The most common urological pathology to which urologists are referred by men over the age of 45 is prostate adenoma. The presence of this pathology significantly interferes with the quality of life of men. One of the most likely consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.
To combat prostate adenoma, surgical and medical treatment methods are used. The most effective drug or method of surgical intervention is selected by the hospital specialist taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of comorbidities. Surgical clinics have created comfortable conditions for treating patients.
The causes of the development of this disease
The occurrence of adenomas is most often associated with age -related changes in the prostate, that is, changes in its structure and an increase in its size. As a result of such changes, the urethra, located in the thickness of the prostate gland, is gradually compressed and disturbances in the process of urination appear.
Prostate adenomas in men develop as a result of hormonal changes in the body associated with age -related changes. Testosterone (male hormone) levels gradually decrease with age, while female sex hormone (estrogen) concentrations, on the other hand, increase. This phenomenon is called male menopause.
The development of prostate adenoma may be due to the following risk factors:
- By the age of the patient - an enlarged prostate gland is very rarely found in men under the age of forty, and after sixty years it is diagnosed almost every second;
- Hereditary predisposition - if a prostate adenoma is diagnosed in a brother who is close to the blood, he has a great risk of inheriting the disease in adulthood;
- Diabetes mellitus, cardiovascular disease - benign tumors (adenomas) of the prostate can occur not only from the disease itself, but also from the harmful effects of drugs for its treatment (for example, beta -blockers);
- Wrong lifestyle - the risk of developing prostate adenoma increases in men with obesity, insufficient physical activity.
Symptoms
Prostate adenoma can be suspected when a man experiences the following symptoms, the most typical for the disease:
- increased desire to urinate;
- appearance of abdominal muscle tension need to urinate;
- the presence of painful sensations, burning, slow flow of urine;
- discomfort and inadequate bladder emptying;
- increase the duration of the urinary process.
Prostate adenoma not only causes a decrease in the quality of life of men, but also the retention of acute urination in it, which requires the use of surgical treatment methods. To avoid surgery, many patients use special medications to treat prostate adenoma, relieve symptoms and restore normal prostate function. However, only a qualified specialist can recommend the best medication for prostatitis and prostate adenoma. It is necessary to contact him when the first symptoms of the disease appear.
Treatment of prostate adenoma is individual for each patient. Drugs for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the treating physician. Taking medications for prostatitis and prostate adenoma on their own is not only ineffective, but also dangerous. Given the presence of certain "personal" chronic diseases in older men, medications for the treatment of prostate adenoma in the elderly should be selected taking into account comorbidities.
The stage of development of the disease
Prostate adenomas are characterized by gradual development, which can be divided into three stages.
- The first stage of the disease persists with minimal urinary disturbances. There may be a slight increase in frequency, especially at night, and a slow flow of urine. The first stage can last from one year to 12 years or more.
- The second stage of prostate adenoma is characterized by more obvious urinary disorders: intermittent urine flow, the appearance of a need to strain when urinating and a feeling of incomplete emptying of the bladder. Residual urine, which is stuck in the bladder and urinary tract, causes an inflammatory process, which is accompanied by pain, a burning sensation when urinating, pain in the lumbar region and above the pubis.
- The third stage is characterized by periodic or continuous urination, which forces the patient to use a urine bag.
Complications
In some men, prostate adenoma does not worsen quality of life and walks without complications. However, in some cases, the disease can cause the following negative consequences:
- Acute urinary retention - characterized by a sudden inability to empty the bladder and pain in the suprapubic region. With such conditions, patients require emergency medical treatment with catheterization or minor surgery;
- The occurrence 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 stagnant urine;
- Bladder damage - with irregular emptying of the bladder, it stretches, the formation of protrusions (pockets) in the walls of organs, where urine stops;
- Kidney damage - increased pressure on the ureters and bladder has the effect of direct damage to the kidneys, as a result of which kidney failure develops.
