 20-110 minutes.
• Laser coagulation - a fiber-optic fiber with a special tip is inserted through the urethra, which sets the laser beam in the desired direction.
• Interstitial laser coagulation - the laser tip is placed directly into the gland tissue, changing its position several times per session. The operation takes 30 minutes.

Transurethral microwave thermotherapy - used for small tumors, for the operation, a catheter with a transurethral antenna is inserted into the adenoma, through which high temperatures of + 55 + 80 ° C are supplied, while the cells can tolerate heating no higher than + 45 ° C.

Transurethral radiofrequency thermal destruction - used to treat adenoma with calcification and sclerotic changes in its tissues. Electromagnetic energy is used, which transfers high temperatures + 70 + 82 ° C to the tissues of the gland. The operation takes 50-60 minutes.

Cryodestruction - freezing and subsequent destruction of tumor tissue with liquid nitrogen supplied through a freezing head. To protect the urethra from damage, a warming element is inserted into its area.

Balloon dilatation - performed in case of contraindications to surgery. The method consists in expanding the urethra with a balloon inserted into the urethra using a cystoscope. Dilation reduces symptoms, but does not destroy or reduce tumor growth.

Urethral stenting - a urethral stent is implanted into the lumen of the urethra to drain the bladder. The method is used in stages 2 and 3 of prostate adenoma to eliminate obstructive symptoms.

Treatment with phytopreparations

If the prostate adenoma is in stage 1 or 2, it is possible to treat the disease with phytopreparations:

• Permikson. A product of the French pharmaceutical industry made from the fruit of the American dwarf palm. Permikson is a 5-alpha reductase inhibitor, exhibits the effect of local antiproliferation, anti-inflammatory properties.

  It has been used for several years in a row. Studies show that its regular use reduces the volume of the gland, the amount of residual urine, and stops the manifestations of the disease. The drug is well tolerated by patients without side effects.

• Prostamol Uno. The drug is made from the fruits of the Sabal palm, is an inhibitor of 5-α-reductase with its antiandrogenic effect, prevents the accumulation of exudate, and is used to prevent inflammation. Does not affect the level of blood pressure, manifestations of erectile function.

What are the consequences of surgery for prostate adenoma?

Complications during surgery are possible, they depend on the chosen tactics of the operation.

Possible negative consequences during and after transurethral resection and open prostate resection:

• Bleeding during surgery - occurs in 2-3% of cases, refers to the most severe consequences, there is a need for blood transfusion.
• Bleeding after surgery - blood clots resulting from a complication interfere with the normal flow of urine. The consequences of complications are eliminated by re-intervention by the traditional or endoscopic method.
• Stagnation in the bladder due to urinary retention - occurs as a result of impaired functioning of the muscles of the bladder.
• Infection of the genitourinary system (acute inflammation of the prostate, testicles and their appendages, renal calyces and pelvis, renal tubular system) occurs in 5-22% of cases.
• Incorrectly performed resection of prostate tissues - the remaining tissues disrupt the process of urination, making it even more painful than before the operation, occurs in 2-10% of cases, the complication is corrected by repeated resection.
• Retrograde ejaculation - the release of sperm during ejaculation outward is impossible, as it is thrown into the bladder.
• Erectile dysfunction - occurs in 10% of cases, a complication may not be associated with the consequences of surgery.
• Narrowing of the urethral canal - a complication occurs in 3% of cases, requires microinvasive endoscopic intervention.
• Urinary incontinence is a rare complication. If it is caused by a dysfunction of the muscles of the bladder, the complication goes away without correction.

Embolization of prostate adenoma

The method of treating prostate adenoma by embolization of the blood flow supplying the tumor has spread relatively recently, in 2009. The essence of the technique is the introduction by the surgeon into the blood vessel of emboli (the smallest particles) that block the blood flow. Due to this, the nutrition of the tumor is disrupted and its size decreases.

This method is an excellent alternative to surgery for the treatment of prostate adenoma. Embolization is carried out by an endovascular surgeon under the control of radiography in an X-ray operating room, that is, special conditions are needed for its implementation.

Embolization technique for prostatic hyperplasia:

• It is carried out with anesthesia by the introduction of intravenous anesthesia.
• After the surgeon has cut the artery in the elbow or shoulder joint, a catheter is inserted into it.
• The catheter is inserted into the vessels feeding the adenoma through the aorta and the internal iliac artery, the manipulation is performed under the control of radiography.
• The surgeon inserts emboli into the vessel through the catheter until the blood flow is blocked.
• The patient goes home a few hours later without any discomfort.

