The most common urological pathology in which a urologist is consulted by men over 45 is prostate adenoma. The presence of this pathology significantly affects the quality of life of men. One of the greatest possible consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.
Surgical and medical treatments are used to combat prostate adenoma. The most effective drugs or methods of surgical intervention are selected by hospital specialists, taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of comorbidities. The surgery clinic has created comfortable conditions for treating patients.
The reasons for the development of the disease
The appearance of an adenoma is most often associated with age-related changes in the prostate, namely, a change in its structure and an increase in size. As a result of such changes, the urethra, which is located in the thickness of the prostate, is gradually compressed, and urination disorders appear.
Adenoma of the prostate in men is caused by hormonal changes in the body that are associated with age-related changes. The level of testosterone (male hormone) gradually decreases with age, while the concentration of the female sex hormone (estrogen), in contrast, increases. This phenomenon is called male menopause.
The development of a prostate adenoma can be due to the following risk factors:
- According to the age of the patient - an enlarged prostate is extremely rarely found in men under forty, and after sixty it is diagnosed almost every second;
- Hereditary Disease - If a man's close blood relatives are diagnosed with prostate adenoma, they are at great risk of inheriting the disease in adulthood.
- Diabetes mellitus, cardiovascular diseases - a benign tumor (adenoma) of the prostate can result not only from these diseases themselves, but also from the harmful effects of drugs used to treat them (e. g. beta blockers).
- Improper lifestyle - The risk of developing prostate adenoma is increased in men with obesity and inadequate physical activity.
Symptoms
Prostate adenoma can be suspected if a man develops the following symptoms that are most typical of the disease:
- increased urination;
- the appearance of the need for tension in the abdominal muscles for urination;
- the presence of painful sensations, burning, sluggish urine flows;
- Discomfort and inadequate emptying of the bladder;
- Extension of the duration of urination.
Prostate adenoma leads not only to a deterioration in the quality of life of men, but also to acute urinary retention in them, which requires the use of surgical methods of treatment. To avoid surgery, many patients use specific drugs to treat prostate adenomas, relieve symptoms, and restore normal prostate function. However, only a qualified specialist can suggest the best remedy for prostatitis and prostate adenoma. It is necessary to contact him when the first symptoms of the disease appear.
The treatment of prostate adenoma is individual for each patient. Drugs for the treatment of prostate adenomas, their dosage and duration of use are prescribed by the attending physician. Taking drugs for prostatitis and prostate adenoma alone can be not only ineffective, but also dangerous. Given the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in the elderly should be selected with due consideration for comorbidities.
Stages of development of the disease
Adenoma of the prostate is characterized by gradual development, which can be divided into three stages.
- The first stage of the disease proceeds with minimal urinary disturbance. Especially at night there may be a slight increase in frequency and a slow flow of urine. The first phase can take a year to 12 years or more.
- The second stage of prostate adenoma is characterized by more pronounced disorders of urination: intermittent flow of urine, the appearance of the need for stress when urinating, and a feeling of incomplete emptying of the bladder. Residual urine retained in the bladder and urinary tract causes an inflammatory process that is accompanied by pain, burning sensation when urinating, pain in the lumbar region and above the pubic bone.
- The third stage is characterized by periodic or constant involuntary urination that forces the patient to use a urine bag.
Complications
In some men, prostate adenoma does not worsen quality of life and proceeds without the development of complications. However, in some cases, the disease can have the following negative consequences:
- Acute urinary retention - characterized by a sudden inability to empty the bladder and suprapubic pain. In such circumstances, the patient needs emergency medical care with catheterization or minor surgery.
- The appearance of infections in the urinary tract - stagnation of urine, which creates favorable conditions for the reproduction of pathogens, leads to the development of cystitis and pyelonephritis;
- The formation of stones in the bladder is also a result of standing urine;
- Damage to the bladder - with irregular emptying of the bladder, it expands, with the formation of protrusions (pockets) in the walls of the organ, in which urine stagnates;
- Kidney Damage - The increase in pressure in the ureters and bladder has a direct damaging effect on the kidneys, thereby developing kidney failure.
