PROSTATE ADENOMA

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Adenoma of the prostate gland is a benign tumor of the prostate gland. It occurs at the age of over 50 years. In the origin of adenoma, dyshormonal disorders, prostatitis , and venous congestion in the small pelvis are important.

The adenoma of the prostate gland consists of the middle and two lateral lobes. Its growth can be directed mainly toward the rectum, less often in the lumen of the bladder. The growth of adenomatous nodes causes elongation and compression of the prostatic part of the urethra and changes in its curvature. The neck of the bladder is lifted by the adenoma. As a result of a complicated outflow of urine from the bladder, compensatory hypertrophy of his muscular wall gradually develops , which then gives way to atony.

The clinical picture and course of the disease depend primarily on the degree of impairment of emptying the bladder. At the beginning of the disease there is a flaccid urine stream, a delayed onset of urination, frequent urge to urinate, especially at night. However, the bladder empties completely and there are no significant changes in the urinary tract (stage I). Decompensation of the muscular wall of the bladder and the presence of the so-called residual urine after natural urination in an amount of 100 ml or more indicate a transition to the second, subcompensated stage. The amount of residual urine continues to increase, and gradually a feeling of incomplete emptying of the bladder appears. In the third, decompensated stage, signs of renal insufficiency - thirst, polyuria , poor appetite, a smell of urine in the exhaled air. There is a paradoxical combination of delay and urinary incontinence - involuntary discharge of urine drop by drop with a full bladder (paradoxical ishuria).

In the I and II stages of the disease, there may be cases of acute urinary retention, which is facilitated by alcohol intake, hypothermia, so-called situational overexposure of urine. In connection with adenoma of the prostate, the development of the veins of the neck of the bladder develops, as a result of which a total painless macrohematuria is possible (see Hematuria). Prolonged urostasis and associated infection often contribute to the formation of bladder stones (see Urolithiasis). In these cases, the frequency of urination is more frequent, especially with active movements, jerking riding; Pain radiating to the glans penis. Adenoma of the prostate gland predisposes to the onset of an inflammatory process in the urogenital system. The most formidable is pyelonephritis , which is acute and chronic, contributes to the progression of renal failure.

The diagnosis . When examining a patient, great importance is attached to careful collection of anamnesis, complaints, especially to changes in the nature of urination. Examination, palpation and percussion allow revealing the overflowing bladder that swells over the pubic articulation. In rectal finger examination, the prostate gland has clear boundaries, a smooth surface, a uniform, tauto-elastic consistency, a smooth interlobar groove. The patient needs to conduct laboratory tests, in particular general blood and urine tests. In case of finding a patient with signs of adenoma of the prostate gland, it should be directed to a consultation with a urologist. The size of the prostate gland, its structure, the presence of stones in the bladder, the amount of residual urine can be established using ultrasound. With the help of X-ray study, assess the condition of the kidneys and upper urinary tract. All instrumental methods of research (cystoscopy, retrograde urethro- and cystography) are performed by a urologist.

Treatment in the I stage of the disease is predominantly conservative. It is aimed at normalizing blood circulation in the pelvic organs, eliminating the inflammatory process in the prostate gland, reducing the size of the adenoma. Patients are advised to avoid prolonged sitting, hypodynamia, to walk outdoors in the morning and evening before going to bed, to practice physiotherapy, which includes exercises for the pelvic floor muscles and thighs. To reduce night diuresis, restrict fluid intake at night, completely exclude alcohol from the diet, restrict the intake of spicy dishes and canned food. Normalization of the act of urination and emptying of the bladder contributes to the appointment of androgens: methyltestosterone 0.005 g 3 times a day for 1 month, if necessary, after 1 month, repeat the course; 1% solution of testosterone propionate intramuscularly for 2 to 3 weeks with interruptions in 2-4 weeks (no more than 3 courses), sustan-250 intramuscularly (2 ml) once a month. A favorable effect with difficulty urinating associated with prostate adenoma and prostatitis, give intramuscular injections of raverone 1 ml daily for 1 month, depostat (depogestagen) 200 mg intramuscularly once a week for 2-3 months. Conduct a long course of treatment with levorin, at the same time - treatment of prostatitis, cystitis and pyelonephritis, which often complicate the underlying disease.

Acute urinary retention and paradoxical ishuria are indications for emergency hospitalization. In acute urination delay, emergency care consists in the catheterization of the bladder. To restore the compensatory capacity of the bladder, it can be drained within 1-3 days by a thin urethral or ureteral catheter. Emergency hospitalization is also shown with total machematuria. Indications for surgery are failure of conservative treatment, decompensation of bladder function with increasing amount of residual urine, violation of urodynamics of the upper urinary tract with the development of chronic renal failure, paradoxical ishuria . Early detection of prostatic adenoma allows performing its transurethral electroresection. When adenomas of large sizes resort to transgender adenomectomy. When the impaired functions of the bladder and kidneys are first necessary to stabilize, the first stage is epicystostomy, after 1-2 months after which a radical operation is performed.

The prognosis for life with adequate treatment and uncomplicated course is favorable. Preventative measures are aimed at normalizing blood circulation in the small pelvis, preventing prostatitis.