Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH), also called adenofibormyomatosis and benign prostatic hypertrophy, is a benign enlargement of prostate.
BPH prostatic hyperplasia comprising stromal cells and epithelial cells, which leads to the formation of large, discrete nodules in the periurethral region of the prostate gland. For sufficiently large size nodules compress the urethral canal than can partially or sometimes almost complete urinary tract obstruction of the urethra, which prevents the normal flow of urine. This leads to symptoms of urinary retention, frequent urination, increased risk of urinary tract infections. Although the serum prostate specific antigen can be raised in such a case, by increasing the volume of the body due to an infection and inflammation of the urinary tract, hyperplasia does not lead to cancer, and it does not increase the risk of cancer development.
Adenomatous prostate growth usually begins around age 30. An estimated 50% of men have histologic evidence of BPH by age 50 years and 75% by age 80; 40-50% of patients with BPH becomes clinically significant.
Signs and symptoms
Symptoms of this disease are frequent urination, urgent need to urinate, urination at night (nocturia), urinary retention, intermittency (when mocheipuskanie starts and stops periodically), pain and dysuria.
BPH can be a progressive disease, especially if left untreated. Incomplete emptying leads to stagnation of bacteria in the bladder residue and an increased risk of urinary tract infection. Urinary bladder stones are formed from the crystallization of salts in the residual urine. Retention called acute or chronic, is another form of progression. Acute urinary retention is the inability to urinate, and in chronic delay residual urine volume gradually increases, and the bladder is inflated. This may lead to hypotension bladder. Some patients suffering from chronic urinary retention, the disease may eventually progress to kidney failure, a condition called obstructive uropathy.
Most experts believe the cause of androgens (testosterone and related hormones). Dihydrotestosterone (DHT), a metabolite of testosterone, is the major mediator of prostatic growth. Synthesized DHT in the prostate of circulating testosterone by the enzyme 5α-reductase type 2. This enzyme is localized predominantly in stromal cells; therefore, these cells are the basis for the synthesis of DHT.
Testosterone promotes proliferation of prostate cells, but in patients with BPH relatively low testosterone levels.
At the microscopic level, elevated hormone can be seen in the vast majority of men over the age of 70 years, around the world. Nevertheless, the rate of clinically significant, symptomatic BPH vary greatly depending on lifestyle. Men who live in large cities, have a much higher level of symptomatic BPH than men, leading a traditional or rural lifestyle. This is supported by research.
Microscopic examination of the various types of prostate tissue (immunohistochemical staining methods).
Rectal examination (palpation of the prostate through the rectum) may reveal a marked increase in the prostate, usually affecting the average share.
Frequently performed blood tests to determine malignant prostate. Elevated levels of prostate specific antigen (PSA) requires further study, such as the revaluation of PSA in terms of PSA density, and determination of free PSA. Then conducted a rectal examination and transrectal ultrasonography. Together, these measures can provide early detection of prostate cancer.
Ultrasound examination of the testes, prostate and kidney is performed to rule out malignancy and hydronephrosis.
Screening and diagnostic procedures analogous to those used for prostate cancer.
Some symptoms may include: weak urinary stream, prolonged bladder emptying, abdominal straining, urinary retention, irregular need to urinate, incomplete bladder emptying, dribbling after urination, irritation during urination, frequent urination, nocturia (the need to urinate at night), urgency of urination, incontinence (involuntary leakage of urine), pains in bladder, dysuria (painful urination), problems with ejaculation
Lifestyle changes aimed at eliminating the symptoms of BPH and includes a reduction of fluid intake before bedtime, alcohol consumption and mitigate caffeinated products. Patients may also avoid the consumption of foods and drugs that can aggravate the symptoms of BPH, including antihistamines, diuretics, and decongestants, opiates, and tricyclic antidepressants. However, such changes must be made with a physician.
Two main methods of treatment for BPH are alpha blockers and inhibitors of 5α – reductase.
Alpha-blockers (technically α1 – adrenergic receptor antagonists) are the most common for initial therapy. Such formulations are equally effective, but have slightly different side-effect profiles. Alpha blockers relax the smooth muscles of the prostate and bladder neck, thereby reducing blocking the flow of urine. Common side effects of alpha-blockers include orthostatic hypotension (dizziness or headache tide on rising or sipping), changes in ejaculation, headaches, nasal congestion and weakness. Non-selective alpha-blockers should be administered with extreme sotorozhnostyu as they can cause syncope, if the dose is too high. Side effects may also include erectile dysfunction.