Adenoma and prostate potential
Prostate adenoma and potential are interrelated. Adenomas disrupt the structure of glandular tissue, which in turn causes damage to other organs, not least - the testes, which are responsible for the production of androgens. Therefore, prostate adenoma can be a cause of impotence, requiring long -term and complex therapy.
Diagnostics
A simple and effective way to make an early diagnosis is to keep a diary of urination by the patient with the setting of quantitative and qualitative parameters: amount of urine excreted, characteristics of fluid intake, essential urges, night urges. The primary physical examination method for suspected prostate adenoma is digital rectal examination of the prostate to detect its enlargement and exclude some other pathologies.
Diagnosis of prostate adenoma in the hospital is made using the following laboratory and instrumental methods:
- General blood and urine tests;
- Biochemical blood tests for markers of kidney levels, urea levels and creatinine;
- PSA test (to rule out prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Uroflowmetry (to determine urine flow rate);
- Determination of residual urine volume (using ultrasound);
- Pelvic floor electromyography;
- Urethrocystoscopy;
- Excretory urography.
Treatment
Treatment for prostate adenoma aims to relieve lower urinary tract symptoms, improve the patient’s quality of life and prevent the development of disease complications. Patients with mild symptoms that do not worsen quality of life are often given follow -up tactics with periodic examinations by a urologist who monitors the course of the disease and gives recommendations on how to stop the growth of prostate adenoma. During this period, attention was focused on non -drug therapy. The above method can be in addition to conservative treatment, namely the intake of the following medications:
- Alpha blockers (Tamsulosin, Alfuzosin);
- 5-alpha reductase inhibitor (finasteride);
- Phosphodiesterase type 5 inhibitor (Sildenafil);
- Combination of 5-alpha reductase inhibitors and alpha blockers;
- Musarin or M-anticholinergic receptor blockers.
For patients with advanced prostate adenoma, surgical treatment is recommended, which can be performed by several methods: transurethral excision, transurethral resection and removal of the prostate.
There are specific indications for the use of surgical treatment:
- Recurrent urinary retention;
- Renal failure, caused by prostate adenoma;
- Urinary stones;
- Recurrent urinary tract infections;
- Recurrent hematuria.
In addition, surgical intervention is required for patients in the absence of efficacy from drug treatment.
During conservative therapy or in the postoperative period, patients require constant medical supervision with standard studies (determination of urine flow rate, ultrasound, analysis of PSA levels).
Drugs
There are certain schemes in which certain drugs are prescribed for the treatment of prostatitis and prostate adenoma. High treatment efficiency is achieved due to the use of drugs of the group of alpha-reductase inhibitors and alpha-blockers. This drug for the treatment of prostate adenoma in men helps to eliminate the main symptoms of the disease, as well as restore adequate urination.
What are the most effective and widely used pills for prostate adenoma? The list is led by alpha1-adrenergic receptor blockers. In addition, the list includes 5-alpha reductase inhibitors, vitamins and minerals.
The drug therapy complex includes not only drugs. In case of prostate adenoma, conservative treatment can be supplemented with biologically active additives - supplements, which enhance the therapeutic effect of drugs and ensure a speedy recovery. Some of it contains zinc. These macronutrients are directly involved in the synthesis of spermatogenesis and testosterone. Plant phytosterols normalize urination.
Treatment with drugs of the alpha1-adrenoceptor group of antagonists
These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and increase the flow of urine. Tamsulosin with the same name as 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 gland, prostate urethra and bladder. Due to the decrease in muscle tone, the outflow and excretion of urine is facilitated. Tamsulosin, like all selective drugs, has few side effects, does not affect vascular tone and can be prescribed to patients with chronic hypertension.
Alpha-adrenergic receptor antagonists must be used continuously, until a gradual decrease in irritation and blockage of the prostate adenoma can be achieved. Tamsulosin drug in the treatment of prostate adenoma takes due priority in the prescription of urologists.
