Prostate enlargement
Synonyms in a broader sense
Benign prostatic hyperplasia (BPH), prostate enlargement, benign prostatic syndrome, prostate adenoma, prostate hypertrophy
definition
There is a benign enlargement of the inner zone ("Transitional Zone") of the prostate (prostate gland). Connective tissue and muscle cells (so-called stromal parts) are particularly affected. Older men are particularly affected.
Illustration of the prostate and urinary bladder
Here an incision was made parallel to the forehead (frontal incision): the prostate encompasses the urethra. Inside the urethra, a little mound bulges into its interior, the seed mound. A small injection canal with the preliminary sperm ends on this from each half of the body. The numerous excretory ducts of the prostate flow into the urethra right next to the seed mound!
- bladder
- urethra
- prostate
- Seed mound with the two openings of the spray tubules
- Excretory ducts of the prostate
frequency
It is the most common cause of voiding problems in men. Approximately 25% of all men between 50 and 60 years of age suffer from urination problems, in those over 60 it is already 40%.
causes
An enlargement of the prostate gland (prostate) usually means an enlargement in the sense of benign prostatic hyperplasia (BPH). This is a benign type of overgrowth. Nevertheless, it can cause discomfort, especially when urinating (Micturition disorders), to lead. Benign prostatic hyperplasia is common in men aged 50-60 years and the incidence increases sharply with age.
Read more on the subject here Prostate hypertrophy.
The causes of the benign enlargement of the prostate have not yet been conclusively clarified. There are several theories on this subject, and hormones in particular seem to play a crucial role. In the prostate, among other things Dihydrotestosterone (DHT) produced. This is an intermediate product (metabolite) of testosterone. Contrary to popular belief, testosterone is usually not the active hormone but its metabolite, DHT. It is created by the enzyme 5-alpha reductase from testosterone. Among other things, DHT causes the prostate to grow. Thus, it is believed that excess DHT leads to prostatic hyperplasia. One of the pillars of drug therapy for the treatment of benign prostatic hyperplasia is based on this hypothesis. So-called 5 alpha reductase inhibitors are used to reduce the volume of the prostate by reducing the formation of DHT. A representative of this group of drugs is Finasteride.
Another factor that is believed to contribute to the enlargement of the prostate is a relative increase in the hormone estrogen in the male body. Estrogen is commonly the hormone of women and testosterone that of men. But that's not entirely true. Women also have testosterone in their blood and men have estrogen. In men, the testosterone concentration in the blood decreases with increasing age, the concentration of estrogens remains the same, but the relative ratio of estrogen to testosterone shifts towards estrogen, which presumably leads to a growth or reduced loss of prostate tissue leads.
Further hypotheses discuss the influence of growth factors and excessive growth of embryonic prostate stem cells as the reason for benign prostatic hyperplasia.
Illustration prostate enlargement
Prostate enlargement
(benign prostatic hyperplasia, BPH)
Benign tumor of the
Prostate gland
- Prostate gland -
prostate - Peritoneal cavity -
Cavitas peritonealis - Ureter -
Ureter - Urinary bladder -
Vesica urinaria - Male urethra -
Urethra masculina - Male member -
penis - Testicles -
Testis - Rectum - Rectum
- Cystic gland (seminal vesicle) -
Glandula vesiculosa - Urine (urine) - Urina
You can find an overview of all Dr-Gumpert images at: medical illustrations
Symptoms
There are two sets of complaints. On the one hand there are irritation symptoms of the bladder and the bladder outlet (irritative symptoms). These include more frequent urination (more often during the day than every three hours and also at night), painful urination, the urge to urinate that cannot be suppressed (so-called imperative urination), incontinence when there is a strong urge to urinate (urge incontinence) and a feeling of residual urine (as if the bladder is incomplete could be emptied).
On the other hand, symptoms of a voiding disorder (obstructive symptoms). The urine stream is weakened. Urination takes longer and stutters. The onset is delayed and dribbling occurs. Occasionally residual urine is also present, which indicates that the bladder cannot be completely emptied.
All of these symptoms can be queried by the doctor using a standardized questionnaire. For each symptom present, points are awarded depending on the frequency of occurrence. This makes it possible to classify the patients from mild to markedly symptomatic.
Pain when the prostate is enlarged
Pain can appear as a symptom of enlarged prostate. They usually only appear in the later stages of the disease.
The anatomical position of the prostate plays a decisive role here. The prostate completely surrounds the urethra, so that when the prostate becomes enlarged, the urethra becomes increasingly narrow. If the diameter of the urethra becomes smaller and smaller, the first problems with urination occur, which can already cause pain.If the enlargement of the prostate has progressed to such an extent that the urine can no longer properly flow out and builds up in the urinary bladder, this can cause severe pain in the affected patient.
The pain is caused by stretching the urinary bladder muscles and is localized in the lower abdomen. If you do not urinate completely, i.e. what is known as urinary retention, you should urgently consult a doctor or a hospital.
