Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease is less likely to occur at an earlier age in men over 40 years of age. According to statistics, the probability of its development after 50 years is about 40%, and more than 75% - after 65. In fact, 90% of all men face the disease sooner or later, so you need to know in advance its causes, risk factors, symptoms and modernTreatment of prostate adenoma.
hazards
Adenoma is a benign formation, so it does not harm the body. However, during growth, the tissues of the formation block the lumen of the urinary tract, which prevents urinary passage. This is due to a number of unpleasant complications and painful sensations, especially in the later stages. The congestion that occurs leads to the formation of infections, stones in the bladder, damage to the bladder, as well as serious disorders of the work of the kidneys up to the development of failure. Therefore, at the slightest manifestation of symptoms, it is necessary to immediately make an appointment with a urologist, undergo a thorough examination and, based on the results, choose the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be roughly divided into three main stages, which are accompanied by various symptoms:
- I - characterized by more frequent compulsive urges, nocturia (an increase in nocturnal urine output), the first signs of incontinence, a sluggish stream. At this stage, the disease can last for several years without developing into a more severe form;
- II - more pronounced symptoms. The urine stream can be interrupted, it is necessary to urinate frequently, which often leads to hernias and rectal prolapse. After using the toilet there is a feeling of dissatisfaction, incomplete emptying. The disease develops more actively, the transition to the next form takes relatively little time;
- III - Due to the cumulative effect, the bladder expands, its elasticity decreases, infections develop, kidney stones appear, and incontinence increases. There may also be general symptoms of intoxication - weakness, loss of appetite, nausea, constipation, persistent dry mouth.
It should be understood that similar symptoms are accompanied by some types of nerve disorders and cancer. An exact diagnosis can only be made in the clinic after appropriate research.
Treatment of the disease
Prostatic hyperplasia is currently a fairly well-studied disease. Its treatment does not present particular difficulties and can be carried out in several ways, depending on the severity of the disease, the nature, speed and stage of development of the patient, the age of the patient, his general health and other factors.
In general, all the procedures are conventionally divided into drug, non-drug, and surgical procedures. There are also many recipes from alternative (traditional) medicine, including with the help of various herbal preparations, the effectiveness of which has not been proven by clinical studies, and in some cases such methods of treating prostate adenoma only complicate the course of the disease, which is the conditionaffect the patient negatively.
Non-drug techniques
In the case of mild symptoms or more severe symptoms that do not impair the quality of life, vigilant waiting, also known as active waiting, is used. It consists in regular monitoring of the condition without the use of medication. Behavioral therapy is also administered, including:
- refusal to take anticholinesterase and diuretics without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- Physiotherapy exercises, Kegel exercises, and other measures to train the pelvic muscles;
- Reducing the use of diuretics and liquids, in particular - three hours before bedtime.
The technology is used both independently and in addition to drug therapy.
Medication
For severe to moderate symptoms, a number of medications may be prescribed, including:
- Alfuzosin, tamsulosin, and other alpha blockers;
- Solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear predominance of the symptoms caused by congestion;
- Type V phosphodiesterase inhibitors - widely used in the treatment of impotence and its causes, but have been shown to be effective in treating hyperplasia;
- Finasteride and other 5-alpha-reductase inhibitors - reduce the rate of proliferation of prostate tissue, reduce their size.
These and other drugs are usually used before surgery or in cases where they are contraindicated for any reason.
surgery
Today, surgical interventions are considered the "gold standard" and the most effective treatment for prostate adenoma. With their help, you can completely remove prostate adenoma with minimal impact on the body and maintain normal urination and erection. Their main advantage is the ability to stop at any stage of the diseaseSeveral main types of surgical interventions are practiced in our clinic. The decision about the treatment of the prostate adenoma is made by the treating physician together with the patient after a thorough examination and examination.
Open adenomectomy
Open adenomectomy is a classic operation in which an incision is made in the perineum or lower abdomen and the inflamed glandular tissue is removed with various instruments. The main advantage of the method lies in its good knowledge and the lack of special equipment, so that it can be used in almost every clinic. However, due to the openness, the operation is often associated with extensive bleeding. In addition, due to the proximity of the prostate to the nerve nodes, there is always the risk of damage that leads to impairment of the sexual and urinary functions.
Transurethral resection
Prostate adenoma TURP is a procedure for removing part of the prostate with an electro-resection loop. Today it is one of the most preferred and most frequently performed surgeries due to its low invasiveness. All instruments are brought into formation through the urethral canal without incisions, which means that there is no blood loss, no scars on the skin and the recovery time is only a few days. In addition, complete information about the condition of the urinary system is collected during the procedure and any abnormalities found are eliminated.
New in the treatment of prostate adenoma
The most promising are minimally invasive methods that use advanced technology and equipment. These include:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions. With the help of a laparoscope, a laser fiber is inserted into the bladder and brought through its neck to the gland. Adenomatous tissue is removed by gentle incisions with an ultra-precise and safe holmium crystal laser and then morcellated. This approach guarantees almost complete damage to healthy tissue and minimal blood loss;
- transurethral photoselective vaporization - the method consists in the complete burning of damaged tissue with focused laser radiation without damaging healthy cells. The procedure is performed through the urethral canal, which eliminates cuts and scars, allows for a minimal number of relapses, and cuts recovery time to several days.
- robot-assisted laparoscopy - performed with the advanced robot complex "Da Vinci", which is equipped with the necessary tools and devices for video recording. The control is carried out by an experienced surgeon at a special terminal and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the operating field. Special algorithms of the robot smooth out all sharp and random movements of the operator and completely eliminate a human factor such as tremors. The use of the complex allows you to perform the operation as accurately and precisely as possible through small incisions of several millimeters.
All of these methods have one significant drawback - expensive equipment and the need for experienced professionals to work with them. As a result, such techniques may not be used in every hospital.