All men after 50 will probably experience discomfort during urination. The prostatic hyperplasia is the most frequent diseases.
The prostate is a small gland in chestnut shape, measuring 3 × 4 cm and weight 10 to 20 grams. It is located just below the bladder and above the final part of the intestine, rectum. Over the prostate are the seminal vesicles, organs also belong to the male reproductive system. According to the Urological Diseases Study Institute ( IMOP ), outside the prostate is surrounded by a fibromuscular sheath extending internally and creates pockets. This is supportive of a prostate layer. Inside, there are age midi a, whereby produced prostate liquid stored in the gland and extruded in the ejaculate through muscular contractions of the prostate to the urethra. At this time we close the neck of the bladder so that the sperm can not leave towards the bladder. Within the prostate, the ejaculatory resources pass to reach the seminal Cofidis, a ridge of the urethra where flowing.
The prostate surrounds the circumferential end portion of the urethra that is said about it prostatic urethra and extends from the seminal Cofidis until the bladder neck. Depending on its recommendation, the prostate is divided into zones.
– The transition zone surrounding the urethra near the bladder and that ypertrefetai benign prostatic hypertrophy. – The central zone extends behind and below the transition and includes the ejaculatory resources. – The peripheral zone extends distally from the preceding to the intestine, from which starts approximately 80% of prostate cancers. – Finally, fibromuscular zone located forward and above the urethra. In prostatic hypertrophy, an increase of the transition zone presses the other and practically occupies the largest part of the gland, in some cases, and inserted into the bladder, and then talk about development middle lobe. In this close anatomical problems urination due relation prostate-urethra-bladder associated with prostate disorders. Benign prostatic hypertrophy Benign prostatic hypertrophy called gland growth observed after 40 years. The increase of prostate size often compresses the wall of the circumferentially urethra and the bladder upwards, causing disturbances in micturition called symptoms from the lower urinary tract. It should be stressed that it has no relationship with prostate cancer, which unfortunately does not give timely symptoms. It is the extremely common condition since 4 out of 10 men have symptoms in the fifth decade of life, 7 out of 10 in the sixth decade, 8 to 10 in the seventh decade, to reach 90% in 90 years. The disease most often occurs in men who are obese, sedentary, suffer from metabolic syndrome, have erection problems and strained family history. Conversely, men with hypogonadism, testosterone deficiency that rarely will show the disease, since the growth of the prostate depends on the male hormone. What are the symptoms of the condition? The symptoms of micturition disorders, i.e. symptoms of the lower urinary tract, are divided into those related to the storage of urine in the bladder and those relating to the elimination of urine from the bladder, i.e. urination. Symptoms associated with the storage of urine in the bladder are as follows: – Frequent urination, when small quantities are caused regular need to urinate. – Nocturia, when we wake up at night to urinate. – Urgent urination, when we can not postpone urinating. – Incontinence when they no longer have time to go to the toilet. Symptoms associated with urine output are: – The urine flow is reduced, when the radius of the urine decreased. – Difficulty in starting urination. – Intermittent urination. – Loss of urine drops after urination. – Feeling of incomplete evacuation, a sensation that the bladder is not completely emptied. – Complete inability to urinate, so-called urinary retention. The only solution, then, in this very unpleasant experience is the direct placement catheter, since the retention pain is unbearable.
Other symptoms include pain in the bladder, particularly during urination, especially in cases of urinary tract infection, and hematite, usually those with bladder calculi.
What treatments exist today? Today there are many treatment options, such as to solve the problem of each man. Your urologist will recommend the most suitable for you and will help you determine what will follow. Let us know, though: Active monitoring This is recommended in patients with mild symptoms in men who do not observe effects on their daily lives. This treatment option includes regular visits to the urologist and possibly changes in the lifestyle of the patient, eg control of liquids and reduce them before going to bed at night, urinate before bedtime, avoid coffee and alcohol have a diuretic and irritant effects, possible constipation treatment, control of drugs used by a patient for other conditions and may aggravate symptoms. One in 3 patients in active monitoring will not need adjuvant therapy for five years. Medication To understand the drug therapy of the disease, we should know the three factors which determine the symptoms of the patient: The first factor is the rib prostate and bladder. The prostate, and the neck of the bladder, i.e. the portion of the bladder tube of the urethra, are muscle fibers through nerve can contract and relax. The nerves that are responsible for the contraction called adrenergic. On ends of these nerves secrete a substance norepinephrine, causing contraction of both the bladder neck and the prostate, when bound to specific receptors, adrenergic receptors.
The first class of drugs, therefore, granted said blocking alpha-adrenergic receptors, because they bind the adrenergic receptors, and thus norepinephrine can not act. Latest data indeed show that these drugs exert their beneficial effect on urination, and activating neural pathways outside the prostate. The main side effect of these drugs is the slight drop in blood pressure, usually manifested as dizziness and weakness, and ejaculation failure.
The second factor that determines the symptoms is the size of the prostate. As the gland grows, the most difficult urination. The gland is increased only in the presence of a hormone dihydrotestosterone (DHT). This is produced from the known male hormone, testosterone. Testosterone is converted to dihydrotestosterone in the prostate by the enzyme 5a-reductase. So, to reduce the size of the gland and to shrink the prostate, using inhibitors of 5-alpha-reductase. Usually administered to patients with prostate over 40 grams and achieve volume reduction by 15-25% within 6 months. As a side effect mentioned the possible reduction of libido and erection problems maybe. The 5a-reductase inhibitors cause notional reduction of PSA up to 50%, which should be taken into account in monitoring the patient. Recently released a pill that combines two classes of drugs, as it contains alpha-blocker that relaxes the gland and inhibitor of 5a-reductase, which shrinks him. This combination therapy has proven to be more effective at improving symptoms, prevention of disease progression, the retention, and therefore to avoid surgery.
