Can BPH affect the kidneys
Prostate enlargement, benign
(Benign) enlarged prostate (BPS = Benign Prostatic Syndrome, BPH = Benign Prostatic Hyperplasia, Prostate Adenoma): The glands of the internal prostate glands begin to enlarge from around the age of 30 and gradually increase over the years, causing problems when urinating. The cause is the hormonal changes that occur with increasing age. Benign prostate enlargement is one of the most common diseases in old age; around 50% of men over 50, 70% of seventy year olds and 90% of eighty year olds are affected. Initially, medication helps, but sooner or later surgery is required to ensure that the bladder is emptied again.
- First complaints: Delayed start to urinate, weaker urine stream and dribbling of urine
- Frequent nocturnal urination, then more frequent urge to urinate during the day and involuntary urination
- Feeling of incomplete emptying of the bladder
- frequent bladder infections due to residual urine
- Incontinence (so-called overflow bladder).
When to the doctor
In the next few weeks at
- frequent urination and weakening of the urine stream.
The next day at
- painful urination or bloody urine (often bleeding from prostate veins).
- Urinary retention (inability to urinate)
- persistent, uncontrollable loss of small amounts of urine ("overflow bladder")
- Kidney pain (backlog of urine to the kidneys)
- Fever and chills (signs of inflammation of the kidneys).
Disease origin and course
The roughly chestnut-sized prostate lies below the bladder on the pelvic floor and produces most of the ejaculate. Several factors lead to the enlargement of the prostate with age. In the majority of men over the age of 50, the sex hormones are unbalanced: an increased conversion of testosterone into the breakdown product dihydrotestosterone (DHT) within the prostate seems to be responsible for this.
Because of this hormonal imbalance, the prostate tissue increases and the urethra constricts as it passes through the prostate. This makes it harder to empty the bladder and increases the pressure when urinating. Often a urine residue remains in the bladder, the residual urine. In order to be able to do the increased effort, the muscles in the bladder grow and thicken, and a so-called is created Bar bubble. This now leads to a narrowing of the ureter orifices, as a result of which the urine can back up into the kidneys and a vesicorenal reflux occurs.
Increased amounts of residual urine, in turn, increase the risk of recurring infections. If the bladder outlet no longer opens at all, very painful urinary retention occurs. If, on the other hand, urinary retention develops slowly, small amounts of urine that exceed the capacity of the already full bladder are repeatedly released in an uncontrolled manner - the doctor calls this overflow incontinence.
Sooner or later, all these complaints force invasive therapy in the form of an operation in the majority of men. Even if this is successful, in some cases the same characteristic symptoms reappear a few years later when the remaining prostate cell aggregates continue to grow.
First, the doctor asks the patient about the average frequency of urination during the day and night and about the symptoms. B. the IPPS (International Prostate Symptom Score Test). Since many drugs such as For example, if antidepressants interfere with urination, the patient should discuss any medication they are taking with their doctor.
The next step is a prostate palpation test to determine any hardening and the approximate size of the prostate (usually ~ 20 g = 20 ml). For a more precise assessment of the prostate tissue, the doctor uses the transrectal ultrasound examination (TRUS). In addition, he performs a "normal" ultrasound to prevent urine from backing up in the kidneys. In addition, the amount of residual urine can be determined, which must not exceed 50 ml.
The doctor uses a urine test to check whether there is a urinary tract infection; Checking the creatinine level in the blood tells you whether there is already damage to the kidneys.
Note: In order to be able to rule out a possible simultaneous prostate cancer with a certain probability, the concentration of the prostate-specific antigen (PSA) is determined in the laboratory.
The urinary stream measurement is also important for therapy planning. For this, the patient appears in the practice with a well-filled bladder and then lets water through a kind of funnel. The recorded curve shows the speed of urine flow and, together with the residual amount of urine and the patient's complaints, provides a basis for making decisions about the type of treatment.
