The most common urological pathology that a urologist consults men over 45 is prostate adenoma. The presence of this pathology significantly affects the quality of life of men. One of the most terrible possible consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.
Surgical and medical methods of treatment are used to fight prostate adenoma. The most effective drugs or methods of surgery are selected by the hospital specialists taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of comorbidity. The surgery clinic has created comfortable conditions for the treatment of 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, that is, a change in its structure and an increase in size. As a result of these changes, the urethra, which is located in the thickness of the prostate, is gradually compressed and disorders in the urination process occur.
Prostate adenoma in men develops as a result of hormonal changes in the body associated with age-related changes. The level of testosterone (male hormone) gradually decreases with age, while the concentration of female sex hormone (estrogen), on the contrary, increases. 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 rarely found in men under the age of forty and after sixty years is diagnosed almost every second.
- Hereditary predisposition - if a prostate adenoma is diagnosed in a man's close blood relatives, there is a huge risk of inheriting this disease in adulthood.
- Diabetes mellitus, cardiovascular disease - a benign tumor (adenoma) of the prostate can arise not only from these diseases themselves, but also from the harmful effects of drugs in their 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 develops the following symptoms, which are more typical of this disease:
- increased desire to urinate
- the need for tension in the abdominal muscles to urinate;
- the presence of painful sensations, burning, slow urine flow
- discomfort and insufficient emptying of the bladder.
- increasing the duration of the urination process.
Prostate adenoma leads not only to a reduction in the quality of life of men, but also to acute urinary retention in them, which requires the use of surgical treatment methods. In order to avoid surgery, many patients use special drugs to treat prostate adenoma, eliminating the symptoms and restoring normal prostate function. However, only a qualified specialist can suggest the best treatment 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. Medications for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the treating physician. Remedies for prostatitis and prostate adenoma can not only be ineffective, but also dangerous. Due to the presence of certain "personal" chronic diseases in older men, drugs should be chosen to treat prostate adenoma in the elderly, taking into account the comorbidities.
Stages of disease development
Prostate adenoma is characterized by gradual development, which can be divided into three stages.
- The first stage of the disease progresses with minimal urination disorders. There may be a slight increase in its frequency, especially at night, and a slow urine flow. The first stage can last from one year to 12 years or more.
- The second stage of prostate adenoma is characterized by more severe urinary disorders: intermittent urine flow, the need for stress when urinating and a feeling of insufficient emptying of the bladder. Residual urine, which is retained in the bladder and urethra, causes an inflammatory process, which is accompanied by pain, burning sensation when urinating, pain in the lumbar region and above the pubic area.
- The third stage is characterized by periodic or continuous involuntary urination, which forces the patient to use a urine bag.
Complications
In some men, prostate adenoma does not worsen the quality of life and progresses without complications. However, in some cases, the disease can cause the following adverse effects:
- Acute urinary retention - characterized by a sudden inability to empty the bladder and pain in the transverse region. With such a condition, the patient requires emergency medical care with catheterization or a minor operation.
- The appearance of infections in the urinary system - 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 consequence of stagnant urine.
- Bladder damage - with irregular emptying of the bladder, it extends, forming protrusions (pockets) on the walls of the organ, where in the urine it stops.
- Kidney damage - increased pressure in the ureters and bladder has immediate kidney damage, resulting in the development of kidney failure.
Adenoma and prostate activity
Prostate adenoma and power are closely linked. Adenoma disrupts the structure of glandular tissues, which in turn leads to damage to another, no less important organ - the testes, which is responsible for the production of androgens. Thus, prostate adenoma can be the cause of impotence, which requires long-term and complex treatment.
Diagnostics
A simple and effective way to determine a preliminary diagnosis is to keep a patient urination diary by defining quantitative and qualitative parameters: excreted urine volumes, fluid intake characteristics, urgency, nocturnal impulse. The main method of physical examination for suspected prostate adenoma is a digital rectal examination of the prostate to detect its enlargement and to rule out certain other pathologies.
Diagnosis of prostate adenoma in hospital is made using the following laboratory and organic methods:
- General blood and urine tests
- Biochemical blood tests for indicators of renal status, urea and creatinine.
- PSA test (to rule out prostate cancer)
- Regular ultrasound examination (ultrasound).
- Uroflowmetry (to determine the rate of urine flow)
- Determination of urine residue volume (using ultrasound).
- Pelvic floor electromyography.
- Urethrocytoscopy?
- Elimination urography.
Treatment
Treatment for prostate adenoma aims to relieve the symptoms of the lower urinary tract, improve the patient's quality of life and prevent the development of complications of the disease. In patients with mild symptoms that do not worsen the quality of life, regular follow-up with regular examinations by a urologist who monitors the course of the disease and gives recommendations on how to stop the development of prostate adenoma is often prescribed. During this period, attention is focused on drug-free treatment. The above methods can be an addition to the conservative treatment, which is the intake of the following drugs:
- Alpha blockers (Tamsulosin, Alfuzosin);
- 5-alpha reductase inhibitors (finasteride).