In addition, an enlarged prostate can also cause more urinary tract infections due to the build-up of urine.
Read more on the topic Prostate pain
Stages of prostate enlargement
There are three Stages of benign prostate enlargement
- Irritant stage
There are obstructive and irritative symptoms - Residual urine stage
The emptying mechanism can no longer be adequately maintained (decompensation). The frequency of urination increases (pollakiuria). There is an average residual urine of 100-150 ml. - Backwater stage
The expulsion function of the bladder fails completely. With increasing residual urine, chronic urinary retention occurs with consequent kidney damage.
diagnosis
Conversation and the questionnaire mentioned above usually give a concrete assumption of the cause of the complaint. Other investigations include:
Rectal exam
The doctor feels for the prostate with his fingers over the anus. The size, contour, symmetry and consistency (hardness) can be checked.
Ultrasonic
This is one of the most important investigations. Of the Ultrasonic can over the abdominal wall (abdominal), over the urethra through the bladder (transvesical) and preferably through the rectum (transrectal). With the latter method, size and structural changes can be identified most precisely.
Uroflowmetry
The amount of urine emptied per unit of time is measured (ml / s). This depends on the pressure applied by the urinary bladder and the resistance of the urethra. Total time and average volume per second can be recorded. In this way, changes in urination noticed by the patient (“weak”, “delayed”, “trickling”) can be objectively confirmed. At least 15 ml / s would be normal for men (women: 20 ml / s). Values below 10 ml / s are definitely abnormal.
Blood tests
Unfortunately, there is no blood test that would specifically prove that the prostate is enlarged. Creatinine levels provide information about the function of the kidney. The prostate-specific antigen (PSA) is used to delimit the Prostate cancer (Prostate cancer) important. For values above 4 ng / ml PSA, a tissue sample should be taken to obtain clarity.
Urogram: A contrast agent containing iodine is introduced into the vein and then excreted by the kidneys. Then, after 7 and 15 minutes, x-rays are taken, on which the kidneys, renal pelvis, ureter and bladder are visible. In a third of the cases pathological changes are found. It is a useful addition to the examination procedure for symptoms such as blood in the urine, suspected tumors, suspected stones (Kidney stones) or urinary obstruction.
Optionally, endoscopic (camera-controlled) examinations of the urinary system may be necessary.
MRI of the prostate
The MRI examination of the prostate has gained increasing importance in recent years.
MRI of the prostate is particularly important when diagnosing a suspected prostate cancer. Samples (biopsies) can now also be taken under MRI control of the prostate.
therapy
If a patient receives the diagnosis of an enlarged prostate, he asks himself what can be done about it. There are a number of different therapy options for prostate enlargement.
These are based, among other things, on the severity of the disease and the associated symptoms. It can be divided into conservative and operative therapy options.
Both herbal and medicinal products are used as conservative therapy.
If both preparations do not help and the symptoms are so pronounced, then an operation should be considered as part of a prostate enlargement. However, this is not carried out in the early stages, but rather after the conservative therapy options have been exhausted.
Therapy can also include accompanying and supportive measures. Especially in the initial stages, you can wait in a controlled manner and observe the symptoms for a while.
In addition, diuretic drinks such as coffee or green tea and the intake of diuretics should be avoided.
The herbal medicine Granufink® counteracts the consequences of an enlarged prostate. These include, among other things, increased urination at night. Read more about this under: Granufink®
You may also be interested in this article: Therapy of prostate enlargement
Treating an enlarged prostate naturally
"Treat naturally" means conservative therapy herbal medicines Roger that. These funds are mainly used at easy stages used for prostate enlargement. There they can often alleviate the symptoms, at least initially.
Play the most significant role in the treatment of prostate enlargement Medicinal pumpkin, Saw palmetto and Nettle.
That contain pumpkin seeds or pumpkin seeds herbal hormones, so-called phytosterols, which belong to the steroid group. They may counteract a further increase in prostate enlargement.
When using nettle, mainly parts of the Nettle root for use. Nettle leaves, on the other hand, have a more urinary effect and tend to have a counterproductive effect on prostate enlargement.
Also the Saw palmetto contains so-called phytosterols. They are also supposed to reduce the formation of steroids, more precisely of dihydrotestosterone, and thus counteract further growth of the prostate. Otherwise, the herbal supplements used as part of a natural treatment have no influence on the size of the prostate.
surgery
If the prostate enlargement is at an advanced stage and the use of medication does not lead to any improvement, come operational measures for use.
During the operation, the prostate tissue is removed down to the capsule. However, the capsule itself remains. This has the advantage that the enlarged prostate no longer constricts the urethra.
There are different surgical techniques. The standard is currently the so-called "TURP". When written out, this means “transurethral resection of the prostate”. A surgical instrument is pushed through the urethra to the prostate. With the help of a Camera and a small wire loop the prostate tissue is now removed. Electric current flows through the wire loop so that bleeding can be stopped immediately. The operation is also carried out under general or partial anesthesia as standard.