Prostate adenoma and potency
Prostate adenoma and potency are closely related. The adenoma disrupts the structure of the glandular tissue, which in turn leads to damage to another, no less important organ - the testes, which are responsible for the production of androgens. Therefore, prostate adenoma can be the cause of impotence and require long-term and complex therapy.
diagnosis
A simple and effective way to make a preliminary diagnosis is to keep a urination diary of the patient with the establishment of quantitative and qualitative parameters: the amount of urine excreted, characteristics of fluid intake, compulsive urge, nocturnal urge. The primary physical exam for suspected prostate adenoma is a digital rectal exam of the prostate to determine its enlargement and to rule out some other pathologies.
Diagnosis of prostate adenoma in the hospital is carried out using the following laboratory and instrumental methods:
- General blood and urine tests;
- Biochemical blood tests for markers of kidney disease, urea and creatinine levels;
- PSA test (to rule out prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Uroflowmetry (used to determine the rate of urine flow);
- Determination of the residual urine volume (using ultrasound);
- Pelvic floor electromyography;
- Urethrocystoscopy;
- Excretory urography.
treatment
Treatment for prostate adenoma is aimed at relieving lower urinary tract symptoms, improving the patient's quality of life, and preventing the development of complications of the disease. Patients with mild symptoms that do not affect quality of life are often prescribed follow-up tactics with regular examinations by a urologist, who will monitor the course of the disease and make recommendations on how to stop the growth of the prostate adenoma. During this time, attention is focused on non-drug therapy. The above methods can be a complement to conservative treatment, in which the following drugs are taken:
- Alpha blockers (tamsulosin, alfuzosin);
- 5-alpha reductase inhibitors (finasteride);
- Type 5 phosphodiesterase inhibitors (sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha blockers;
- Muscarinic receptor blockers or M-anticholinergics.
Surgical treatment is recommended for patients with advanced prostate adenoma, which can be performed using several methods: transurethral excision, transurethral resection, and removal of the prostate.
There are certain indications for the use of surgical treatment:
- Recurrent urinary retention;
- Kidney failure caused by prostate adenoma;
- Bladder stones;
- Recurring urinary tract infections;
- Recurrent hematuria.
In addition, surgical intervention is required for patients in whom drug treatment is ineffective.
During conservative therapy or in the postoperative phase, patients require constant medical monitoring with standard studies (determination of the urine flow rate, ultrasound, PSA analysis).
Drugs
There is a certain scheme according to which certain drugs are prescribed for the treatment of prostatitis and prostate adenoma. A high efficiency of treatment is achieved through the use of drugs from the group of alpha reductase inhibitors and alpha blockers. These drugs, used to treat prostate adenoma in men, help eliminate the main symptoms of the disease and restore adequate urination.
What are the most effective and widely used pills for prostate adenoma? The list is headed by blockers of alpha1-adrenergic receptors. In addition, this list includes 5-alpha reductase inhibitors, vitamins, and minerals.
The complex of drug therapy includes not only drugs. In the case of prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements that enhance the therapeutic effect of drugs and ensure rapid recovery. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urination.
Treatment with drugs of the alpha1-adrenoceptor antagonist group
These drugs, used to treat prostatitis and prostate adenoma, relax the smooth muscles of the urinary system and improve the flow of urine. Tamsulosin with the same name of the active ingredient, which is part of other drugs (alfuzosin, silodosin, etc. ) is a highly selective drug that has a selective effect on the alpha1-adrenergic receptors of the muscles of the prostate, prostate, urethra and bladder. Due to the decrease in muscle tone, it facilitates the outflow and elimination of urine. Tamsulosin, like all selective drugs, has a minimal number of side effects, does not affect vascular tone and can be prescribed to patients with chronic hypertension.
Alpha-adrenergic receptor antagonists must be used continuously in order to achieve a gradual decrease in irritation and obstruction in prostate adenoma. The drug tamsulosin in the treatment of prostate adenomas has a well-deserved priority in the prescription of urologists.
The tablet form of the drug is considered to be more progressive, as the active substance is in a constant concentration in the body due to the controlled release of tamsulosin. The drug enters the bloodstream evenly, reducing the chance that the main side effect of drugs in the adrenergic blocking group - a sharp drop in blood pressure.
