- General information
- Stages and symptoms
Adenoma is a benign tumor, but it can grow, causing painful and even life-threatening symptoms. After 50 years, many men have already heard a diagnosis of prostate adenoma from their doctor. However, this may happen at an earlier age.
The evolutionary development of the prostate continues until the puberty of the young man, then gradually the reverse process – invasion – starts. As a result, since the age of 30, prostatitis is often detected in men, and adenoma is possible from the age of 45. Both diseases lead to an increase in prostate size and a change in its structure. In prostatitis iron grows in volume due to edema caused by inflammation (infections, stagnant phenomena), and in adenoma its increase is due to tumor formation. During diagnosis, the doctor will easily distinguish between types of pathologies.
Prostate adenoma (code N40 by МКБ-10) has another popular name, “benign hyperplasia (excessive cell reproduction) of the prostate gland.” And until the end of the 30th years in the course there was an incorrect term “prostate gland hypertrophy” (a hypertrophy – increase in cages of body in volume, but not in quantity).
Adenoma is a benign epithelial tumor in the form of one or more spherical nodes. It develops not from prostate tissues, as many wrongly believe, but due to the growth of para- and periuretic gland groups. They are located in the submucosal layer of the posterior part of the urethra and in the area of the bladder neck. Muscle and connective tissue are also involved in the process.
The urethra passes through the prostate, so when the periurethral glands grow, the mucous membrane of the urethral canal protrudes into the lumen (from which it narrows) and the muscle layer presses the prostate tissue. As a result, they shift laterally and erode, and the tumor forms a surgical capsule from them.
Tumor behavior is largely determined by the types of tissues that form it, localization, and shape.
The following adenoma species are identified in the direction of development:
- Subsurface (rectal), grows towards the rectum. It is considered the safest in terms of freedom of urination;
- Intrapusory, heading towards the bladder. Due to the pressure exerted by the tumor, the bladder neck is deformed and the urethra narrows;
- Retrotrigonal, growth direction – to the urethral triangle (the area on the bottom of the bladder formed by the left and right ureters, as well as the urethra). The tumor is not pressed into the bubble walls, but raises the organ, giving it an unnatural position.
The direction of growth depends on the degree of resistance of the surrounding tissues: prostate and bladder neck.
According to the configuration of the adenoma there can be several types: pear, dicotyledonous, bunny (depending on the group of growing glands).
There is also a gradation of adenoma by weight:
- Less than 30 g – small;
- Up to 80 g – average;
- Up to 250 g – large;
- More than 250-300 g – giant.
Adenoma is characterized by three main types of structure:
- Iron (adenoma itself). Iron epithelium cells grow. The process begins with the appearance of small nodes;
- fibrous (fibroadenoma). It is formed by two types of tissues – fibrous and iron. It grows slowly inside the prostate, protected from healthy cells by a kind of capsule;
- muscular (fibromioadenoma). It consists of smooth muscle and iron fabric. This type of tumor occurs very rarely, causing pronounced discomfort in the early stages.
All of the above parameters have important diagnostic significance.
Adenoma is considered a hormone-dependent tumor. The development of glandular prostate tissue is regulated by hormones: male (androgens) and female (estrogens). Tissue growth factors also play a role. Against the background of age decrease of testicular functions (andropause) hormonal balance is disturbed, leading positions in the male body are gradually occupied by estrogens, to which periurethral glands are very sensitive.
Bad habits, stagnant processes due to lack of movement, abundance of fatty food, lack of sexual life can indirectly contribute to the development of adenoma, but the root cause is not.
In young men, hormonal failures caused by diseases, such as adrenal cortex adenoma, can drive the formation of a benign prostate tumor. Overweight is also a serious threat because it is in adipose tissue that androgens are converted into estrogens.
Stages and symptoms
Adenoma symptoms depend on its shape and direction of growth. Due to tumor enlargement, the following changes may occur on the part of the urogenital tract:
- The anterior and posterior walls of the urethra are not uniformly extended;
- The neck of the bladder under adenoma pressure is deformed and lifted, sometimes the “leg” of the tumor overlaps its opening;
- It is possible to change the shape of the bladder.
The first symptom that should alert a man is painless and painless frequent urination, especially at night (more than 2 times per night).
One of the frequent signs of adenoma is the weakening of the head of the urine jet, the elongation of the urination process.
However, urinary symptoms in adenoma occur only in half of cases. Tumor size does not always affect the degree of urination disorder. The determining factor is the direction of its growth and localization. The lumen of the urinary canal can be blocked by a small adenomatous “leg,” in the end a complete delay in urination is possible. And a large tumor growing towards the rectum won ‘t give any symptoms for a long time.
