Benign prostatic hyperplasia (BPH) or adenoma is an overgrowth of the stromal component or epithelium of the prostate.The disease occurs in men over 40 years of age, less often at an earlier 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 sooner or later face the disease, so it is necessary to know in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Dangers
Adenoma is a benign formation, so it does not harm the body by itself.However, as the tissues grow, they block the lumen of the urethra, preventing the passage of urine.This is associated with a number of unpleasant complications and painful sensations, especially in the later stages.The resulting congestion leads to the formation of infections, stones in the bladder, damage to it, as well as serious disorders in the functioning of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, you should immediately make an appointment with a urologist, undergo a thorough examination and, based on its results, choose the most effective method of prostate adenoma treatment.
Stages and symptoms
The course of the disease can be divided into three main stages, accompanied by different symptoms:
- I - characterized by more frequent urges, nocturia (increased volume of nocturnal urine), first signs of incontinence and a slower flow.The disease can remain at this stage for several years without developing into a more severe form;
- II – more severe symptoms.The stream of urine can be interrupted, you have to strain often to urinate, which often leads to hernia and prolapse of the rectum.After visiting the toilet, a feeling of dissatisfaction and incomplete emptying remains.The disease develops more actively, the transition to the next form takes relatively little time;
- III – due to the cumulative effect, the bladder stretches, its elasticity decreases, infections, kidney stones develop, and incontinence increases.General symptoms of poisoning may also appear - weakness, lack of appetite, nausea, constipation, constant dry mouth.
It is worth understanding that such symptoms are accompanied by some types of nervous disorders and cancer.An accurate diagnosis can only be made in a clinic after conducting appropriate tests.
Treatment of the disease
Currently, hyperplasia of the prostate adenoma is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in different ways, depending on the severity of the disease, its type, speed and stage of development, the patient's age, his general state of health and other factors.
In general, all methods are conditionally divided into drug, non-drug and surgical.There are also many recipes from alternative (traditional) medicine, including the use of various herbal preparations, but their effectiveness has not been proven by clinical trials, and in some cases such methods of treating prostate adenoma only complicate the course of the disease, which negatively affects the patient's condition.
Non-drug methods
For mild symptoms of the disease or for more serious ones that do not affect the quality of life, watchful waiting, also called active waiting, is applied.It consists in regular monitoring of the condition without the use of drugs.Behavioral therapy is also available, including:
- refusal to take anticholinesterase and diuretic drugs without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before going to bed;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reducing the consumption of diuretic products and liquids, especially three hours before bedtime.
The technique is used both independently and as an addition to drug therapy.
Drug treatment
For severe to moderate symptoms, patients may be prescribed a number of medications, including:
- alfuzosin, tamsulosin and other alpha blockers;
- solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear predominance of symptoms caused by congestion;
- phosphodiesterase type V inhibitors - usually used in the treatment of impotence and its causes, but have proven their effectiveness in the treatment of hyperplasia;
- finasteride and other 5-alpha reductase inhibitors - reduce the rate of proliferation of prostate tissue and reduce its size.
These and other drugs are used, as a rule, before surgery or in cases where it is contraindicated for some reason.
surgery
Surgical operations are currently considered the "gold standard" and the most effective treatment for prostate adenoma.With their help, you can achieve complete removal of the prostate adenoma with minimal consequences for the body, maintaining normal urination and erection.Their main advantage is the possibility of use at any stage of the disease.Our clinic practices several main types of surgical interventions.The decision on how to treat prostate adenoma is made by the attending physician together with the patient after a thorough examination and examination.
Open adenomectomy
An open adenomectomy is a classic operation that involves an incision in the perineum or lower abdomen and removal of the inflamed tissue of the gland using various instruments.The main advantage of the method is that it is well researched and does not require special equipment, so it can be used in almost any clinic.However, due to the open nature of the operation, it is often accompanied by profuse bleeding.In addition, due to the proximity of the prostate to the nerve nodes, there is always a risk of their damage, which leads to a violation of sexual and urinary functions.
Transurethral resection
TUR of a prostate adenoma is a procedure to remove part of the prostate gland using an electroresection loop.Today, it is one of the most preferred and frequently performed operations due to its low invasiveness.All instruments are brought to the formation through the urethral canal without incisions, as a result of which there is no blood loss, no scars on the skin, and the recovery period is only a few days.In addition, during the procedure, complete information on the state of the excretory system is collected and detected anomalies are eliminated.
New in the treatment of prostate adenoma
Minimally invasive methods using modern technologies and equipment are considered the most promising.These include:
- Holm laser enucleation of prostatic hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions.Using a laparoscope, a laser fiber is inserted into the bladder and through its neck to the gland.Adenomatous tissue is removed through careful incisions made with an ultra-precise and safe holmium crystal laser, then morcellated.This approach guarantees almost complete absence of damage to healthy tissue and minimal blood loss;
- transurethral photoselective vaporization - the method consists in completely burning the damaged tissues with the help of focused laser radiation, without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates any incisions and scars, allows a minimal number of relapses and reduces the recovery time to a few days;
- robot-assisted laparoscopy - performed with an advanced Da Vinci robotic complex equipped with the necessary tools and equipment for video recording.Control is performed by an experienced surgeon on a special terminal, and the image from the camera is displayed on a large, high-resolution monitor, which significantly expands the surgical field.The robot's special algorithms smooth out all sudden and random movements of the operator, completely eliminating the human factor such as tremors.The use of the complex allows you to perform the operation as precisely and accurately as possible, through small incisions of a few millimeters.
All these methods have a significant drawback - expensive equipment and the need for experienced, qualified personnel to work with it.Therefore, such techniques cannot be used in every hospital.