Another treatment option are inhibitors 5α – reductase finasteride, and alopecia. These drugs inhibit 5a-reductase, which in turn inhibits the production of the DHT hormone responsible for prostate enlargement. The effect of these preparations may occur later than that of alpha-blockers, but it persists for many years. Side effects include decreased libido and ejaculation.
Minimally invasive treatments
In 2009, two Israeli doctors, Yigal Gat and Menahem Goren nonsurgical method was developed Ghat – Goren treatment of BPH. This method is performed using interventional radiology techniques that reduce and change the volume of the prostate BPH symptoms. This medication is known as a super-selective androgen ablation of the prostate, involves percutaneous venography and sclerotherapy of the internal spermatic vein network, including retroperitoneal veins. This method leads to a decrease in prostate volume, nocturia significant reduction, improved urinary flow and bladder evacuation without the potential side effects and complications of classical surgery.
Although medications are often prescribed as the first choice of treatment, many patients are not observed sustained improvement, or they have to discontinue use because of side effects. There are also options in treating urologist’s office, in order to avoid operational methods.
The two most common types of such therapy is transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA). Both of these procedures rely on the achievement of strength of sufficient energy to create a desired amount of heat, causing cell death (necrosis) in the prostate gland. The purpose of such treatment methods cause necrosis at which prostate reduced, freeing a urethra. These procedures are usually performed under local anesthesia, and the patient returns home the same day.
Transurethral microwave therapy (TUMT) was originally approved in the United States. Since 1996, other companies and countries received FDA approval for the use of TUMT equipment (including Urologix, Dornier, Thermatrix, Celsion and Prostalund). The general principle underlying all devices is a microwave antenna in urethral catheter, which is inserted intraprostatic urethra area. The catheter is connected to the control unit is energized to direct microwave radiation to the prostate tissue and heating vyzvaya necrosis. This disposable treatment method that takes 30 minutes to 1 hour, depending on the system used. Tech equipment is also circulated coolant which passes through the treatment zone in order to avoid damaging the urethra while heating the prostate tissue around the urethra.
Transurethral needle ablation (TUNA) is performed with a different type of energy. This radio-frequency (RF) energy, but its purpose, action and dissemination of the same area as that of TUMT. TUNA device is inserted into the urethra using a rigid frame, in the same manner as the cystoscope. Energy is fed into the prostate using two needles, which are located on both sides of the device through the wall of the urethra in the prostate gland. Treatment usually takes place in a single session, but may take several needles, depending on the size of the prostate.
If medical treatment is not successful, or if the patient refuses to mini-invasive therapy, or it is not advised by the doctor, the patient may be offered a transurethral resection of the prostate (TURP). Basically, considered the gold standard TURP prostate surgery. This method involves the removal of the prostate gland through the urethra. However, as a result of this operation, the male becomes sterile. Thus, for a man who plans to become a father, this procedure is not suitable.
Over the past 5-10 years in Israel, new methods, including the use of lasers in urology. Among these techniques VLAP involving Nd: YAG laser, as well as a similar technology called Photoselective Vaporization of the Prostate (PVP) with a laser GreenLight (LBO crystal). This is done using a high laser power is 180 watts and a wavelength of 532 nm using a 650 – micron fibers. In prostate introduced laser fiber which is internally reflected with an angle of deviation of 70 degrees. It is used to vaporize the tissue of the prostate capsule. GreenLight laser 532 nm extends the target hemoglobin chromophore and usually have a penetration depth of 0.8 mm (twice deeper than laser Golmium).
Another procedure called ablation of the prostate Holmium laser (HOLAP). It is also widely accepted and recognized worldwide procedure. During the procedure, the prostate HOLAP provide laser fiber 550 microns, which directs the beam from high-power 100 W and at an angle of 70 degrees to the fiber axis. Holmium laser wavelength – 2140 nm, which allows her to get in the infrared part of the spectrum and be invisible to the naked eye. Holmium laser penetration depth <0.4 mm, thus avoiding the complications associated with tissue necrosis, which often occurs in deeper penetration.
Holmium laser enucleation of the prostate (HoLEP) is another laser procedure that carries less risk than any TURP or open prostatectomy. HoLEP is largely analogous procedure HOLAP. The main difference is that this procedure is generally performed on the larger the prostate. Instead of tissue ablation, laser removes a portion of the prostate gland. As regards the procedure HOLAP, perhaps some bleeding during or after the procedure. Holmium laser enucleation of the prostate most commonly used procedure in Israel.
After surgery usually installed temporary catheter or stent to accelerate healing and excretion of urine from the bladder. The stent is removed after a few days.
Open prostatectomy, or removal of the prostate is performed in very rare cases.