Prostate adenoma is one of the most common diseases in the world among older men. Benign prostatic hyperplasia occurs in almost every third man over 50 years of age. Recent studies suggest that in almost half of patients, pathological changes in the prostate start as early as the age of 30, although the first symptoms of the disease begin to appear after 60 years. The prevalence of the disease varies among different ethnic groups. For example, African Americans are much less prone to hyperplastic changes in the prostate than the eastern part of the world's population.
Etiological and pathogenetic aspects of prostate adenoma
The most important etiological factor in the development of prostate adenoma is considered to be age-related hormonal imbalance in men. In the process of aging, testosterone production by the testes decreases, which entails a natural increase in estrogen levels. As a compensatory mechanism, enhanced proliferation of prostate cells is triggered, and the process of their apoptosis is disrupted. The essence of the process of hyperplasia is the formation of multiple proliferative zones, mainly from stromal and acinar cells of the gland. Hypertrophied prostate tissue compresses the tissues of the bladder, resulting in dysfunction of its detrusor.
Classification of benign prostatic hyperplasia
There are three stages of prostatic hyperplasia:
- Compensation stage - in this stage, a compensatory increase in the detrusor develops, as a result of which the bladder is emptied in full, kidney function is not impaired.
- Subcompensation stage - detrusor hypotrophy occurs, the bladder is not completely emptied, chronic urinary retention and vesicoureteral reflux develop.
- Decompensation stage - the detrusor loses its contractility, urinary retention becomes complete, due to the development of paradoxical ischuria, renal failure occurs.
Clinical picture of prostate adenoma
The most characteristic symptoms of developing prostate hyperplasia are symptoms of urination disorders. Men complain of frequent urge to urinate, while it is difficult, there is a delay in urination before the start of urination, the act of urination itself lasts a long time, often intermittent, the urine stream is thin and sluggish, after urination there is a feeling of incomplete emptying of the bladder. As a result of prolonged overstretching of the sphincter of the bladder with a large amount of residual urine, its hypotension develops, symptoms such as imperative urge to urinate, frequent nighttime urination, sometimes even involuntary, appear. In severe cases, with a large size of prostate adenoma, urination becomes painful, there is a feeling of heaviness and pain in the lower abdomen.
Laboratory and instrumental methods for diagnosing prostate adenoma
At the initial stage of diagnosis, anamnesis and physical examinations are taken. During the examination of the patient, with a large size of the hyperplastic prostate, you can see the bladder protruding above the womb. On digital rectal examination, which is performed in all elderly patients with complaints of urination disorders, an enlarged, painless, smooth and elastic prostate gland is palpated. A general urinalysis and measurement of blood creatinine is performed to obtain information about the functional state of the kidneys. It is mandatory for all patients to determine the prostate-specific antigen, which is necessary to exclude the diagnosis of prostate cancer. Of the instrumental diagnostic methods, sonography, urodynamic studies (uroflowmetry, cystometry), urography, ultrasound and tofographic studies. With the help of instrumental studies, it is possible to determine the functional abilities of the bladder, the size of prostate adenoma, the direction of its growth, the nature of changes in the bladder wall, the state of adjacent organs. Urethrocystoscopy, as the final stage of diagnosis, allows the most accurate assessment of the condition of the bladder and prostate.
Conservative and surgical treatment of prostate adenoma
Among the methods of treatment of prostate hyperplasia, conservative and surgical methods are distinguished. All of them are aimed at reducing the size of the prostate and eliminating bladder detrusor ischemia. Among medications, alpha-blockers and 5-alpha-reductase inhibitors are currently considered the most effective. They contribute to the elimination of hypoxia and ischemia of the walls of the bladder, which directly leads to an improvement in the state of the detrusor. If medications are ineffective, non-surgical methods are used, such as the installation of permanent or temporary urethral stents that improve urine outflow, as well as thermal methods for eliminating hyperplastic tissue by influencing it with thermal, ultrasonic, electromagnetic and laser sources.
In the absence of the desired effect of conservative methods of treatment and the deterioration of the general condition of the patient, surgical methods are used to treat prostatic hyperplasia - partial or complete removal of the prostate gland. With timely and effective treatment, the prognosis for the patient is favorable: the patient's ability to work and quality of life remain good.
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