- Phosphodiesterase type 5 inhibitors (Sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha inhibitors.
- Muscarinic receptor blockers or M-anticholinergics.
For patients with advanced prostate adenoma, surgical treatment is recommended, which can be performed by several methods: perforation, transurethral resection and removal of the prostate.
There are some indications for the use of surgical treatment:
- Repeated urinary retention
- Renal failure, caused by prostate adenoma.
- Bladder stones
- Recurrent urinary tract infections
- Recurrent hematuria.
In addition, surgery is necessary for patients in the absence of efficacy of the medication.
During conservative treatment or in the postoperative period, patients need continuous medical monitoring with standard studies (determination of urine flow rate, ultrasound, PSA level analysis)
Medicines
There is a specific regimen according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. The high effectiveness of the treatment is achieved due to the use of drugs of the group of alpha-reductase inhibitors and alpha-inhibitors. These drugs for the treatment of prostate adenoma in men help to eliminate the main symptoms of the disease, as well as to restore adequate urination.
What are the most effective and widely used pills for prostate adenoma? The list is headed by α-adrenergic receptor blockers. In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.
The complex of drug therapy includes not only drugs. In case of prostate adenoma, conservative treatment can be supplemented with biologically active supplements - dietary supplements, which enhance the therapeutic effect of drugs and ensure rapid recovery. Some of them contain zinc. This macronutrient is directly involved in the synthesis of spermatogenesis and testosterone. Phytosterols plant urination.
Treatment with drugs of the alpha-adrenoceptor antagonist group
These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve urine flow. Tamsulosin with the same name of the active substance, which belongs to other drugs (Alfuzosin, Silodosin, etc. ), is a highly selective drug that has a selective effect on the alpha-adrenergic receptors of the muscles of the prostate, prostate, urethra and urethra. cyst. Due to the reduction of muscle tone, the outflow and excretion of urine is facilitated. 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 should be used continuously so that a gradual reduction in irritation and obstruction of the prostate adenoma can be achieved. The drug Tamsulosin in the treatment of prostate adenoma takes a worthy priority in the prescriptions of urologists.
The tablet form of the drug is considered more progressive, as due to the controlled release of tamsulosin, the active substance is in the body in a stable concentration. The drug enters the bloodstream evenly, thus reducing the likelihood of the main side effect of the drug in the adrenergic blocking group - a sharp drop in blood pressure.
An equally effective drug with the active substance tamsulosin is Urorek. Taking this drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, increased incidence of angina in patients with coronary heart 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-blocking group allow to achieve good therapeutic action with almost complete absence of side effects.
Drugs of the reductase inhibitor group (inhibitors)
Drugs of this pharmacological group (Finasteride, Dutasteride) help to relieve urinary outflow and, consequently, to eliminate the main symptoms of the disease. A stable therapeutic effect appears within two to three weeks after the start of the course. All symptoms stop completely after three months. According to the results of clinical trials, maximum effectiveness is achieved after six months of treatment with these drugs.
Finasteride and Dutasteride are specific inhibitors of type 2 5-alpha reductase (a cellular enzyme responsible for converting testosterone to dihydrotestosterone). Prostate growth in BPH is directly related to this testosterone conversion. Thanks to 5-alpha-reductase inhibitors, the production of endoprostatic dihydrotestosterone is inhibited and its concentration in the blood is significantly reduced.
Finasteride and Dutasteride are used for the following purposes:
- Treatment and control of prostate hyperplasia.
- Improving the outflow of urine and eliminating the symptoms of prostate adenoma.
- Reducing the risk of developing acute urinary retention and the need for surgery.
Finasteride and Dutasteride have a strong antiandrogenic effect, ie they help reduce the level of male hormones in the blood. In addition, these drugs have a teratogenic effect, so they should be taken with caution. With the help of modern medicine, it is possible to stop the growth of the prostate and avoid the need for surgical treatment.
Anticonvulsants and pain pills to make the disease worse
The main purpose of antispasmodic and analgesic drugs in the worsening of prostate adenoma is to alleviate the general condition of the patient and eliminate pain. Non-steroidal anti-inflammatory drugs (NSAIDs) (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help fight not only the painful sensations that arise when urinating, but also the constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, the swelling of the prostate gland is reduced, the body temperature is normalized and the unpleasant symptoms are also eliminated.
Non-opioid analgesics, produced in the form of tablets or suppositories, help relieve pain syndrome when prostate adenoma worsens. However, this drug is rather intended for single use, as it can only act on mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthesia 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, radioprotective agent and irreplaceable binding in reproductive processes. Vitamin E at a dose of 400 mg urologists prescribe in patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.
Treatment of such a serious chronic disease as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medicines on your own, without first consulting your doctor, as self-medication in this case can be not only ineffective, but also dangerous to men's health. Only a qualified professional can tell you which prostate adenoma pills are most effective in each case and which ones can cause adverse effects.
Functions
The hospital urologists skillfully perform classic and minimally invasive surgeries, apply innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the surgery that suits him best.
