Prostate adenoma

Prostate adenoma or benign prostatic hyperplasia (BPH) is the most common disease in the world among elderly men. It is associated with an excessive growth of prostate tissue. The incidence of this pathology is 11.3% in the age group of 40-49 years. At the age of 60-69 years, 43% of men suffers from this disease. After 80 years, 95.5% of the male population are diagnosed with the disease.

Prostate adenoma – Diagnostics

Diagnostics of this disease begins when a man visits a doctor with complaints of urination disorders. The doctor conducts a digital rectal examination and notes the fact of the prostate enlargement. Further diagnostic procedures are required for the following purposes:

• To determine the degree of the prostate gland enlargement
• To perform differential diagnostics (identify the cause of the enlargement: adenoma, inflammation, or a prostate cancer)
• To assess the degree of the urinary tract and other organs compression
• To identify complications of the disease, primarily, connected with kidneys (these complications are the most dangerous for patient's life)

A blood analysis for total and free prostate-specific antigen (PSA) helps to distinguish the adenoma from cancer. A prostate biopsy is performed in doubtful cases.

Instrumental methods of diagnostics are:

Prostate ultrasound examination. The most informative transrectal examination, which is carried out through the rectum. It allows to identify the following aspects:

• To determine the prostate gland volume
• To assess direction of the organ growth
• To identify nodes, cysts, stones, and calcifications
• To detect changing in the prostate configuration (in case of adenoma it becomes spherical or ovoid).
• To assess the amount of residual urine in the bladder

Analysis of the prostatic secretion. Microscopic examination is performed in order to identify signs of the prostate gland inflammation. It is carried out when a patient feels pain during digital rectal examination. It may be indicative of the prostatitis development.

Uroflowmetry assesses the urodynamics (urine flow). It can be used as a screening examination in order to identify the category of the patients who should undergo further examination.

Kidney ultrasound examination is carried out in order to assess their structure. A progression of renal insufficiency is possible even at the first stage of the prostate adenoma. This disease is associated with the death of nephrocytes (renal cells). Moreover, clinical symptoms appear only when the number of nephrocytes is reduced by 90% (it means that only 10% of cells remain viable). Renal insufficiency in patients with prostate adenoma occurs due to the compression of the ureters and the increase of the pressure inside the pelvis. At the first stage of the prostate adenoma the renal function is impaired in 18% of patients, at the second stage number of such patients reaches 74%. Terminal renal insufficiency which requires hemodialysis develops in 11% of patients.

Kidney ultrasound examination also helps to identify pyelonephritis (purulent inflammation of the kidneys). It develops in no less than 50% of men with the prostate adenoma. It is one of the main causes of death in such patients.

Excretory urography is an X-ray examination method. The contrast is injected intravenously and later excreted by the kidneys. A few images are taken during this procedure. A doctor can see how the contrast spreads within the cup pelvis system. He assesses the structure and patency of the urinary tract, as well as the function of the kidneys (the contrast accumulates more slowly in case of renal insufficiency).

This examination is not performed in all patients, only according to the following indications:

• Presence of blood in the urine.
• Urinary tract infections, including the past ones
• Kidney stone disease
• Urinary system surgeries in the past

CT or MRI of the prostate can be performed according to the indications. This method provides more comprehensive information about the location of the prostate gland and its interrelation with the neighboring organs. The results can be used to determine the prognosis of the disease and choose therapeutic tactics.

Best clinics for the prostate adenoma diagnostics in Germany:

University Hospital of Ludwig Maximilian University of Munich

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Catholic Clinic Koblenz-Montabaur

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University Hospital Ulm

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Prostate adenoma – Treatment

Conservative or surgical treatment is performed in case of prostate adenoma. Conservative therapy is indicated at the early stages. There are two effective groups of the drugs which are used for the treatment of prostate adenoma:

• Alpha adrenergic blockers are prescribed in order to normalize urodynamics and eliminate urination difficulty (the main symptom of the disease)
• 5-alpha reductase inhibitors reduce the level of dihydrotestosterone in the male body, which slows down further enlargement of the prostate gland

Surgical treatment is required in case of a large volume of the prostate and symptoms progression. The main techniques which are currently used:

Minimally invasive methods include transurethral microwave therapy, needle ablation, laser coagulation, focused ultrasound thermal ablation, and others. They allow to reduce the volume of the prostate gland by the partial destruction of its tissue.

