BPH is the expansion of the glandular tissue and the stroma of the prostate, which leads to an increase in the organ. Prostate adenoma causes urinary disorders: a weak urine jet, frequent or nightly urination, paradoxical ischuria.
The diagnosis is established on the basis of the level of PSA, uroflowmetry and the questionnaire for assessing the symptoms of IPSS.
Treatment correlates with the volume of the gland, age, concomitant pathology and severity of symptoms. Tactics of waiting, drug therapy, surgical intervention, including minimally invasive techniques can be used.
Benign prostatic hyperplasia (prostate adenoma, BPH) is a global problem that affects from 50 to 90% of patients who have reached the age of 85 years. According to statistics, about 30 million men have genitourinary dysfunction associated with BPH, and this figure is increasing year by year. Pathology is more common in African Americans because they have a higher level of testosterone, the activity of 5-alpha reductase, growth factors and expression of androgens receptors (population feature). In the eastern countries, prostate adenomas are less commonly recorded which is probably due to the consumption of a large number of products containing phytosterols (rice, soy, and its derivatives).
Causes of BPH
Obviously, the prostate adenoma is a multifactorial illness. The main factor is the change in the hormonal background associated with natural aging in the normal functioning of the testicles. There are many hypotheses that explain the mechanisms of pathology development (the theory of stromal-epithelial interactions, stem cells, inflammation, etc.). However, most researchers consider the hormonal theory as the main one. It is anticipated that the age-old predominance of dihydrotestosterone and estradiol stimulate specific receptors in the gland that trigger hyperplasia of cells.
In 35% of patients, there is acute urinary retention on the background of BPH. Residual urine has the ability to crystallize; in this case in the urinary bladder concretions with secondary inflammation are formed. Increased intra-bladder pressure contributes to the formation of bladder-ureteral reflux, hydronephrosis, and CRF. Also, there is a probability of stricture of the urethra after transurethral resection (5-7%), urinary incontinence (1-2%), erectile dysfunction (9-14%), retrograde ejaculation (74-87%).
Treatment for BPH
The therapy of prostate adenoma depends on the degree of severity of obstructive symptoms, complications and concomitant pathology. All existing treatments are aimed at restoring adequate urine derivation.
With the advent of alpha-blockers (Terapress, Alfusin 10), many patients with hyperplasia of the prostate gland were able to avoid the surgery. Drugs relax the muscles of the prostate and urethra, which increases the urine flow.
5-alpha-reductase inhibitors are prescribed to prevent the progression of symptoms of obstructive urination. According to testimony, combined therapy is possible. Inclusion in the scheme of inhibitors 5-phosphodiesterase improves the flow of urine and positively affects the erectile function.
Medicinal therapy is performed in patients with severe and moderate disorders of urination.