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.
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscesses of the abdominal cavity
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenial diverticulum
- Epiphrenial diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Cholelithiasis
- Urinary retention acute
- Zollinger-Ellison syndrome
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Mediastinitis
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Perforated ulcer
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
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