Adenoma in its development passes 3 conditional stages:
- Compensated. Urination is frequent (more than 2 times at night), and the process can begin with delay. Gradually, the man has to strain the abdominal muscles to completely empty the bubble. The determining feature of the stage is not more than 50 ml of residual urine, as the bubble muscle system (detrug) is still able to expel it completely. The duration of the period ranges from several months (if the adenoma grows inside the bubble) to 10 years or more.
- Subcompensated. The detrusor is gradually losing functionality, the walls of the bubble are atrophied. Every act of urination requires muscle tension. Due to the accumulation of a substantial volume of residual urine, there is a constant feeling of incomplete emptying. For the same reason, kidney function is disrupted because the outflow of urine from ureters and lochs is difficult. At the same time dryness in the mouth appears, thirst increases, appetite is lost.
- Dekompensirovanny. The bladder is already very stretched, its muscles hardly cope with the withdrawal of urine, the internal sphincter loses tone. The calls to urination become almost constant. Urine is released dropwise, not only when visiting the toilet, but also inadvertently. The bubble accumulates about 2 litres of residual urine, which leads to serious kidney disorders, dehydration, intoxication. Common weakness, constipation are characteristic. The patient begins to smell urine, even from the mouth. The last symptom requires urgent hospitalization.
It should be taken into account that the longer a visit to a doctor is postponed, the less effective conservative therapy will be. In 2% of cases, adenoma results in death.
In the absence of adequate therapy, adenoma is fraught with serious complications. A stretched harmless bladder with yawning ureter mouths is a picture characteristic of chronic urine delay. Urina is thrown back into the kidney ducts, leading to their intoxication. As a result, renal failure develops – a condition threatening with death.
In adenoma, acute urine delay can occur suddenly. In no way can a self-evident tumor clog the urinary tract. In such cases, urgent catheterization is used – forced withdrawal of urina.
Against the background of constant urinary stagnation, the urethral microflora is activated, resulting in urethritis and cystitis. These diseases are also frequent catheterization satellites.
The cystitis-causing infection along the lymphatic pathways or through the seed-withdrawing ducts is able to reach the seed bubbles, testicles and their appendages. As a result, vesiculitis, orchitis and epididymitis develop. In case in testicles or appendages there is a risk of development of urosepsis-life threatening condition.
Cystitis, bladder stones (due to urine stagnation), pyelonephritis or vein rupture in the adenoma capsule lead to blood in the urine – hematuria.
As for the malignant rebirth of adenoma, there is no scientific confirmation of this. Cancer can develop against the background of a benign tumor, but these formations are not related.
The task of diagnostics is to establish the stage of adenoma development, its localization and shape. In order to choose treatment tactics, it is also important to check the condition of other organs, in particular kidneys.
A special I-PSS questionnaire has been developed for patients with prostate diseases, which helps to determine the presence and extent of symptoms by the total number of points.
Among the methods of examination, palpation produced through the rectum is of great importance. In this way, the urologist determines the size, consistency, shape of the prostate, the presence of knots and seals.
To evaluate kidney performance, it is necessary to pass urine and blood tests (for creatinine and urea). The presence of inflammatory reactions, the presence of prostate-specific antigen (PSA) produced by the prostate, is also determined from the blood. Exceeding the norms of this indicator may indicate the occurrence of tumor processes in the gland.
A reliable and simple diagnostic method for adenoma is prostate ultrasound using a rectal sensor. Transabdominal (conventional) ultrasound is informative for determining the amount of residual urine, detecting stones in the bladder, examining its walls, and examining the kidneys.
Urophloumetry is used to estimate the urination rate. The procedure technique is idle – it is enough for a man to wash in a special tank with sensors.
The following methods are also used to clarify the diagnosis:
- Cystoscopy – examination of the bladder by an endoscopic device introduced through the urethra;
- Cystomanometry – measurement of bladder pressure, diagnostics of detrug functions and urethra cross-country capacity;
- Pneumocystotomography – a method that allows to clearly visualize prostate tissues. Oxygen is injected into the bladder with a catheter, and a series of tomograms is carried out;
- CT and MRI make it possible to accurately distinguish adenoma from malignant formation;
- Excretory urography – series of X-ray images of kidneys, ureters and bubble after introduction of contrast substance.
Other methods are prescribed if necessary, including prostate biopsy – taking a small tumor fragment to investigate the structure of its cells. The indication is the asymmetry of the gland, the presence of nodes in its structure, the increased PSA.
There are no conservative methods by which adenoma growth can be reversed and cured. The only way to get rid completely is by hatching the tumor from the gland.