The third factor has to do with bladder function. Many times, the bladder presenting disorders of the rib, thereby retracted involuntary urine volumes less than normal, i.e. below 400ml. Then, we talk about overactive bladder. This, of course, the overactivity is expected to hyperplasia, in bladder attempt to empty. However, when there is a pathological level, the urinary frequency, nocturia and urinary urgency deteriorate significantly, even in patients with mild obstruction. In these cases, conjointly with drugs acting on the prostate and the so-called anticholinergic drugs. They act on specific receptors in the bladder nerves and reduce the involuntary contractions, allowing it to store more urine. Major side effects of these medicines are dry mouth and constipation. In patients with severe obstruction, can cause inability to empty the bladder and rarely urinary retention.
For the pharmaceutical treatment of the symptoms of hypertrophy of the prostate have also been widely used for many herbal preparations such as Serenoa repens and Pygeum African mom. Although they have shown positive results, the doses in different packages vary and, when used, should it be on the advice of a physician. It should also be mentioned the use of desmopressin, a synthetic analog of the antidiuretic hormone, for the treatment of nocturia in patients with high nocturnal urine production. This medicine needs special attention when given to men with coexisting cardiovascular problems or in elderly patients.
Finally, another class of drugs, phosphodiesterase inhibitors of type 5, the known drugs for the treatment of erectile dysfunction have been shown to effectively improve the symptoms of urination in patients suffering from prostate hyperplasia. Although there is still no indication of disorders of urination, the daily administration to be an attractive proposition for future patients with micturition disorders and erectile dysfunction. surgical treatments All of us avoid surgery, but in some cases necessary. The surgery for the disease usually done with epidural or spinal anesthesia and the improvement of symptoms is apparent immediately after surgery. It should be noted that the improvement in symptoms that offer surgery is much greater than that achieved with medication. As with any surgery, the risks to the patient depends on the preoperative status and health problems. Surgery to the prostate are divided into open, ie incision, and in endoscopic, ie through a special endoscope that enters into the urethra. The most frequent intraoperative complication is bleeding, so patients taking anticoagulants and aspirin pills will have to interrupt several days before surgery.
Postoperative complications are urinary tract infections and, rarely, the urinary retention.
After surgery, most men experience for about 1-2 weeks, urgent need to urinate and possibly hematuria. Postoperatively, in most men observed retrograde ejaculation, i.e., while the erection and orgasm are not affected, no ejaculation. This is because now opens the neck of the bladder and semen travels freely in the bladder. Urinary incontinence occurs in approximately 1% of patients, while the need for re-operation in the future is not very frequent. The types of interventions are: – Transurethral prostatectomy It is so far the most common surgical treatment for patrons to 80 grams, although internationally limited, due to the development of less invasive procedures such as laser prostatectomy. A special tool, the file trot MOS imported from the penis into the urethra and reaches the bladder. At the edge, there is a special bracket that cuts the prostate with electricity in small pieces. At the same time, it is cauterization of prostate points bleeding due to the cutting. The pieces of tissue are cut accumulate in the bladder and are removed by washes with specific serum. After completion of surgery, a catheter is placed through the urethra, and through the catheter are consecutive washes bladder to prevent blood clots that clog the catheter. The catheter usually remains for 2-4 days. – Open prostatectomy Open prostatectomy is when the prostate has grown so -usually more than 80 grams in order to prevent the application of transurethral prostatectomy safely. Through a cut in the lower abdomen, the gland is removed without the capsule. Two already open prostatectomies: the transversal wherein the prostate removed through the bladder and retropubic wherein the prostate capsule is opened and the gland was removed. After the open prostatectomy, the catheter placed in the bladder for 5 to 7 days. The recovery period is 4-6 weeks. Complications of open prostatectomy are bleeding and may have transfusion rarely follow the wound, which is typically surface contamination. – Transurethral prostatectomy with laser use This is a technique in the last 10 years is gaining ground and replacing the transurethral prostatectomy and open internationally. It is done by introducing a specific organ within the urethra by direct vision, and the use of special optical fiber associated with laser production machines of different types. The most proven techniques are the laser Holmium and green light laser. The Holmium laser is prostate resection,Healthy figures , which falls into the bladder and then a special tool is dissolved and aspirated. The results are comparable open prostatectomy with less risk of complications, and therefore safer for the patient. With the green light laser -which is called so because of the color of the light beam is laser- selective emission of the laser beam on the prostate and the energy of the beam sublimates him. The effectiveness of this technique in all studies is comparable to classical transurethral prostatectomy. The main advantage of laser prostatectomy, beyond the one-day treatment, the absence of bleeding and thus the method can be used in high-risk patients with greater certainty, as men with severe cardiovascular or men taking anticoagulants. Upon completion of surgery the laser, is placed a catheter through the urethra for 24 hours, and the patient leaves the day of surgery Healthy figures . The message As shown, the symptoms of urination due to an increase in prostate size can now be treated easily and effectively. To live with the problem is not a solution and a visit to the urologist can save us from a daily concern and inconvenience. While not previously done this, so less likely to need surgical treatment.