The causes of BPH, its symptoms and treatment

What is BPH, or benign prostatic hyperplasia? This is a benign tumor, and most often it occurs in older males. The first symptoms usually occur at age 60 or older, but, according to studies, Pathologo-morphological features can be detected and 30-year-old men.

Scientists have observed that the prevalence of inflammation of the male reproductive play the role of racial differences. Among black males BPH occurs much less frequently than Asians. It is also noticed that growth of adenomas is influenced by alcohol, Smoking, sex, diseases of the cardiovascular system, diabetes, cirrhosis of the liver and infections of the genitourinary system.

The etiology of hyperplasia

Prostate has three main zones that perform specific functions and which are the main Central, transitory and peripheral. The essence of the pathological process of the adenoma is the formation in these zones centers nodular hyperplasia. As sprawl is squeezing the urethra, changing the angle of its bend, and the lumen becomes slit-like shape. This obstruction and prevents the emptying of the bladder.

Continuing its growth, the tumor compresses the healthy tissue of the prostate gland that leads to its atrophy. Its for adenoma similar with early stages of prostate cancer, differential diagnosis of which will help to carry out a biopsy. The exact cause of BPH is still not known. But clarified certain factors that may be a catalyst for tumor growth. These include:

• Violations of hormonal regulation.
• Chronic inflammatory processes in the prostate.
• The increased activity and number of alpha-1-adrenoceptors of the prostate.
• A sedentary lifestyle.
• Bad habits: alcohol, Smoking, drugs.

Classification of BPH

Classical classification proposes to divide the disease into 3 stages. They reflect the gradual changes of the prostate gland and the impact on the health of men. These include: the stage of compensation, subcompensation and decompensation.

The clinical symptoms and pathological changes
№ p/p	Stage	Pathogenesis	Symptoms
1	Compensation	The muscle layer of the bladder is hypertrophied, andhis account is overcome urethral resistance and urination occurs in full. Acute urinary retention does not occur. The cause of be alcohol, hypothermia, hyperactive sex, spicy food and other factors.	The first symptom of this stage of BPH is pollakiuria (frequent painful urination), to which later joined by night frequent urination. Over time, the bladder urination becomes difficult and the jet weakens.
2	Subcompensation	The contractile apparatus of the hollow body over time, is depleted, and hypertrophy of the muscle layer is replaced by malnutrition. The walls are weakened, and their power is not enough to carry out the act of urination, and he defined the growing increase in residual urine volume. There is chronic urinary retention, which becomes a cause of difficult evacuation of urine from the renal pelvis. The lack of treatment of the adenoma in this case is complicated by chronic renal failure. The bladder wall form a protrusion, and a constant delay of waste products causes the formation of stones.	Signs of increasing. The jet becomes thinner, and the patient has to strain to commit an act of emptying urination, and in several stages. There is a feeling of incomplete emptying, not far from the truth, as the residual urine volume reaches 400 ml. Dysuria is weak. You may experience acute urinary retention without apparent reason. Emergency treatment is catheterization.
3	Decompensation	If the treatment of the adenoma is not conducted in a timely manner, developing the third stage of the disease. It is characterized by thinning and complete loss of function of reducing hollow organ. Developing the total delay of the evacuation of the liquid. The urethral sphincter is gaping and distended, in the same way is and external sphincter. The residual urine volume reaches 1000 ml.	Bladder emptying is almost impossible, but overstretched sphincter is not able to become an obstacle to the outflow of urine dropwise and she stands out from the urethra. The reason for this phenomenon becomes enlarged prostate. In the past this symptom was called "the passage of urine over the edge of the bladder." At any time after the terminated and there will be full delay of urine output.

Of great importance is the direction of prostate growth. With the development of intravesical growths BPH symptoms develop very quickly, as evena small tumor can cause the cessation of the outflow of bodily fluid from the bladder. The least favorable is the growth of adenomas in the direction of the vesical triangle Leto – it leads to compression of the ureter and violation of the outflow of urine from the upper urinary tract. Podozrenie growth direction for a long time is no symptoms while adenoma will not reach the huge sizes. To determine which side has suffered, will not only help symptoms a biopsy, but ultrasound. Abnormal growth of the adenoma and its effect on urination in the absence of adequate treatment can lead to terrible complications.