Drug therapy is particularly effective at the initial stage of adenoma, when the accumulation of residual urine in the bubble has not yet been recorded. In other cases, the drugs can alleviate symptoms, but with varying degrees of efficacy.
5-alpha reductase inhibitors (a substance without which synthesis is impossible) are used to block excess dihydrotestosterone formation (synthesized from testosterone). Drugs such as Proskar (finasteride), Avodart (dutasteride), combination drugs (Sonyrid Duo) are prescribed. Under their influence (after about six months of administration) the expression of symptoms on the side of the urinary system is reduced, the size of the prostate is slightly reduced.
Alpha-andrenoblocators (Omnik, Setazin, Prozazin) are a group of drugs whose action is aimed at relaxing the smooth muscle tissue of the prostate and urethra, which facilitates the urination process.
Antibiotics and sulfanylamides are used in case of complications in the form of pyelonephritis, cystitis.
A separate role in the drug treatment of adenoma is played by plant preparations based on extract (lipidosterol extract) from the fruits of verolistic palm. The most popular remedy is Permikson, whose effectiveness has been scientifically proven.
Exhaust has the following effect:
• Inhibits the process of converting testosterone to dihydrotestosterone in the prostate;
• Suppresses 5-alpha reductase activity;
• Reduces gland swelling due to local metabolic stimulation;
• Improves bladder detrusor tone.
In stages 1 and 2 of adenoma, many doctors prescribe a Tadenan drug based on African plum extract. This substance inhibits the growth of connective tissue cells (fibroplasts) that are involved in tumor formation.
It is possible to significantly alleviate the condition in adenoma by regular use of pumpkin seed or preparations based on it:
Pumpkin seeds contain a large amount of zinc, which plays an important role in prostate work. If the amount of this element in prostate tissues falls below 350 mg/g, the prerequisites for tumor formation are created.
There are preparations based on prostate extract of cattle: Prostatilen, Robaveron. They improve blood microcirculation in the prostate, stimulate venous outflow.
Folk medicine in adenoma recommends taking bee undergrowth, pollen, herbal collecting (shwosch, wort, chamomile, crust bark, planter, popsticks), infusion from roots and grass parsley, dill seeds, alcohol tincture from topolic kidneys. Effectively prevents the growth of the tumor, the decapitation of nettle, as well as the mixture of its juice and vodka (4:1). The infusion of ivan-tea (boiling cake), decoction of onion husks with the addition of honey is useful.
Diuretic agents cannot be used in adenoma. This can lead to bladder rupture, acute urine delay.
The patient should minimize the amount of sugar and coffee consumed. It is desirable (and 2 all stages – mandatory) to completely exclude alcohol (except medicinal infusions), smoked, pepper, mustard, canned food. It is important to avoid constipation and supercooling. All of the above can trigger urine delay. It will ease the state of excess weight discharge, increase of motor activity.
Physiotherapy in adenoma is aimed at stimulating the protective reactions of the body, activating blood flow in order to more effectively transport medicines into the gland. The main non-specific methods are magnetic, laser, induction therapy.
The tumor can be partially destroyed by specific physiotherapeutic methods:
• Cryotherapy – freezing of prostate with liquid nitrogen with cryosond;
• Thermoablation- targeted exposure of the gland to high temperatures;
• Transurethral needle ablation – a procedure during which thin needles introduced into the prostate pass radio frequency pulses;
• Microwave therapy – exposure of the tumor to microwaves emitted by the introduced mini-generator.
All procedures are performed by introducing endoscopic instruments through the urethra as well as through small punctures in the abdominal wall.
Operational interventions on the prostate are often accompanied by complications, so in most cases conservative therapy and dynamic observation are used. Indications for surgical removal of adenoma are:
- Abundant bleeding from the urethra;
- Bladder stones;
Chronic inflammation (cystitis, pyelonephritis, prostatitis);
- Recurrent urine delays;
- renal failure.
To remove large adenoma against the background of complications (for example, urethral narrowing), adenomectomy is used — tumor hatching through the incision above the pubic or in the perineum region (rarely).
Much less traumatic is TOUR – transurethral electric resection. The method is used for small tumor sizes. A special electric furnace is introduced into the urethra, which cuts the affected tissues. A device for prostate washing, blood withdrawal and cut elements is also inserted into the operated area.
Ignoring the indications for surgery may lead to the need for an emergency surgery, thereby significantly increasing the percentage of complications.
Urologists joke that every man will sooner or later live to his adenoma. This is a natural phenomenon, there is no prevention. However, in those who lead a relatively healthy lifestyle, symptoms of adenoma usually appear at a very old age. In most cases, they can be successfully adjusted without bringing them to surgery.