A cystoscopy enables the doctor to rule out other diseases - for example of the bladder - and to take a look at the prostate from the urethra. It is mostly used when drug therapy fails or when urinary retention or blood in the urine develops hematuria. X-ray examinations, such as B. the urogram are rarely used nowadays. In unclear cases, e.g. If, for example, there are additional disorders of the bladder muscle as in diabetes, the doctor will arrange a complete urodynamics before a planned operation.
Differential diagnoses: Urination problems typically also occur in chronic prostatitis, pelvic floor myalgia, neurogenic voiding disorders and prostate cancer.
If the maximum urine stream and residual urine values are still largely normal, therapy can initially be dispensed with (compensated prostate adenoma). In 40% of the patients the symptoms improve spontaneously. If the symptoms persist, drug treatment or surgery follows.
However, many doctors recommend taking herbal remedies (phytotherapeutic agents) as early as the watchful waiting phase. They have a regulating effect on the hormonal balance, are anti-inflammatory and inhibit the growth of the prostate. Most often, the following substances are prescribed individually or in combination:
- Saw palmetto fruits (dwarf palm fruits, Sabal e.g. Prostagutt®)
- Pumpkin seeds and pumpkin seed seeds (e.g. Granu Fink®)
- Nettle root (e.g. Prostaforton®)
- Rye pollen (e.g. Cernilton®)
- Vitamin B6 supplements.
In the early stages of the disease, these substances are said to reduce the frequency of urination during the day and night, improve the urine stream and reduce the amount of residual urine.
However, it is not clear whether the herbal supplements really help. A positive effect could not be proven in more recent studies.
If the discomfort increases, the doctor often prescribes Alpha blockers (e.g. tamsulosin such as Omnic®, Alna® and Prostadil® or alfuzosin such as UroXatral® or Alfunar®), which open the bladder outlet. However, they are not free from side effects, the most common being a drop in blood pressure and dizziness.
If the prostate has enlarged to over 40 ml, the doctor will prescribe the enzyme-inhibiting one as an alternative 5 alpha reductase inhibitors such as finasteride (e.g. Proscar®) or dutasteride (e.g. Avodart®). They affect the testosterone metabolism and thereby reduce the prostate volume, but have some side effects: Mainly, they falsify the PSA value and can lead to impotence.
In the case of urinary tract problems in connection with benign prostate enlargement, a therapy attempt with tadalafil (Cialis® 5 mg) is also possible. The medicine is said to improve blood circulation and relax the muscles of the prostate and bladder within two weeks.
Medicines often delay an operation for years, but do not always prevent it. Surgery is essential, if
- Urinary retention or urinary tract infections keep recurring
- haematuria (blood in the urine) persists for a long time
- There are bladder stones
- kidney damage caused by an enlarged prostate becomes apparent.
If the prostate is enlarged up to about 70 ml volume, the following procedures are possible:
- (Transurethral Resection of the Prostate, TUR-P, TUR prostate, electroresection). Here the doctor inserts a metal loop carrying high frequency current through the urethra and "planes" the protruding parts of the prostate with it (similar to the TUR-B). The procedure is performed under general anesthesia. After this operation, ejaculation to the outside is often reduced or absent, which means that most of the ejaculate enters the bladder (retrograde ejaculation), and consequently there is usually an inability to conceive after the operation.
Electroresection technique for prostatic hyperplasia. The endoscopic image at the top right shows the prostate adenoma before the procedure, which is severely constricting the urethra. The picture below on the left shows the condition after the procedure.
Georg Thieme Verlag, Stuttgart
- A TUIP (Transurethral incision of the prostate) is a minimal variant of TUR-P and is sometimes performed when the prostate is only slightly enlarged. The doctor only cuts a small notch in the prostate (prostate notch). With gland sizes of approx. 30 ml, the TUIP is just as successful as the TURP.
- In the TUNA (Transurethral needle ablation of the prostate) needles are placed into the prostate via the urethra and heated, which leads to heat necrosis, i.e. the death of prostate tissue. This technique is particularly suitable for patients for whom TURP is not an option. There are few complications, but more often than with TURP, second interventions are necessary.