Complications

Despite the fact that the BPH for a long time does not cause unpleasant symptoms, pathological processes in the absence of adequate treatment continually affect the urinary tract and are the cause of many complications. While the vast majority of cases they involve a violation of the outflow of urine. Therefore, they affect not only the kidneys and bladder, but also on the whole body. Consider the following complications:

1. Renal failure occurs most often in stage 3 disease. Because of full delay, the outflow is formed ureterohydronephrosis, and any change in the parenchyma of the kidneys leads to renal failure. Men appear excessive thirst, dry mouth, weakness and lethargy, and many other symptoms. Kidney failure has a negative impact on sex and libido.
2. Joining infection leads to cystitis, ascending pyelonephritis or even urosepsis. Much less common are urethritis and epididymitis.
3. Micro and gross hematuria occurs due to an increase in venous pressure and leads to tamponade of the urinary bladder sphincter blood clots.
4. The accumulation of residual urine stimulates the growth of stones.
5. The accepted alcohol, hypothermia, and other factors can cause acute urinary retention.
6. The lack of treatment and changes in hormonal background can cause a degeneration of the prostate in prostate cancer, so, to avoid such a diagnosis, and biopsy of the prostate.

Diagnosis of the disease

According to the recommendations of urology, methods of diagnosis of BPH are divided into: rational (recommended); optional (at the discretion of the physician); unauthorized (their feasibility is confirmed only for certain cases). But in any case, patient looking for an individual approach; as each case is unique and BPH may be accompanied by concomitant diseases and complications, and the purpose of the research is chosen carefully for each caseseparately. This is an important process, and accurately establish the diagnosis and cause of the disease, the doctor will know how to treat BPH.

Recommended methods:

1. Collection of information: complaints and anamnesis, evaluation of quality of life, impact of disease on the sex.
2. Manual examination: palpation and assessment of the external genitalia, abdomen, perineum, and digital rectal examination of the prostate.
3. PSA and creatinine in the blood.
4. Laboratory studies of urine.
5. Ultrasound of the pelvic organs.
6. Transrectal ultrasonography of the prostate.
7. Uroflowmetry.
8. Biopsy.

Additional methods for the primary diagnosis is not mandatory. They are left to the discretion of the physician. Most often, the specialist uses them in the treatment of diseases for treatment and clarify the causes of the complications. Used instrumental methods of investigation:

1. Ultrasound – transabdominal, which are determined by the size, the structure of the gland, the presence of cysts and stones and tumors. Also performed inspection of the bladder, ureter, pelvis and renal parenchyma.
2. Transrectal ultrasonography of the prostate ‒ gives more detailed information about the condition of the prostate, and the latest devices provide the ability to obtain cross-sectional image of the prostate and to determine the characteristics of blood flow.
3. Study on pressure-flow ‒ may be useful in preparation for surgery.
4. Urethrocystoscopy ‒ allows you to define the number of lobes of the prostate, hyperplasia of the affected, their size, and the degree of deformation of the urethra and the condition of the urethra. Urethrocystoscopy consider not only the last stage of diagnosis, but the first step of endoscopic treatment.
5. Re-biopsy of the prostate.

To nerekomenduojama methods include computed tomogram, magnetic resonance therapy, urethrography. Such studies will provide valuable assistance in identifying the direction of growth of the adenoma.

Symptoms of BPH are similar in manifestation and course of many diseases of the urogenital area men. Therefore, carefully carried out differential diagnosis of prostatitis, prostate cancer (it will indicate a biopsy), urethral stricture and voiding disorders of other origin. From the correct diagnosis depends on successful treatment of the patient.

Therapeutic measures

The goal of prostate treatment is to improve the quality of life of men, to return to his sex life, peace of mind and to prevent the further growth of the adenoma, and even its reduction, and saving the life of a patient with the development of threatening complications. Radical methods of treatment of adenoma does not exist. When surgical intervention the risk is great enough, especially in the case ofof elderly patients or old age.

Conservative treatment is possible only in men since the first or at least second stage of the disease. But for some patients the diagnosis of an adenoma becoming a serious psychological blow. So conservative treatment is one of the ways to prepare for surgery and the doctors are sensitive to patients and often go at them on occasion, especially if there are no life-threatening condition.

Given the progressive nature of BPH, treatment can be lengthy and sometimes a man will need to take pills all my life. The most commonly used drugs for the conservative treatment of BPH are the inhibitors of 5-alpha-reductase, alpha-1-adrenoblockers and herbal extracts. Some experts believe that the adenoma can be reduced by propolis, but it is a controversial issue and opinions on it.

