Prostate adenoma

Adenoma of the prostate gland is an adenomyomatosis of the periurethral glands. An important role in the origin of the disease is the involution of hormonal metabolism in old age. In a number of cases, the hereditary factor, as well as the occupation (the sedentary lifestyle was conducted by almost 60% of patients) is important. Expanded periurethral glands prevent emptying of the bladder, as a result of hypertrophy of the muscular membrane of the bladder with the formation of trabeculae and diverticula. When decompensated in the bladder, residual urine appears, and an increase in intravesical pressure leads to vesicoureteral reflux. Stagnation of urine, the formation of diverticula and trabecula contribute to the infection of urine and stone formation in the bladder.

Symptoms, course. The disease often occurs after 50 years, with age, the incidence of the disease increases, more than 50% of patients older than 60 years. In the clinical picture, dysuric phenomena prevail: the delay in the beginning of urination, the weakening of the urine stream, the pollakiuria, caused by the presence of residual urine and its infection. With a significant increase in residual urine, pain over the pubis and urge to urinate, then pain in the lumbar region (vesicoureteral reflux); With renal insufficiency, the occurrence of gastrointestinal disorders.

Stages of the disease. Stage I-preclinical-is more often observed at the age of 50-60 years against the background of the transferred infections of the genitourinary system. There are minor violations of the act of urination, discomfort in the perineum, in the lower abdomen, in the back of the urethra. The initial symptom may be premature ejaculation, hypospermia.

Stage II-dysuria-frequent urination at night, and then during the day. Typically, the appearance of a symptom of imperative urination, which unlike cystitis is not accompanied by soreness and cloudiness of urine, but its intensity is very high. An imperative urge leads to urinary incontinence. Periodically, dysuric phenomena can disappear indefinitely. Acceding infection strengthens dysuria. There is difficulty urinating at first after sleep, prolonged sitting, bladder overflow. The stream of urine weakens, especially at the beginning of the act of urination (a thin stream falls vertically downwards), night pollakiuria and polyuria intensify. The general condition of the patient at this stage is quite satisfactory. With a significant pollakiuria at night, patients become nervous and irritable,

Stage III-incomplete chronic urinary retention - characterized by the presence of residual urine, the amount of which is gradually increasing. Detrusor tone falls, the wall of the bladder gradually thinens, numerous small false diverticula appear. Inadequate emptying of the bladder leads to the expansion of the ureters and the renal pelvis, the renal parenchyma is atrophied, the kidney function is violated. At first, their concentration function is lost, and then the ability to breed. The course of the disease is gradual, the patient gets used to his condition, not noticing the increasing amount of residual urine. This is also due to a decrease in the sensitivity of the wall of the bladder. Gradually the bladder stretches, it can contain up to 2 liters of urine, the pressure of the urine accumulated in the urinary bladder overcomes the resistance of the sphincters, and the urine starts to spontaneously stand out drop by drop.

Stage IV - the period of "paradoxical ishuria" - "detention with incontinence". In this period, renal insufficiency with the phenomena of intoxication is expressed: thirst, weight loss, icteric sclera, dyspeptic phenomena, cardiovascular disorders. When palpating and percussion of the abdomen in the suprapubic region, an increase in the size of the bladder is determined. In finger research, the rectum reveals a smooth, elastic, enlarged prostate that is evenly densified (knots in the prostate gland are suspected of cancer!). At a catheterization of a bladder the residual urine is found out. Clarify the nature of the violation of kidney function with the help of urine (pyuria), biochemical blood tests (residual nitrogen, creatinine, urea). Excretory urography in outpatient settings can be performed in patients with a relative urine density of 1012-1015 and normal residual blood nitrogen. It is possible to determine the functional state of the kidneys and upper urinary tract. Cystography with contrast or oxygen makes it possible to determine endovezical growth of prostatic adenoma, the presence of stones in the bladder. Ultrasound examination of the prostate gland is possible with the use of a special rectal sensor - determine the size of the gland, the presence of seals in it (cancer!). Ultrasonography of the bladder helps in detecting residual urine. In the diagnosis of urinary disorders, uroflowmetry is effective.

Complications: acute urinary retention occurs during the I-II stages of the disease, cystitis, pyelonephritis, epididymitis.

Treatment. Conservative therapy includes hygiene, diet, medication. Patients should avoid cooling, especially the feet. Prolonged sitting, follow the activity of the intestine. From the diet should exclude pepper, mustard, smoked products, canned food, alcoholic beverages. The last meal or liquid should be at least 2-3 hours before bedtime.

Hormone treatment is a palliative method. Androgen therapy is used only in the initial stages of the disease, when surgical treatment has not yet been shown. After 65-70 years, estrogen therapy is more effective and can give a temporary improvement. Large doses of estrogen can exacerbate cardiovascular disorders.

Only surgical treatment is radical. Indications for surgery: the appearance of residual urine, persistent urinary tract infection, recurrence of acute urinary retention, gumaturia, bladder stones, a sharp increase in nighttime urination. Weakened patients with a poor kidney function show a two-stage crespusary adenomectomy: the first stage - superficial fistula superimposition before improvement of renal function; The second stage is the transesubular enucleation of the adenoma. Simultaneous transesophageal adenomectomy is characterized by simplicity of approach and relatively low lethality (2%).

The prognosis for timely treatment and the absence of severe concomitant diseases is favorable.