Indications for surgery - the size of the prostate gland is 80 cm ³ or more. Its prognosis is a decrease in the size of the adenoma by 2 or more times without complications that are often encountered in traditional surgical interventions.

Ineffective treatments

Treatment of prostate adenoma with alternative methods is an absolutely ineffective tactic of treating this disease. Hazel decoction, pumpkin juice, walnuts, fir water will not slow down the growth of adenoma. On the contrary, relying on "miraculous remedies", the patient loses precious time to fight the disease. Prostate massage also refers to ineffective treatment methods.

The smaller the adenoma, the easier and safer it will be to treat with minimally invasive methods. Therefore, do not postpone a visit to the doctor with the first signs of adenoma. This will make the treatment easier, and the risk of complications will decrease.

Prostate adenoma: what can and cannot be done?

Can any physiotherapy methods be used to treat BPH? For the penetration of drugs directly to the tissues of the prostate gland, electrophoresis is used.

Prohibited physiotherapy methods:

• Electromagnetic wave treatment;
• Exposure to high temperatures on the prostate;
• Vibration procedures;
• Ultrasound treatment.

All these procedures worsen the patient's condition and the course of prostate adenoma.

Can massage be used as a treatment method? Massage is used to treat chronic prostatitis, this method is not used in the treatment of prostate adenoma, being an absolute contraindication.

What foods should I eat? At the early stage of treatment of the disease, the use of pumpkin seeds gives an excellent effect. They are used daily, which improves the effect of drug therapy.

Are there exercises to be done for BPH? As a remedial gymnastics, it is recommended to perform the following set of exercises daily:

• The starting position is lying on your back, buttocks are raised from the floor. In time with breathing, we draw in and relax the muscles of the anal region.
• The starting position is standing on all fours. At the same time, we stretch the leg back - to the side, the opposite arm forward. We alternate the right and left legs and arms.
• The starting position is lying on your back, legs bent at the knees. Pull them to the stomach, lower it to the right and then to the left of the pelvis.

Each exercise should be performed for 5-10 approaches.

Is there a malignant prostate adenoma? Adenoma of the prostate is a benign transformation of tissues that does not give metastases to neighboring organs. Its growth is limited by the size of the prostate.

However, over time, the adenoma can turn into a malignant tumor of the prostate gland. The beginning of this process is determined by the appearance of PSA (prostate-specific antigen) in the blood. Biopsy and histological analysis of biological material will confirm or deny the diagnosis.

The earlier treatment is started, the better the prognosis of the disease. Prostate cancer, in contrast to adenoma, metastases to nearby and distant tissues.

Prevention and prognosis

To prevent the development of adenoma, the following measures are used:

• The exclusion of a sedentary lifestyle, dosed physical education and sports - with physical activity, the risk of blood stagnation in the pelvic organs is reduced.
• Correction of obesity, excess weight - accelerates metabolism, general metabolism.
• Refusal to use clothes that restrict blood flow in the small pelvis: tight jeans, trousers, swimming trunks.
• Elimination of promiscuous sexual intercourse as prevention of STDs.
• After 40 years, an annual visit to a urologist, a blood test for PSA for early diagnosis of the disease.
• Correction of the diet - the active inclusion of vegetables and fruits (up to 50% of the total diet), fortified foods, refusal of smoked meats, marinades, spicy and overly salty foods, limiting fatty, fried meat, large amounts of animal protein, cheese, strong tea, etc. coffee. If the adenoma has begun to develop, it is recommended to actively consume dairy products, legumes, boiled or baked dietary meat.

Early diagnosis of prostate adenoma and correct treatment guarantee a favorable prognosis for the course of the disease. It will become unfavorable if you delay seeing a doctor. Possible complications in this case are acute urinary retention, the development of urolithiasis, and frequent recurrence of urinary tract infections.

Renal failure, which develops in severe cases, increases the risk of death. Malignant adenoma leads to prostate cancer. Malignancy of the prostate gland is possible with late diagnosis, ignoring therapeutic and preventive measures.

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Author of the article: Lebedev Andrey Sergeevich | Urologist

Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.