An equally effective drug with the active ingredient tamsulosin is Urorek. The use of this drug is not associated with the following undesirable effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary artery disease, so it can be prescribed to men with heart disease. A well-chosen dosage and compliance with all the rules for the use of drugs of the alpha-blocker group make it possible to achieve a good therapeutic effect, without the appearance of side effects.
Medicines of the group of reductase inhibitors (blockers)
The drugs of this pharmacological group (finasteride, dutasteride) help to relieve the urine outflow, and consequently eliminate the main symptoms of the disease. A stable therapeutic effect occurs within two to three weeks after the start of the course. All symptoms have completely stopped after three months. According to the results of clinical studies, the maximum effectiveness is achieved after six months of therapy with these drugs.
Finasteride and dutasteride are specific inhibitors of type 2-5 alpha reductase (a cellular enzyme responsible for converting testosterone to dihydrotestosterone). The growth of the prostate in BPH is directly related to this conversion of testosterone. Thanks to 5-alpha reductase inhibitors, the production of intraprostatic dihydrotestosterone is blocked and its concentration in the blood is significantly reduced.
Finasteride and Dutasteride are used for the following purposes:
- Treatment and control of prostatic hyperplasia;
- Improving urine outflow and eliminating symptoms of prostate adenoma;
- Reduce the risk of acute urinary retention and the need for surgery.
Finasteride and dutasteride have a pronounced antiandrogenic effect, i. H. help lower the levels of male hormones in the blood. In addition, these drugs have a teratogenic effect, which is why they must be taken with caution. With the help of modern drugs, it is possible to stop the growth of the prostate and prevent the need for surgical treatment.
Antispasmodics and pain relievers to make the disease worse
The main purpose of drugs with antispasmodic and analgesic effects in the exacerbation of prostate adenoma is to relieve the general condition of the patient and eliminate pain. Nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen) have anti-inflammatory and analgesic effects. They help fight not only painful sensations that occur when urinating, but also with constant pain in the groin and perineum. Thanks to the action of nonsteroidal anti-inflammatory drugs, the inflammatory process decreases, the swelling of the prostate decreases, the body temperature normalizes, and unpleasant symptoms are also eliminated.
Non-opioid analgesics, which come in the form of tablets or suppositories, help relieve pain syndrome during the exacerbation of prostate adenoma. The most readily available of these is metamizole sodium. However, this drug is more intended for single use as it can only work in mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthesin and novocaine (ikhtammol, benzocaine, tribenoside + lidocaine) are effective.
Vitamin E 400
Tocopherol acetate, or vitamin E, is often included in the complex treatment of prostate adenoma as an antioxidant, radiation protection agent, and irreplaceable compound in reproductive processes. Vitamin E in a dosage of 400 mg urologists prescribe patients with erectile dysfunction and spermatogenesis related to prostate adenomas.
Treatment of such a serious chronic disease as prostate adenoma should be prescribed and supervised by a urologist. It is strictly forbidden to take certain drugs on your own without first consulting your doctor, since self-medication in this case can be not only ineffective, but also harmful to the health of men. Only a qualified specialist can tell you which pills for prostate adenoma are most effective in each case and what negative consequences they can have.
Operations
The hospital's urologists masterfully perform classic and minimally invasive surgical interventions and use innovative methods for the surgical treatment of prostate adenomas. Each patient is selected for the surgery that best suits them.
The generally accepted standard in the surgical treatment of prostate adenomas is transurethral resection of the prostate. The operation is very efficient. After the procedure, patients are relieved of any obstruction of the bladder outlet (narrowing of the urethra) and associated symptoms. The rehabilitation period is short. Bleeding, the syndrome of "water intoxication" of the body, may occur during or after the operation.
Alternative methods of treating prostate adenomas include the following surgical interventions:
- Stenting;
- Balloon dilatation;
- Hyperthermia;
- Thermotherapy;
- Ultrasound, laser and needle ablation;
- Interstitial coagulation.
After that, complications are less common, but these techniques are clinically and economically inferior to transurethral resection in terms of effectiveness.
