Definition and causes
An enlarged prostate (prostatic hyperplasia) is caused by a benign growth of kirtelvævet in men. There is both growth of the central kirtelvæv, surrounding the urethra, and growth of smooth muscle and tissue in Volume glands. Prostate can both grow around the urethra, so that this will be squeezed in, and it can grow up in the urinary bladder.
The centerpiece of the disease is that the increased growth of glands pushing urethra, which ended the resistance of urine from the bladder becomes bigger, and it is therefore more difficult to empty the urinary bladder.
This may in the long term due to overfilling of the bladder cause complications weakening of the bladder muscle and tend to residualurin (residual urine) in bladder after urination.
Prostatahypertrofi are extremely frequent among older, and there was an increase with age so that 80% of men over 80 years, changes in the prostate. Approximately 10-25% of these sheep so pronounced prostataforstørrelse that they are consuming operation within 80 years of age.
Since the main problem is getting empty the bladder, you will see the following symptoms related to urinate:
- Frequent urination with small portions of urine.
- Nocturnal urination.
- Heavy water.
- The above symptoms seen in 50-80%.
- -Urge incontinence, which are sudden onset of heavy water, which is not possible to comment on toillettet. Seen in 30%.
Obstruction Symptoms due to the compressed urethral:
- In connection with urination may be starting trouble when you have to wait and push until you can urinate.
- Weak jet force and after dripping. Feeling that your bladder is not emptied completely.
- Sudden onset of total urination stop seen in 20-25%.
- Blood in the urine seen in severe cases from around. 10%.
Precautions and diagnosis
If you have problems to pass urine and signs of the above symptoms to contact their own doctor to be provided. Here, your doctor will start by taking blood samples to examine the general condition and see if the kidneys would be affected. Blood sample can also show whether there were any risk of prostate cancer. It should also urinate on a small plastic strip (urinstix), which can tell if you have small remnants of blood or bacteria in the urine.
The doctor will also mark the prostate with a gloved finger up in the end the intestine (rektaleksploration). This is an important study, because we know prostate cancer could mark a clear difference in the glands in relation to prostatahypertofi.
Then you get handed over a table where you have to take note of fluid intake and urination pattern of 2-3 days. Using. A detailed questionnaire will be questioned Monday about his urination problems, so the doctor can get an impression of severity. This is called a symptom score.
It will be referred to a specialist unit (urological department) of getting into a flow survey (measuring pressure and volume of urine), which is how pronounced the obstruction of the urethra is, and how effective the bladder muscle is. Here you can also make an ultrasound of the bladder after urination to get an idea of how much urine is left. By suspicion of prostate cancer or by a very large prostate can you create an ultrasound of the prostate through endeta
In severe cases, where there is blood in the urine, or blood tests indicate kidney damage, can undergo a contrast study of kidney and urinary tract to see if there are changes in the kidneys and urinary leaders.
These studies will help to provide an overview of the severity of prostatahypertrofien, and whether to be treated with medication or surgical operation. Similarly, the studies help to exclude other diseases such as prostate cancer, urinrørsforsnævring, blærebetændelse and prostatitis.
Depending on the severity of prostatahypertrofien, as judged from the above studies, you can choose to treat with medication or surgery.
For moderate symptoms can be treated with sympathetic alpha receptor blockers, which have smooth muscle in the bladder neck area to relax. Also, you can deal with the 5-alfareduktasehæmmere undergoing prostate to shrink up to 20% after 6 mdrs. treatment. These 2 forms of medical treatment can reduce symptoms by up to 20-30% over 6-9 months
In severe symptoms and complete stop of the urethra is chosen to perform a surgical operation. It keeps a telescope up through the urethra and scrape some layers of the prostate, so that its scope will be smaller and do not press the urethra. The operation is in full anesthetic. In rare cases where the prostate is very large, an open surgery. There is always risk of infection and bleeding in the surgical treatment, but the risk is very small.
You can also use a procedure called transuretral mikrobølgetermoterapi, which through urethra heat treating prostate cancer, so that size is reduced. The effect is about. 20-30%.
In the event that none of the above options are possible, takes Monday a permanent catheter (a plastic-long) through the urethra to the bladder, so that you can get by with urine.
Select and complications
After a surgical treatment experienced 90% to get a satisfactory urination and a clear improvement in the quality of life. Complication They then can be problems with sædafgang of 60-80%, where the semen at ejaculation smoke up into the bladder instead of out of the urethra. There is temporary incontinence in 25% and arvævsforsnævring of the urethra from 5-10%.
Medical treatment and termobehandling is not as effective as surgical treatment, but may by the moderate cases give a clear improvement in the quality of life.
If you choose not to respond to the symptoms and treat prostate hypertrophy, may be complications as the formation of bladder stones, which can prevent urine drained. There is also increasing the risk of urinary tract infections and sudden stop of urine drained.
In severe cases with urination stop or recurrent urinary tract infections may be acute renal pelvis.