Inhibitors of 5-alpha-reductase

At the present time widely used drugs of this pharmacological group of the first and second type. Such substances cause natural cell death benign tumors and reduce the size of the prostate. A prostate biopsy indicates significant improvement. The maximum effect of the medicine show after a year of use. In addition to reducing the volume of the prostate gland, the action of these drugs leads to an improvement of the process of urination and a significant reduction of PSA levels in serum.

It should be remembered that sex and taking the pill inhibitor difficult because one of the side effects of drugs is decreased libido, and in some cases, and temporary impotence. Used Finasteride, Dutasteride and other medicines containing the substance of this pharmacological group.

Alpha-1-blockers

Thanks to the mechanism of action of this group of drugs relaxes the muscles of the body and reduce the appearance of obstruction. Improvement the patient will feel after two days but the maximum effect will occur only after a month of intensive treatment. For drugs in this pharmacological group include Prazosin, Alfuzosin, Terazosin and Tamsulosin. Side effects of drugs are headache, dizziness, drowsiness, and nasal congestion.

Plant extracts

Especially popular in Europe and the USA are extracts of saw Palmetto and African plum. It is noticed that long-term use of such drugs can significantly reduce swelling, relieve inflammation and have a positive impact on the contractile activity of the bladder. In addition, the common use of saw Palmetto extract, preparation "Enteron", oil seedspumpkins, and other. Pills with plant extract used only in the dosage prescribed by your doctor.

Antibiotics

If the evaluation were foci of latent infection or inflammation, then to the main treatment, attach antibacterial drugs. Due to the fact that the insight of the tissues of the gland is significantly reduced, the intake of these medicines can be quite lengthy. Most often used Levorin and Hypertrophy.

Traditional medicine

Experts of folk medicine believe that to halt the growth of the adenoma and to resume the normal function of the urinary organs is possible with propolis. It is believed that under its influence, decrease of inflammatory symptoms, painful symptoms, restoring the body's defenses and is updated fabrics.

Propolis treatment of BPH is only its aqueous solution, since alcohol even in small doses, becomes the cause of acute urinary retention. Some healers mix the tincture of propolis with herbal decoctions to enhance the effect. Propolis treatment seems quite harmless and gives hope, but before you can begin to receive infusions should inform your doctor as not all pills are combined with bee products, and incompatibility of the active ingredients is the cause of many health problems.

Minimally invasive treatments

Most often these methods are used if there are contraindications to surgery. To facilitate the patient's condition in the prostatic Department of the urethra establish a permanent, temporary or absorbable stents. They do not allow to squeeze the urethra enlarged prostate tissue. But there is a high risk of encrustations of implants salts as well as addition of pathogenic microorganisms and development of inflammatory processes.

Thermal methods based on the effects on prostate tissue high or low temperatures, which are the source of ultrasound, laser, radio frequency and other physical effects. Under the influence of these factors adenoma tissue are destroyed and restored the free flow of urine. Transurethral radiofrequency thermotherapy (TUMT) and thermal degradation (TUNA) lead to the formation sites of coagulation necrosis in the thickness of the prostate. In contrast to the above methods, high-intensity focused ultrasound (HIFU) using a special transrectal probe and a computer guidance program allows you to create a limited increase in temperature to 80-120 °C. ultimately, the destruction of cells occurs only in certain areas of the prostate without affecting surrounding organs and tissue.

Surgicalintervention

The absence of effect of conservative treatment or severity of the disease the second or third stage may require surgical treatment. Transurethral resection is the first choice for the treatment of BPH, but some clinics still operate the old fashioned way and treat the prostate by the method of open adenomektomii. Besides, there are palliative (partial removal of the prostate), and radical (prostatectomy) surgical treatment. In parallel with the operational intervention of biopsy material for histological examination. Whatever method is chosen, the main goal is to relieve men from obstruction and restoration of normal urination. The indication and cause of surgical intervention consider:

• Chronic infectious processes in the prostate.
• Acute retention of urine, even after a successful catheterization.
• The lack of effect from drug treatment.
• Renal failure.
• Stones in the bladder.
• A large amount of residual urine.

The prognosis is favorable with timely and proper treatment and with the right approach allows you to resume an active life, the sex and forget about the unpleasant symptoms. In very rare cases, after surgery there may be relapses, but only if the adenoma has been removed completely. In the absence of adequate treatment the prognosis is not favorable. The progression of growth of the prostate adenoma will lead to chronic kidney failure, and that, in turn, to death.