What is prostate adenoma
The prostate gland is located under the bladder and covers the initial part of the urethra. With age, its tissue grows - benign nodes are formed, which gradually squeeze the urethra from the inside, like a hand squeezing a garden hose.
The bladder has to work harder to push urine through the narrowed passage. At first he copes: the muscle wall thickens, and the symptoms are almost unnoticeable. Over time, the compensation is depleted, the bladder stops emptying completely, and urine constantly remains in it.
It is important to understand: the size of the gland and the severity of complaints are not directly related. A small adenoma that grows towards the urethra can cause severe symptoms, while a large one can hardly bother you. Therefore, the decision on treatment is made not by the volume of the gland, but by the totality of complaints, examination data and complications.
Symptoms of prostate adenoma
All manifestations of BPH are usually divided into two groups: those associated with difficulty in the outflow of urine and those associated with irritation of the bladder.
- Weak, sluggish stream of urine that may be interrupted
- Having to strain to start urinating
- Delay in onset of urination for a few seconds
- Feeling of incomplete emptying of the bladder
- Frequent urination in small portions during the day
- Getting up to go to the toilet at night - nocturia; one of the earliest and most debilitating symptoms
- Sudden, difficult to control urge, sometimes with leakage of urine
- Dripping at the end of urination
Night climbs deserve special attention. Men often attribute them to age and do not see a doctor for years, although it is nocturia that disrupts sleep, increases fatigue and increases the risk of falls in older people.
Causes and risk factors
The exact mechanism of development of BPH is not fully understood. The main role is played by age-related changes in hormonal levels - the ratio of testosterone, dihydrotestosterone and estrogens, which affect the growth of prostate tissue.
- Age is a major factor; after 50 years the probability increases markedly and increases with each decade
- Heredity: an adenoma in a father or brother increases the risk and shifts the onset of the disease to an earlier age
- Obesity and metabolic syndrome
- Diabetes mellitus type 2
- Arterial hypertension and atherosclerosis
- Low physical activity
- Chronic inflammatory processes in the pelvis
Contrary to popular belief, adenoma does not develop due to sexual activity or lack thereof, is not transmitted through contact and is not a consequence of previous sexually transmitted infections.
Why adenoma is dangerous: complications
- Acute urinary retention - a sudden inability to urinate when the bladder is full; requires emergency assistance
- Chronic urinary retention with a constant large volume of residual urine
- Bladder stones formed in stagnant urine
- Recurrent urinary tract infections and chronic cystitis
- Vesicoureteral reflux, hydronephrosis and kidney damage
- Chronic kidney disease and renal failure in advanced cases
- Bleeding from dilated veins of the bladder neck
- Irreversible overdistension and loss of bladder contractility
Diagnostics: what examinations are needed
The purpose of the examination is to confirm that the cause of the complaints is in the prostate, to assess the degree of disturbance in the outflow of urine and be sure to exclude prostate cancer, which in the early stages gives similar symptoms or does not give them at all.
- The IPSS survey is a standardized assessment of the severity of symptoms and their impact on quality of life.
- Digital rectal examination of the prostate
- A blood test for PSA (prostate-specific antigen) is a key test for excluding cancer
- Ultrasound of the prostate and bladder with mandatory determination of the volume of residual urine
- TRUS - transrectal ultrasound for accurate measurement of the volume of the gland and assessment of its structure
- Uroflowmetry - measurement of urine flow rate
- Urinalysis and culture if infection is suspected
- Blood creatinine to assess kidney function
- Diary of urination for 2–3 days
- Cystoscopy and prostate biopsy - according to indications
Elevated PSA does not automatically mean cancer: the indicator also increases with adenoma, prostatitis, after catheterization or cycling. It should be interpreted by a urologist taking into account age, gland volume and dynamics.
Treatment without surgery
With moderate symptoms and no complications, treatment begins with observation and drug therapy. It does not remove nodes, but reduces the tone of the smooth muscles of the prostate and bladder neck, and sometimes reduces the volume of the gland.
- Alpha adrenergic blockers - relax the muscle fibers of the prostate and urethra, improve the flow; the effect is usually felt within a few days or weeks
- 5-alpha reductase inhibitors - reduce the volume of the gland with significant hyperplasia; act slowly, the effect is assessed after months
- Combination therapy for large gland volumes and high risk of progression
- Bladder medications for severe irritative symptoms - prescribed with caution and under the control of residual urine
- Lifestyle adjustments: limiting fluids in the evening, avoiding alcohol and caffeine at night, treating constipation, regular physical activity
Drug therapy for BPH is long-term. Unauthorized withdrawal of drugs after improvement almost always leads to a return of symptoms, and sometimes to acute urinary retention.
Surgical treatment: TUR, HoLEP and other methods
Surgery is indicated when medications do not help, symptoms significantly worsen the quality of life, or complications have developed: urinary retention, bladder stones, repeated infections, bleeding, impaired renal function.
- TUR of the prostate (transurethral resection) is a long-term standard: tissue is removed through the urethra using a resectoscope loop, without incisions in the skin; optimal for medium gland volumes
- HoLEP - laser enucleation: the enlarged node is completely separated from the capsule by a holmium laser and removed; the method is suitable even for very large adenomas and has less blood loss
- Transvesical adenomectomy is an open operation; today it is used less frequently, mainly for gigantic volumes of the gland or concomitant pathology of the bladder
- TUR or incision of the bladder neck - for a small gland with a predominant narrowing of the neck
- Trocar cystostomy - does not treat adenoma, but removes urine and saves the kidneys during a delay when surgery is temporarily impossible
The choice of method depends primarily on the volume of the gland, as well as the presence of bladder stones, the use of anticoagulants, and the condition of the heart and lungs. The surgeon discusses with the patient the expected outcome and possible consequences, including retrograde ejaculation, a common consequence of prostate surgery that does not affect erections but does affect fertility.
Recovery and life after treatment
- In the first days after endoscopic surgery, the urine may be pinkish - this is normal; The doctor prescribes a drinking regime and monitoring
- Limiting heavy lifting and intense exercise for a period determined by the surgeon
- Temporary increased frequency of urination and burning gradually disappear as healing progresses
- Control examinations with ultrasound and determination of residual urine
- Continued monitoring of PSA - surgery for adenoma does not cancel oncological monitoring
- Treatment of constipation and adequate physical activity
Prevention and surveillance
It is impossible to prevent age-related growth of the prostate, but it is possible to detect the problem in time and prevent complications.
- For men over 45–50 years old, an annual examination by a urologist with PSA and ultrasound, even in the absence of complaints
- If there is a hereditary burden, start regular examinations earlier
- Monitoring weight, blood pressure and glucose levels
- Regular physical activity, avoiding prolonged sitting
- Don’t tolerate a full bladder and don’t put off going to the toilet for too long
- Be careful with medications that impair the flow of urine: some cold and allergy medications can cause acute retention
Where is prostate adenoma treated in Tashkent
To treat BPH, it is important that the clinic can both examine and operate: we need TRUS, uroflowmetry, laboratory facilities, an endoscopic stand, laser equipment and a hospital with an anesthesiology service.
In Tashkent, diagnosis and treatment of prostate adenoma, including TUR of the prostate and laser enucleation HoLEP for large volumes of the gland, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
At the appointment, it makes sense to clarify in advance: what is the volume of the gland according to ultrasound, what surgical methods are available in the clinic, how long the hospitalization lasts and how the observation after discharge is structured. Clinic contacts and online registration are below on the page.