In addition to the general surgical and anesthetic risks, there are also special risks the "TURP". It can too Ejaculation disorder come. The so-called "TUR syndrome" may also occur. It comes to Symptoms such as nausea, Vomit, Confusion and restlessnesscaused by the hypotonic irrigation fluid used in the operation.
Complications
The enlargement of the prostate is harmless in itself. The worsening symptoms and complications that affect the urinary tract and kidneys, such as: B. Urinary tract infection / Cystitis. A acute urinary retention can occur at any stage. Here the already narrow bladder exit is completely closed by additional swelling. It is an emergency that occurs immediately by bringing in a Urinary catheter (Urinary drainage tube that is inserted into the urethra) or through urinary drainage by puncturing the bladder through the abdominal wall (suprapubic bladder puncture) must be treated. A backlog of urine over a long period of time (due to impaired emptying) can lead to pouches in the ureter or renal pelvis.
Prostate enlargement in old age
The Prostate enlargement is a typical illness of Age.
At Deceased became a enlarged prostate found in around 50% of 60-year-olds and around 90% of men over 80 years of age. An enlarged prostate does not have to cause symptoms, but it often leads to benign (= benign) prostate syndrome (BPS).
That is what it means simultaneous occurrence from Prostate enlargement and Problems at the bottom Urinary tract (LUTS). these are complaints at the Urination and with the Continence.
The BPS begins in its development roughly im 50 years of age and occurs most often between the ages of 60 and 70. In Germany, around 15% of men over 50 show signs of being Urinary flow disorder from the bladder. Around 40% of those over 50 have Complaints in need of treatment with the bladder or when urinating (LUTS). Increasing age applies alongside increased PSA mirror and an enlarged Prostate volume to the Main Risk Factors for developing ailments.
Factors responsible for the emergence of a BPS be held responsible, hang out with that Age together. The age-related increase of Estrogen levels with simultaneous Humiliation of Testosterone levels viewed.
But also testosterone seems to play an important role: it turns out that Men without testosterone production even in old age no enlarged prostate develop. Other factors that influence the size of the prostate occur more frequently in old age and can therefore make the occurrence of the Prostate enlargement explain supportively. These are above all Sedentary lifestyle, hypertension and Diabetes mellitus, such as Obesity and Cirrhosis of the liver.
In the therapy of BPS in old age must pay special attention Comorbidities and Medication intake be placed. The risk for a surgery must be assessed and Interactions of drugs with previous illnesses and their medication must be observed.
For example, the coronary heart disease Phosphodiesterase inhibitors (Tadalafil) and in the Heart failure Phosphodiesterase inhibitors (tadalafil) and alpha blockers (alfuzosin) are not prescribed.
Consequences of enlarged prostate
A benign enlarged prostate (BPH) can exist without complaints to cause. However, it can become one Drainage obstruction For urine develop because the prostate lies the opening of the bladder directly to and the Urethra lruns through the beginning prostate.
As a result, there are so-called complaints in the lower urinary tract (LUTS). These are initially through the laying of the urethra conditional (obstructive disorders): a decreased urine flow (measured by uroflowmetry) up to dripping, the need to squeeze, multiple stopping of the urine stream and after urination Residual urine sensation such as After running of the urine.
These complaints can sometimes be more pronounced and sometimes less pronounced. In the long run that tries bladder however, to overcome the obstacle by sending out more stimuli. One develops Irritable bladder. This leads to so-called irritative disorders:
The frequency of Urge to urinate is increased overall (Pollakiuria), sleep disturbances occur at night due to the urge to urinate (more than 2 x per night, Nocturia), urination can be difficult (Dysuria) or be associated with pain (Alguria). Another onerous consequence is that sudden need to urinate the up to Incontinence can lead.
Of the constant residual urine and the increased pressure in the bladder lead to a long-term modification of the Bladder wall. First thickened the Musculature, in the further course there is a severe overstretching and to one modification in connective tissue.
This creates a Overflow bubble:
small Urine volume go out unintentionally, because when new urine arrives the Elongation of the bladder is already exhausted. There can also be bulges in the bladder form what the development of Bladder stones promotes.
The constant residual urine provides good condition for the Multiplication of bacteria there, it happens frequently Urinary tract infectionsthat up to kidney can ascend. Also through the Backwater can they Kidneys be permanently damaged.
Further Complications are on the one hand Blood (Hematuria) in the urine. Small amounts can be added Infections be returned, large amounts usually come through Bursting of veins at the Press conditions. On the other hand, it can be acute urinary retention come. This is indicated by strong pain in the Lower abdomen with simultaneous inability to urinate. This is an acute emergency because both bladder as well as kidney can be harmed. It is through an exonerating Puncture or one Urinary catheter treated.
A connection between the benign prostate enlargement (BPH) and the malignant prostate cancer (Prostate cancer) is a controversial topic in science. In general, however, both diseases must be differentiated from one another.
