Benign hyperplasia of a prostate

Description:

Benign hyperplasia of a prostate - a benign tumor, increase in number of cells of periurethral glands of a prostate.

The most frequent disease at men of advanced age.
Arises at the age of 40-50 years. At the age of 50 years about 25% of men have DGPZh symptoms, and at the age of 65 years - already 50%, over time the disease develops at 85% of men.

Histologic (microscopic) signs of DGPZh meet, already since 30-40-year age.

Symptoms of the Benign hyperplasia of a prostate:

DGPZh is shown by disturbances of an urination which call the Symptoms of the Lower Urinary Tract (SLUT):

Symptoms of filling (irritation) - frustration of the neuromuscular device of a bladder:
frequent urination day and night (nokturiya)
urgent (imperative) desires to an urination
Symptoms of emptying (obstruction) - narrowing of a gleam of an urethra the increased prostate and spazmirovanny muscles:
urination delay
the complicated urination,
need of the expressed tension of a front abdominal wall to start an urination
weak stream of urine
intermittence of a flow of urine
dropping at the end of the act of an urination
feeling of incomplete bladder emptying
There is no direct dependence between the DGPZh sizes and expressiveness of disturbance of an urination which also depends on the direction of growth of DGPZh and dysfunction of a bladder. At growth from back group of glands an average share of DGPZh, hanging over an urethra in the form of the valve, can cause an ischuria. At the same time the big DGPZh growing from side periurethral glands back towards a rectum, can not give any clinical displays of a disease.

Quite often acute (sudden) ischuria becomes the first clinical manifestation of DGPZh.

On a clinical current allocate three stages of DGPZh:

First stage.

The urination, especially at night, sometimes to 5-8 times becomes frequent. The stream of urine becomes sluggish, an urination complicated eventually to empty a bubble, it is necessary to natuzhivatsya. The urine incontience owing to any relaxation of an outside sphincter of an upetra is possible during sleep. Full emptying of a bubble is reached thanks to komlensatorny function of a muscular wall (detruzor) of a bladder. Function of kidneys is usually not broken.
Duration of the first stage from 1 to 12 years.

Second stage.

The feeling of incomplete bladder emptying joins. Desires to an urination are speeded up day and night. Often in the morning patients should urinate in 2-3 receptions. The stream of urine becomes steep, is interrupted by drops, the patient is forced to make an effort that can lead to herniation or a prolapse of the rectum. At a hypertrophy of a wall of a bubble the rough skladchatost interfering inflow of urine from upper urinary tract because of what it stagnates in ureters and kidneys is formed. Gradually there occurs thinning, an atony of muscle fibers of a detruzor. A part of a wall of a bladder, free from muscle fibers, is extended, forming bags - false diverticulums of a bladder. The residual urine makes 100-200 ml, and sometimes to liter and more. Signs of a renal failure develop: dryness in a mouth, a polydipsia, etc.

Third stage.

The quantity of a residual urine increases to 1,5-2 liters. The bladder is sharply stretched, its contours are looked through in the form of the spherical or oval tumor reaching a navel above, its sensitivity decreases, and patients mistakenly believe that there occurred improvement. At night, and then and wetting periodically in the afternoon or all the time is allocated involuntarily, drops from the crowded bladder - an inconscience with overflow. There are works of kidneys caused by disturbance total loss of appetite, weakness, thirst, dryness in a mouth, nausea locks - a chronic renal failure. In the absence of adequate therapy patients die of uraemia.

The wavy current - symptoms is characteristic of symptomatology at DGPZh amplify, are weakened even without treatment. Deterioration in symptomatology often happens is connected with such provocative factors as cooling, alcohol intake, stresses.

DGPZh - slowly progressing disease, is frequent without development of any symptoms. With age there is a gradual growth of a prostate, strengthening of symptoms. Also cases of improvement of both subjective, and objective parameters meet.

DGPZh influences quality of life of the patient, forces to change the way of life: to limit drink, to rise during the night for an urination, to limit social and sexual activity.

Reasons of the Benign hyperplasia of a prostate:

The reasons of DGPZh are definitely not known, it is supposed that this polyetiological, depending on many reasons, a disease. It is authentically known that DGPZh depends on availability of male sex hormones - androgens.

At approach of atrophic processes in a prostate by the time of fading of sexual activity it is uncontrollable paraurethral pieces of iron in the center of a prostate which function still is completely not clear expand. It is supposed that they are hemadens, antagonichesky in relation to male gonads. In formation of DGPZh it is involved not only ferruterous, but also muscular and connecting fabrics therefore it can have not only adenomatous (ferruterous), but also fibrous (cicatricial) or myomatous (muscular) character. In small knots of connecting fabric happens usually more, than ferruterous, sometimes in the ratio 4:1 and even 5:1. The more nodes and the size of a prostate, the most part are occupied by a ferruterous component. The DGPZh nodes in process of growth force out and replace gland fabric.

Depending on development of nodes within this or that zone of a prostate side shares or an average share form.

Disturbances of an urination at DGPZh are caused both by a mechanical prelum of an urethra (urethra) the DGPZh nodes, and reduction of muscles of a prostate and urethra owing to a hyperactivity of adrenoceptors of a neck of a bladder, prostatic department of an urethra and a prostate.

Disturbance of outflow of urine forces "to strain" a detruzor - a bladder muscle the expelling urine. It leads to its damage and development in 52-80% of patients with DGPZh of a prostate of a hyperactive bladder.

Treatment of the Benign hyperplasia of a prostate:

Treatment of DGPZh depends on a stage of a disease and specific features, individual portability of drugs.

In the I stage treatment usually conservative.
In the II stage in the absence of effect of conservative - operational treatment.
In the III stage only surgical treatment.