The tablet form of the drug is considered more progressive, because due to the controlled release of tamsulosin, the active substance is in the body at a constant concentration. The drug enters the bloodstream evenly, thus reducing the likelihood of the main side effect of the drug on the group of adrenergic blockers - a sharp drop in blood pressure.
An equally effective drug with the active ingredient tamsulosin is Urorek. Taking this drug is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary heart disease, so it can be prescribed to men with cardiac pathology. Well-chosen doses and adherence to all rules for the use of drugs of the alpha-blocker group allow to achieve a good therapeutic effect with almost no side effects.
Drugs of the group of reductase inhibitors (blockers)
Drugs from this pharmacological group (Finasteride, Dutasteride) help to reduce the outflow of urine, and, thus, to 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 stopped completely after three months. According to the results of clinical studies, maximum effectiveness is achieved after six months of therapy with this drug.
Finasteride and Dutasteride are type-specific inhibitors of 2-alpha reductase (the cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone). The growth of the prostate gland in BPH is directly related to this testosterone conversion. Thanks to the 5-alpha-reductase inhibitor, 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 prostate hyperplasia;
- Improves urine outflow and eliminates symptoms of prostate adenoma;
- Reduces the risk of developing acute urinary retention and the need for surgery.
Finasteride and Dutasteride have significant antiandrogenic effects, which help reduce the levels of male hormones in the blood. In addition, this drug has teratogenic effects, so the drug must be taken with caution. With the help of modern medicines, it is possible to stop the growth of the prostate and prevent the need for surgical treatment.
Antispasmodics and pain pills to make the disease worse
The main purpose of drugs of antispasmodic and analgesic action in exacerbating prostate adenoma is to alleviate the general condition of the patient and relieve pain. Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help fight not only the painful sensations that arise during urination, but also with constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, swelling of the prostate gland is reduced, body temperature is normalized, and unpleasant symptoms are also eliminated.
Non -opioid analgesics, produced in the form of tablets or suppositories, help relieve pain syndrome during prostate adenoma exacerbation. The most readily available is Metamizole sodium. However, this drug is intended for one use, as it can only act on mild pain syndromes. 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, radioactive agent and an irreplaceable link in the reproductive process. Vitamin E in a dose of 400 mg urologists prescribe to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.
Treatment of serious chronic diseases such as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medications on their own, without first consulting a doctor, because self -treatment in this case is not only ineffective, but also dangerous for men's health. Only a qualified specialist can tell you which pills for prostate adenoma are most effective in each case, and which pills can cause negative consequences.
Operation
Hospital urologists perform classical and minimally invasive surgical interventions, applying innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the surgery that best suits him or her.
The generally accepted standard in the surgical treatment of prostate adenoma is transurethral prostate transplantation. The operation is very efficient. After the intervention, the patient gets rid of the blockage of the bladder outlet (urethral narrowing) and related symptoms. The recovery period is not long. During or after surgery, bleeding may occur, the body's "water intoxication" syndrome.
Alternative methods for treating prostate adenoma include the following surgical interventions:
- Stenting;
- Balloon widening;
- Hyperthermia;
- Thermotherapy;
- Ultrasound, laser and needle ablation;
- Interstitial freezing.
Thereafter, complications occur less frequently, but this technique is inferior to transurethral resection in terms of effectiveness, both clinically and economically.
Laparoscopic removal of a prostate adenoma is used when the tumor has grown significantly, and it is problematic to remove it using transurethral resection. The operation is more difficult and is performed under general anesthesia. Through a small incision, the surgeon introduces a special instrument into the body cavity, with which it removes the prostate adenoma. The operation is performed in accordance with the image from the video camera, which is displayed on the screen. The main advantages of the intervention are the minimum amount of blood loss and the low likelihood of complications. After surgery, patients do not require long -term rehabilitation.
