Symptoms of prostate adenoma

In the clinic prostate adenoma (prostate gland) distinguish symptoms that are associated with pathophysiological changes in the lower urinary tract, symptoms caused by secondary changes in the kidneys, upper urinary tract, and the presence of complications of prostate adenoma (prostate). Dysfunction of the bladder and urethra is the main factor determining the clinical symptoms of prostate adenoma (prostate).

Symptoms of prostate adenoma (prostate gland) are most typical disorders of urination, which occurs as a result of a complex interaction between the prostate and the bladder. These symptoms are observed in 15% of men in 40-49 years and v 50% in 60-69 years.

Infravesical obstruction in prostate adenoma is caused by two components: static (as a result of mechanical compression of the urethra by hyperplastic prostatic tissue - compression) and dynamic (due to hyperactivity of the alpha-adrenoreceptors of the bladder neck, the prostatic part of the urethra and the prostate gland). In this regard, the symptoms of prostate adenoma (prostate gland) can be divided into two groups: obstructive, associated with a progressive obstruction of urinary outflow as a result of prostate hyperplasia, and irritative (ie, irritation symptoms), determined by the degree of functional disorders of the neuromuscular apparatus of the bladder.

[1], [2], [3]

Obstructive symptoms of prostate adenoma (prostate)

• initial delay of urination,
• a languid stream of urine,
• feeling of incomplete emptying of the bladder,
• the need to strain the abdominal muscles when urinating,
• intermittent urination and urine separation by drop at the end of urination

These symptoms of prostate adenoma are revealed when the bladder is emptied, they can be caused not only by infravesical obstruction, but also by a possible reduction in the detrusor's contractile ability.

Irritative symptoms of prostate adenoma (prostate)

Irritative symptoms of prostate adenoma (prostate gland) are associated with instability of the bladder and are manifested during the stage of accumulation and the presence of urine there:

• day and night pollakiuria,
• imperative urges and urinary incontinence due to involuntary reductions of detrusor with its secondary hyperactivity in response to obstruction.

Detrusor reflex occurs when the small part of the bladder volume is filled (50-200 ml) and is not inhibited by strong-willed effort. The first urge to urinate, coinciding with the detrusor reduction, patients are already noted with the minimum amount of urine in the bladder. Following him immediately noted repeated imperative desires caused by uncontrolled detrusor reductions, and a weak flow of urine is observed.

Detrusor instability is observed in approximately 70% of men with prostatic adenoma and symptoms of obstruction, and a correlation between detrusor dysfunction and the degree of obstruction to urinary outflow was noted. Preservation of normal detrusor function was observed only in 32% of patients with prostatic adenoma with symptoms of obstruction, while 68% noted its instability. In 83% of patients who complained of frequent urination, the functional capacity of the bladder was less than 200 ml.

One of the leading symptoms of prostate adenoma is nocturnal pollakiuria (nocturia), 3 times or more, which complicates the life of patients. However, an increase in the frequency of nighttime urination and the volume of urination (nocturia) may be due to the functional state of the kidneys. Age-related changes in the kidneys tend to weaken the function of the tubular apparatus, and the clearance of free will decreases significantly more than glomerular filtration. One of the causes of nocturia in elderly men is the weakening of the concentrating ability of the kidneys. Another cause of nocturia in the elderly and old age may be a violation of the biological rhythm of urine output during the day and night.

With the normal functioning of the bladder's blocking mechanism, the detrusor reduction occurs with a wide opening of the bladder neck. Changes in the flow of urine occur with an involuntary unstable contraction of the smooth muscles, which opens the inner opening of the urethra, as well as with the detrusor dissections of the detrusor and the cervical sphincter apparatus.

The mechanism of detrusor instability in patients with prostatic adenoma appears to be due to a change in its activity with respect to adrenergic influences against the background of weakening of contractile properties as a result of hypertrophy. Overgrowth of the bladder, especially in the area of the urinary bladder, the growth of hyperplastic prostate tissue leads to a local increase in the sensitivity of alpha-adrenergic receptors related to the sympathetic nervous system.

The nodes of hyperplasia cause a violation of blood circulation in the neck of the bladder and the back of the urethra, which along with a decrease in the threshold of excitability of the detrusor and the neck of the bladder and the non-simultaneous inclusion of mechanisms that ensure urination. Leads to detrusor dysfunction, manifested by irritative symptoms of prostate adenoma. In addition, the severe hypoxia of detrusor plays a significant role in the pathogenesis of urinary disorders, against the background of its ultrastructural changes. The cause of detrusor instability in infravesical obstruction is referred to typical examples of postsynaptic denervation hypersensitivity. The decrease in the number of cholinergic receptors in the detrusor instability is proved.

Instability of detrusor often occurs in patients with prostate adenoma without signs of an infravesical obstruction both in the presence and in the absence of neurological disorders. Detrusor hyperreflexia can be a consequence of some neurological diseases, accompanied by a violation of the detrusor innervation at the supraspinal level ( multiple sclerosis, parkinsonism, cerebral circulation disorder). At the heart of the mechanism of detrusor hyperreflexia in organic diseases of the central nervous system is a decrease in the cortical and hypothalamic inhibitory effect on the spinal centers that regulate urination. In this process, age-related hemodynamic changes in the cortex and subcortical structures of the brain may play a role.

The pronounced degree of infravesical obstruction in patients with prostate adenoma amid decompensation of detrusor, a decrease in the sensitivity of the wall of the bladder, and impaired transmission of neuromuscular impulses can lead to the development of hyporeflexia and detruxia of detrusor. Detrusor hyporeflexia is characterized by severe oppression or absence of signs of contractions of the bladder. It can be a consequence of a violation of segmental innervation of detrusor as a result of trauma. Tumor or lesions of the cone of the spinal cord, diabetic myelopathy.

Timely determination of the nature of urodynamic disorders and, first of all, detrusor instability, prostate adenoma patients is of great practical importance, since non-recognition of this factor significantly worsens the functional results of operative treatment of prostate adenoma. About 25-30% of patients referred for surgical treatment fail to meet the urodynamic criteria of infravesical obstruction according to the results of a comprehensive examination, and up to 30% of patients with reduced detrusor contractility without signs of obstruction are unreasonably promptly treated. Detrusor instability disappears in 60% of patients with prostate adenoma after prompt elimination of the obstruction to urinary outflow.

At the same time, 15-20% of patients with prostatic adenoma after the operation observe irritative symptoms: frequent urination, nocturia, imperative urge to urinate and urinary incontinence. First of all, these are cases when there is no correlation between the severity of symptoms of irritation and infravesical obstruction. In this regard, a comprehensive study of urodynamics of the lower urinary tract is shown to all patients with clinical symptoms of detrusor instability in order to identify its cause and to establish the relationship with obstruction in the vesicoureteral segment.

Thus, the diagnostic value of symptoms characteristic of prostate adenoma is relative, since the symptoms of prostatic adenoma do not always indicate the presence of an enlarged prostate or infravesical obstruction. Most of these symptoms are in older women.