Transurethral resection of the prostate (TURP) is one of the most common operations which can be performed on the organ with the volume up to 90 cubic centimeters. The prostate is removed endoscopically with the access through the urethra. Among the advantages of the operation, absence of the soft tissues trauma in case of transurethral access to the prostate gland and short rehabilitation period should be noted.

Open adenomectomy is performed when the prostate size is more than 90 cubic centimeters. This is a traumatic surgery. The access is performed through the bladder wall. In this way, it is possible to remove adenoma of any size. This method guarantees the complete recovery from the disease. But there are disadvantages, such as the operational risks and long-term recovery.

Holmium laser enucleation is the most modern method of treatment. It is less traumatic and allows removing the prostate with size up to 200 cubic centimeters. The access is performed through the urethra. The prostate is mechanically shifted to the bladder. The tissue morcellation is performed there. The tube of the device sucks in the fragments of the prostate gland, and the lobes located inside shred them. It makes possible the removal of even large tissue parts through the urethra.

The advantages of the operation are:

• High efficiency and possibility of carrying out holmium laser enucleation even with prostate adenoma of a large size
• Fast recovery
• Low risk of complications
• Preservation of erectile function

The patient stays in hospital for some time after the treatment. In case of holmium laser enucleation it takes 3 days, after TURP – 5 days, after open adenomectomy – 7 days or longer.

Best clinics for the prostate adenoma treatment in Germany:

University Hospital of Ludwig Maximilian University of Munich

Treatment of benign prostatic hyperplasia (BPH) with HoLEP

11619.86

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Treatment of benign prostatic hyperplasia (BPH) with Greenlight Laser

17262

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Surgical treatment of benign prostatic hyperplasia (bph) with transurethral resection of the prostate (turp)

8089.05

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DRK Altenkirchen-Hachenburg Hospital

Treatment of benign prostatic hyperplasia (BPH) with HoLEP

10897.038397.03

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Catholic Clinic Koblenz-Montabaur

Treatment of benign prostatic hyperplasia (BPH) with Greenlight Laser

15588.47

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Surgical treatment of benign prostatic hyperplasia (bph) with transurethral resection of the prostate (turp)

8332.3

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Treatment of benign prostatic hyperplasia (bph) with transurethral microwave therapy (tumt)

8322.91

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Prostate adenoma – Rehabilitation

The most modern rehabilitation programs are used in Germany. They are adapted individually for each patient, and are based on the recent disease, age, physical possibilities, and the results of treatment. Different specialists such as: therapists, urologists, psychologists, rehabilitators, physiotherapists are involved in the rehabilitation process.

The following methods of rehabilitation are used:

• Dosed physical activity
• Training on the simulators and in the pool
• Individual selection of the orthoses
• Physiotherapy
• Acupuncture
• Manual therapy
• Transcranial magnetic stimulation
• Natural factors of the nature (mud, thermal waters, etc.)
• Individual or group work with a psychologist

The rehabilitation may include medicamentous support. It is necessary to hold a consultation with the patient about the proper nutrition and the way of life which is important for him in the current situation.

Rehabilitation programs in Germany are designed for 2 weeks. If necessary, they can last much longer. In this country, the patient is provided with qualitative care, accommodation in comfortable rooms and individually selected meals.

Rehabilitation programs in Germany show one of the best results in the world. Most patients successfully restore their employability and excellent health there. They remain physically active, return to the full social and family life.

Best clinics for general therapeutic rehabilitation in Germany:

Max Grundig Clinic Buehl

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Authors:

The article was edited by medical expert, board certified Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Centers for Disease Control and Prevention

Medscape

The Lancet