When there are signs of prostate adenoma in men, doctors use a high -tech method to treat the adenoma - laser enucleation. Interventions are performed with large neoplasms. Excess tissue is removed using a laser. The operation is performed through the urethra. The tumor is separated, divided into small sections, and then removed. This method is considered minimally invasive. It has a number of significant advantages: does not violate the integrity of the cavity, does not cause unnecessary damage.
Laser vaporization is the destruction of an adenoma by laser vaporization. The urologist introduces a special device through the urethra, brings it to the neoplasm and acts on it with a powerful green laser. The depth of penetration of the laser and the accuracy of its hitting make it possible to avoid damage to nearby areas. The method is minimally invasive, non -bleeding, fast and effective. The only drawback is the inability to take tumor tissue for histological examination.
In some cases, the unavoidable method of treating prostate adenoma is abdominal surgery - adenomectomy. It is done when other methods cannot help the patient. During surgery, the surgeon uses a scalpel to access the prostate gland and manually, using a surgical instrument, removes the adenoma. As a result of surgery, significant blood loss can occur, and complications may arise. After surgery, patients require long -term rehabilitation.
Removal of prostate adenoma by transvesical adenomectomy method consists of radical excision of hyperplastic prostate tissue through longitudinal incision of the anterior abdominal wall and bladder. Surgery is performed in the advanced stages of the disease, when the tumor reaches a large size, the bladder is too much caused by its overflow with accumulated urine, and kidney failure develops.
The bladder is pre-catheterized and filled with a sterile solution of furacilin or other material. Then isolated and taken in two places on a special handle, on which the walls of the organ are lifted. The surgeon dissects the folds that form and opens the bladder.
Along the tip in the fitted urinary catheter, it defines the area of the bladder neck and around the urethral opening that appears in the field of view, departing from it at a distance of 0. 5-1 cm, making an incision on the mucous membrane. Afterwards, the operating urologist penetrates the thickness of the prostate with his finger, inserts it between the tumor capsule and the adenomatous node, removing the latter. At the same time, with the finger of one hand, previously inserted into the patient’s rectum, the doctor feeds the gland toward the anterior abdominal wall. It becomes easier to manipulate. Thanks to this technique, the operating time is shortened and blood loss is reduced.
Then the surgeon performs hemostasis (stopping the bleeding) of the bed of the removed adenoma and sutures the bladder, leaving a thin drainage in the wound. It is designed to remove cavities from blood clots that have formed. Urinary catheters, inserted before the start of surgery, are not removed for 7-10 days. A new portion of the urethra is formed around it instead of the prostate portion of the urethra that is removed during surgery.
Transvesical adenomectomy is one of the most traumatic techniques of all used for prostate adenoma. It is accompanied by the risk of the following complications:
- Bleeding from the neoplasm bed;
- Congestive pneumonia;
- Violation of intestinal motor transfer function, which is indicated by constipation.
To avoid complications, after surgery in the hospital, patients are given early activation. The following undesirable consequences of surgery to remove a prostate adenoma may occur:
- Inadequate bladder drainage;
- Shrinking his neck;
- Urinary tract infiltration of peri-vesicular tissue;
- Formation of "pre-bladder" (cavity residue where prostate adenoma is removed);
- Formation of narrowing of the urethral lumen;
- Urinary incontinence.
This has a negative impact on the patient’s quality of life and prolongs recovery time for adequate urination.
The consequences of the operation are less clear when the intervention is performed using a laparoscope. Laparoscopic prostate adenoma surgery is one of the less invasive options for surgical intervention on the prostate gland. This technique is used by hospital urologists if the patient has a fairly large prostate adenoma.
If the size of the prostate gland of a patient with an adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients who require surgery, this option is not suitable, because the gland reaches a size of more than 120 cm3. Laparoscopic surgery to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticula, ankylosis of the joints of the lower legs is not performed. In this case, decisions about the possibility of surgery are made collectively by urologists, andrologists, abdominal surgeons and other hospital specialists.