The generally accepted standard in prostate adenoma surgery is transurethral resection of the prostate. The operation is very efficient. After the intervention, patients are relieved of obstruction of the bladder outlet (urethral stricture) and related symptoms. The recovery period is short. During or after surgery, bleeding, the body's "water poisoning" syndrome, may develop.
Alternative treatments for prostate adenoma include the following surgeries:
- Stenting;
- Expansion of the balloon?
- Hyperthermia?
- Thermotherapy?
- Ultrasound, laser and needle removal
- Intermediate coagulation.
After these, complications occur less frequently, but these techniques are inferior to transurethral resection in terms of effectiveness, both clinically and financially.
Laparoscopic prostate adenoma removal is used when the tumor has grown significantly and is problematic to remove using a transurethral resection. This operation is more difficult and is performed under general anesthesia. Through small incisions, the surgeon inserts special instruments into the body cavity, with which he removes the prostate adenoma. The operation is performed according to the image from camcorders, which is displayed on the screen. The main advantages of the intervention are the minimal amount of blood loss and the low probability of complications. After surgery, the patient does not need long-term rehabilitation.
When there are signs of prostate adenoma in men, doctors use a high-tech method to treat the adenoma - the nuclear laser. The operation is performed with large neoplasms. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor is separated, divided into small parts and then excreted. The method is considered minimally invasive. It has many important advantages: it does not violate the integrity of the cavities, it does not cause unnecessary damage.
Laser evaporation is the destruction of the adenoma by laser evaporation. The urologist inserts a special device through the urethra, brings it to the tumor and acts on it with the powerful green laser. The depth of penetration of the laser and the accuracy of the blow make it possible to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the inability to obtain tumor tissue for histological examination.
In some cases, an unavoidable method of treating prostate adenoma is abdominal surgery - adenomectomy. It is performed when other methods can not help the patient. During surgery, the surgeon uses a scalpel to access the prostate and manually, using surgical tools, removes the adenoma. As a result of the operation, significant blood loss may occur and complications may occur. After surgery, the patient needs long-term rehabilitation.
Removal of the prostate adenoma by the method of transverse (transverse) adenomectomy consists of a radical excision of the prostate hyperplastic tissue through a longitudinal incision of the anterior abdominal wall and the bladder. The operation is performed in the advanced stages of the disease, when the tumor reaches a large size, the bladder is exaggerated due to the overflow with accumulated urine and kidney failure develops.
The bladder is pre-fixed and filled with a sterile solution of furacillin or another substance. It is then isolated and taken in two places in special cases, for which the wall of the instrument is raised. The surgeon cuts the shaped fold and opens the bladder.
Along the inner edge of the installed urinary catheter, it defines the neck area of the bladder and around the opening of the urethra that appears in the field of view, departing from it by 0. 5-1 cm, makes an incision in the mucous membrane. After that, the urologist surgeon penetrates the thickness of the prostate with his finger, inserts it between the capsule of the tumor and the adenomatous nodes, excretes the latter. At the same time, with the finger of the other hand, which was previously inserted into the patient's rectum, the doctor supplies the gland to the anterior abdominal wall. It becomes more accessible to handle. Thanks to this technique, operating time is reduced and blood loss is reduced.
The surgeon then performs a hemostasis (cessation of bleeding) of the removed adenoma and sutures the bladder, leaving a fine drainage on the wound. It is designed to flush its cavity of formed blood clots. The urine catheter, which is inserted before the start of the operation, is not removed for 7-10 days. A new part of the urethra forms around it instead of the protective part of the urethra that was cut off during the operation.
Transverse adenomectomy is one of the most traumatic of all the techniques used for prostate adenoma. Accompanied by the risk of the following complications:
- Bleeding from the tumor bed.
- Congestive pneumonia?
- Violation of the function of motor emptying of the intestine, manifested by constipation.
To avoid complications, after the operation in the hospital, the patient is given early activation. The following side effects of surgery to remove a prostate adenoma may occur:
- Insufficient drainage of the bladder.
- Narrowing of his neck
- Penetration of periaster tissue into urine.
- The formation of a "pre-bladder" (residual cavity at the site where the prostate adenoma was removed).
- Stenosis of the urethral lumen.
- Urinary incontinence.
This negatively affects the quality of life of patients and prolongs the recovery time for adequate urination.
The consequences of the operation are less pronounced when the operation is performed using a laparoscope. Laparoscopic prostate adenoma surgery is one of the least invasive options for prostate surgery. This technique is used by hospital urologists if the patient has a large enough prostate adenoma.
If the prostate gland size of a patient with adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients who need surgery, this option is not suitable, as the gland reaches a size larger than 120 cm3. Laparoscopic surgery is not performed to remove the prostate adenoma with urolithiasis, inguinal hernia, vaginal cyst, anchoring of the joints of the lower extremities. In this case, the decision on the possibility of surgery is made collectively by the urologist, andrologist, abdominal surgeon and other specialists in the hospital.