Laparoscopic removal of the prostate adenoma is used when the tumor has grown significantly and it is problematic to remove it with transurethral resection. This surgery is more difficult and is performed under general anesthesia. The surgeon inserts special instruments into the body cavity through small incisions, with which he removes the prostate adenoma. The operation is carried out according to the image from video cameras displayed on the screen. The main advantages of the intervention are the minimal blood loss and the low likelihood of complications. After the operation, the patient does not need long-term rehabilitation.
When men show signs of prostate adenoma, doctors use a high-tech method to treat adenoma - laser enucleation. The intervention is carried out with large neoplasms. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor is separated, divided into small pieces, and then excreted. The method is considered to be minimally invasive. It has a number of significant advantages: it does not violate the integrity of the cavities and does not cause unnecessary damage.
Laser vaporization is the destruction of the adenoma through laser vaporization. The urologist inserts a special device through the urethra, brings it to the neoplasm and acts on it selectively with a strong green laser. The depth of penetration of the laser and the accuracy of its hit make it possible to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. The only drawback is the inability to extract tumor tissue for histological examination.
In some situations, abdominal surgery - an adenomectomy - is an inevitable method of treating prostate adenoma. It is carried out when other methods cannot help the patient. During surgery, the surgeon accesses the prostate with a scalpel and manually removes the adenoma using surgical instruments. Significant blood loss and complications can occur as a result of the surgery. After the operation, the patient needs long-term rehabilitation.
Removal of the adenoma of the prostate by the method of transvesical (transvesical) adenomectomy consists in the radical removal of hyperplastic prostate tissue through a longitudinal incision of the anterior abdominal wall and bladder. Surgery is performed in the advanced stages of the disease, when the tumor becomes large, the bladder is overstretched from overflowing with accumulated urine, and kidney failure develops.
The bladder is pre-catheterized and filled with a sterile solution of furacilin or another substance. Then it is isolated and picked up in two places on special holders, for which the wall of the organ is raised. The surgeon dissects the crease that has formed and opens the bladder.
Along the inner end of the installed urinary catheter, it determines the area of the bladder neck and around the opening of the urethra, which appears in the field of vision and deviates from it by 0. 5 to 1 cm, it makes an incision in the mucous membrane. After that, the operative urologist penetrates the thickness of the prostate with his finger, enters between the tumor capsule and the adenomatous nodes and excretes them. At the same time, using the finger of the other hand, previously inserted into the patient's rectum, the doctor feeds the gland in the direction of the anterior abdominal wall. It becomes more accessible to manipulation. Thanks to this technique, the operation time is shortened and blood loss is reduced.
Then the surgeon stops the bleeding (hemostasis) of the removed adenoma bed and sutures the bladder, leaving a thin drainage in the wound. It is designed to flush its cavity from the blood clots that have formed. The urinary catheter inserted before the start of the operation is not removed for 7-10 days. A new section of urethra will be formed around it instead of the prostate part of the urethra that was cut out during surgery.
Transvesical adenomectomy is one of the most traumatic of all techniques for prostate adenoma. There is a risk of developing the following complications:
- Bleeding from the bed of the neoplasm;
- Congestive pneumonia;
- Violation of the motor evacuation function of the intestine, manifested by constipation.
In order to avoid complications, the patient is activated early after the operation in the hospital. The following undesirable consequences of surgery to remove prostate adenoma can occur:
- Inadequate drainage of the bladder;
- Narrowing of his neck;
- Urinary infiltration of the perivesicular tissue;
- The formation of a "pre-bladder" (residual cavity where the prostate adenoma was removed);
- Formation of a narrowing of the lumen of the urethra;
- Urinary incontinence.
This negatively affects the patient's quality of life and increases the recovery time for adequate urination.
The consequences of the operation are less pronounced if the procedure is performed with a laparoscope. Laparoscopic prostate adenoma surgery is one of the less invasive options for prostate surgery. This technique is used by hospital urologists when the patient has a sufficiently large prostate adenoma.
If the size of the prostate in a patient with adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. However, for 10% of patients who require surgery, this option is not suitable as the gland grows to a size of more than 120 cm3. Laparoscopic surgery to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticulum and ankylosis of the joints of the lower extremities is not performed. In this case, the decision about the possibility of the operation is made jointly by the urologist, andrologist, abdominal surgeon and other hospital specialists.