- The procedure with the holmium laser shows similar successes as the TURP. Here the prostate tissue is not "cut off", but removed with a laser. The advantage of this procedure is the lower complication rate.
- The TUMT (= Transurethral microwave therapy of the prostate) is sometimes used in patients with a greatly increased risk of anesthesia, as it is carried out without anesthesia. Here the doctor inserts thin probes into the urethra and heats the prostate to temperatures above 70 ° C. As the prostate tissue dies and the nerve fibers are destroyed, the prostate shrinks and the symptoms improve.
If the prostate has reached a volume of more than 70 ml, the doctor removes it in one open surgery via an abdominal incision. In contrast to surgery for prostate cancer, surgery for benign prostate enlargement does not remove the prostate capsule and seminal vesicles. Because of the strong prostate veins, profuse bleeding sometimes occurs after the operation. For this reason, a catheter must remain in the bladder for the first 12–24 hours after the operation, through which the bladder is constantly rinsed so that any blood clots that may have formed can be drained from the bladder immediately.
In the case of residual urine from around 100 ml, an overflow bladder and as an immediate measure in the event of complete urinary retention, the bladder must be completely emptied via a catheter. Catheterization is carried out by the urologist and, if necessary, by any general practitioner. The easiest way is natural access through the penis (transurethral catheter).
If the patient can be operated on, surgical therapy follows in the following days - if this is not possible at first, the catheter must be left in the bladder as an indwelling catheter. This is not always without problems: There is a risk of infection, especially with the transurethral catheter. Indwelling catheters are therefore not a permanent solution, especially since several minimally invasive surgical techniques are now available that are reasonable for the very old and incapable of anesthesia. If the catheter has to remain in place for a long time, the doctor punctures the bladder above the pubic bone and places the catheter through the abdominal wall (suprapubic catheter).
In a comparison of conservative management, laser therapy and classic TUR-P, TUR-P performed best in a study with regard to effectiveness: one year after the start of therapy, there was a significant improvement in symptoms
- 15% of those treated with medication
- 67% of patients who received laser therapy
- 81% of TUR-P patients.
The TUR-P is also gentle on potency. At least 95% of the patients who had received TUR-P showed no restrictions after the operation.
Your pharmacy recommends
What you can do yourself
Even if the causes of prostate enlargement cannot be combated, there are some measures that can be taken to alleviate the symptoms of a moderately enlarged prostate. It is effective to minimize any mechanical irritation to the prostate.
- Avoid long periods of sitting: stand e.g. B. in predominantly sedentary activities from time to time and walk up and down a few minutes.
- Your underwear should be comfortable; H. don't be too tight.
- Do not suppress the urge to urinate: the more frequently the bladder is emptied, the lower the risk of the bladder becoming overfilled or overstretched.
- Make sure you have regular bowel movements so that there is no additional pressure on the bladder and urinary tract.
The significance of alternative medical procedures is low in this clinical picture, as well-tolerated herbal remedies are usually taken anyway in the case of slight complaints. Homeopathic substances such as Conium for nocturnal urination or Sabal serrulata for a weakened urine stream are most likely to be recommended here.
According to the data available to date, a balanced diet with sufficient phytochemicals probably also protects against prostate enlargement due to the phytophenols present. These include the phytoestrogens, plant components with a weak estrogen-like effect, which are found in soybeans, spinach and broccoli. They are said to reduce the hormonal changes in old age.
- T. Ebert; B.J. Schmitz-Dräger: Prostate - Diagnosis and Therapy. Kilian-Verlag, 2000. Very good, helpful guide.
- G. Leibold: Prostate. Oesch-Verlag, 2005. This guide goes into detail about the prostate and helps to prevent complaints by naturopathic medicine, to recognize and treat ailments. The opportunities and risks of surgical treatments are also not ignored.
AuthorsDr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:55
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