Benign Prostatic Hyperplasia Pathologic Behavior
Benign prostatic hyperplasia starts with insular area and then embraces lateral parts. Further growth is explained by hyperplasia of paraurethral glands that increase in sizes towards the exterior part of prostatic gland. As a result, there is a shift of neighboring organs: inner sphincter of urinary bladder gets displaced upwards; terminal part of urinary tract gets prolonged. Also, the gland increases towards rectum ampulla.
Causes of Benign prostatic hyperplasia
In case of impairment of metabolic processes in prostatic tissues there is an increase of cells life duration. Resulting from long-term life span, they have time to divide more times than usually which leads to alteration of organs volume. Uncontrolled male organ’s tissues growth is called hyperplasia. Since the growth occurs only within the borders of prostatic gland and doesn’t give metastases, the tumor is considered to be benign. The cause of malfunctioning of glandular cells is impairment of hormonal balance in the process of age-related rebuild of organism. At the age of 50-55 years men experience the decrease of male sexual hormones production. Along with that, there is a concentration of some female sexual hormones that trigger the change in metabolic rate in prostatic cells. With the age, a man experiences higher odds for pathology development. Thus, men at the age of 55-60 years appear to have BPH in 50% of cases; for representatives of the stronger sex above 60 years, this statistics goes further up to 80-90%. The concurrent factors able to boost the probability for pathology disclosure are overweight and hereditary predisposition.
Forms and Types of Hyperplasia
Regardless of the common moments in mechanism of this pathology development, the process of tissues growth may occur in different ways. While diagnosing, the structure of tumor, its location and growth direction are taken into account. Depending on these characteristics, each individual case may be different from standard clinical picture. Also, there is a generally accepted division into three stages of the disease where each of them has a certain number of symptoms.
Adenoma Types According to Location and Growth Direction
According to localization, there are three types of the pathology:
The most pronounced symptomatology belongs to intravesical hyperplasia. The growth of the swelling occurs towards urinary bladder in this case. First, prostatic gland underpins the bladder’s bottom and then it grows into it causing considerable deformation of urethral cervix and upper section of urethra. Further growth of the tumor causes an increase of external pressure on urinary channel that leads to gradual narrowing of its lumen. This type of the pathology is characterized by urination disorders: urge or difficult urination. In case a patient doesn’t treat this disorder at an early stage, one of its complications may turn into a renal failure.
First of all, prevesical growth of tissues induces increase of lateral parts of prostatic gland. This swelling doesn’t lead to considerable alterations of bladder’s shape and its cervix. The disease doesn’t have pronounced symptoms; therefore, a man may not notice its development for a long time.
Undervesical hyperplasia is tumor swelling that is localized in the back part of prostatic gland adjoining to straight intestine’s wall. This type of pathology doesn’t result in impairment of urination process. Nevertheless, it may take impact on functioning of upper urinary tract and kidneys. Undervesical swelling tends to cause feeling of discomfort during defecation.
According to the type of tissues growth, there are two types of adenoma:
- In case of diffuse growth, prostatic gland increases in size evenly;
- In case of nodular form in glandular tissues, solidary or multiple nodes are formed.
Hyperplasia Classification in Regards to Swelling Structure
Prostatic gland consists of several types of cells: muscular, glandular (producing secretion) and stromal (they participate in formation of connective tissue). The structure of swelling depends on the character of tissues it started to form in. The type of benign prostatic hyperplasia can be determined by means of cytologic analysis of tissues samples. Sampling is made with the help of prostate biopsy.
Upon termination of laboratory tests, the one of the following adenoma types are identified:
The tumor’s structure includes cells releasing prostatic juice and connective tissues cells. The growth of cells in this case has uniform character.
There is increase of the quantity of glandular cells. To confirm this type of prostatic hyperplasia, it is possible to estimate increased level of prostatic specific antigen. Most men have glandular adenoma in the form of multiple nodes that get gradually increased in size. The characteristic feature of this pathology is slow growth of swelling. Due to the absence of symptoms, patients do not guess of the disease progression. Very often the disorder is exposed accidentally during prophylactic examination or in the process of diagnosis of another disease.
The distinctive feature of benign prostatic hyperplasia is separation of nodes and indurations by protective capsule from connective tissue. Swelling growth is made of stromal and glandular cells. The exposure of fibrous adenoma requires constant control over the state of swelling with high likelihood of its regeneration and malignization.
- Muscular hyperplasia (adenomyoma)
Such growth of tissues is diagnosed quite rarely.
Stages of the Pathology Development
There are three degrees of prostate increase: compensated, subcompensated, and decompensated. Diagnostics of the disease should take into account patient’s condition, presence of characteristic symptoms, as well as structural and functional alterations in the organs of urinary system.
Compensated stage starts with insignificant disorders with urination. At first, a man may have precipitant urination. Emptying of urinary bladder requires additional efforts. In order to accelerate the rat of urination, a patient needs to toughen muscles of pelvis and abdominal wall. Urine stream may be weak and even discontinuous for a couple of seconds. Regardless of urination difficulty, this stage allows emptying bladder completely.
While examination of a patient, impairment of the structure of kidneys and urinary tract is absent. Timely consultation by a specialist, therapy of BPH on compensated stage may be quite different: some men have this period for 3-4 years, others – from 10 years and longer.
Subcompensated stage begins with the moment when urinary bladder cannot complete its function properly. It means that resulting from regular pelvic muscles tension during urination, urinary bladder walls have lost their elasticity and cannot pull out accumulated urine. At first, the volumes of remained urine after urination do not exceed 20-50ml. Further progression of the disease may increase the volume up to 500ml. At this stage, the first disorders of kidneys functioning are observed. Conservative treatment of men with subcompensated stage of benign prostatic hyperplasia doesn’t give expected therapeutic effect. In the majority of cases, patients are recommended undergoing surgery with the usage of minimally invasive endoscopic instrument.
Benign prostatic hyperplasia in decompensated stage is manifested by volumes increase of residual urine up to 800ml and more. Moreover, many men experience uncontrolled urination. Regular detention of urine leads to such complications as kidney stone disease, severe renal failure, and intoxication of the organism by the products of nitrogen metabolism. In case a patient has such symptoms as complete absence of appetite, nausea, weakness, acetone odour, immediate medical attendance is required. Absence of therapy may lead to lethal outcome.
As benign prostatic hyperplasia is similar to some other urological diseases according to its manifestations, the first stage of diagnostics requires differential diagnostics for exclusion of urinary bladder inflammation, neurological disorders, diabetes, etc. At suspicion on adenoma, digital rectal investigation is conducted for examination of glandular shape, possible presence of nodes and indurations, and morbidity.
After making the primary diagnosis, examination is conducted according to the following scheme:
- A questionnaire for estimation of the diseases according to IPSS principle is filled out;
- The life quality of a patient is evaluated;
- The following laboratory analyses are performed: common urine analysis, general blood analysis, blood urea nitrogen test, PSA;
- Ultrasound research of prostatic gland and urinary system organs is conducted;
- Also, such research as urofluometry (determination of the speed of urination) is recommended.