Diagnosis and treatment of prostate adenoma

The most common urological pathology that is referred to a urologist by men over the age of 45 is prostate adenoma. The presence of this pathology significantly impairs the quality of life for men. One of the most deplorable 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 combat prostate adenoma. The most effective medications or methods of surgical intervention are selected by the hospital specialists taking into account the stage of the disease, the general condition and age of the patient and the presence of concomitant diseases. The surgical clinic has created comfortable conditions for the treatment of patients.

Causes of disease development

The appearance of an adenoma is most often associated with age-related changes in the prostate, namely, a change in its structure and increase in size. As a result of such changes, the urethra, which is located in the thickness of the prostate gland, gradually narrows and there are disorders of the urinary process.

Prostate adenoma in men develops as a result of hormonal changes in the body, with age-related changes. The level of testosterone (male hormone) gradually decreases with age, on the contrary, the concentration of female sex hormone (estrogen) increases. This phenomenon is called male menopause.

The development of prostate adenoma may be due to the following risk factors:

• For patient age - Prostate enlargement is very rare in men under the age of forty and is diagnosed almost every second after sixty years;
• Hereditary predisposition - If a prostate adenoma is placed in a close relative of a man, he has a risk of inheriting this disease in adulthood;
• Diabetes mellitus, cardiovascular disease - benign prostate cancer (adenoma) can be caused not only by these diseases, but also by the harmful effects of medications (eg, beta-blockers);
• Improper lifestyle - The risk of developing prostate adenoma increases in overweight men, with insufficient physical activity.

Symptoms

Prostate adenoma can be suspected when a man has the following symptoms that are most typical for this disease:

• Increased urge to urinate;
• The appearance of the need for abdominal muscle tension for urination;
• Existence of painful sensations, burning, sluggish urine flow;
• Discomfort and insufficient emptying of the bladder;
• Increase the duration of the urinary process.

Prostate adenoma causes not only a decrease in the quality of life of men, but also acute urinary retention in them, which requires the use of surgical methods of treatment. To prevent surgery, many patients use special medications to treat prostate adenoma, relieve symptoms, and restore normal prostate function. However, only a qualified specialist can offer the best remedy 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 attending physician. Arbitrary intake of prostatitis and prostate adenoma medications can be not only ineffective but also dangerous. Given the presence of certain "personal" chronic diseases in older men, prostate adenoma treatment drugs in older men should be selected taking into account concomitant diseases.

Stages of disease development

Prostate adenoma is characterized by a gradual development that can be divided into three stages.

• The first stage of the disease is accompanied by minimal urinary disorders. There may be a slight increase in its frequency, especially at night and with sluggish urine. 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 urinary flow, the need for tension during urination, and the feeling of incomplete emptying of the bladder. Residual urine, which is stored in the bladder and urinary tract, causes an inflammatory process accompanied by pain, a burning sensation when urinating, in the lumbar region and in the head.
• The third stage is characterized by periodic or persistent involuntary discharge of urine, which forces the patient to use a urine park.

Complications

In some men, prostate adenoma does not worsen the quality of life and proceeds without the development of complications. However, in some cases, the disease can lead to the following negative consequences:

• Acute urinary retention - characterized by a sudden inability to empty the bladder and pain in the suprapubic area. In such a condition, the patient requires emergency medical care through catheterization or minor surgery;
• Emergence of urinary tract infections - 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 the result of stagnant urine;
• Damage to the bladder - with irregular emptying of the bladder, it stretches, forming a rash (pockets) in the walls of the body in which urine stops;
• Kidney Damage - Increased pressure in the ureters and bladder directly damages the kidneys, resulting in the development of kidney failure.

Prostate adenoma and potential

Prostate adenoma and potential are closely related. An adenoma disrupts the structure of glandular tissues, which in turn causes damage to another, no less important organ - the testicles, which are responsible for the production of androgens. Thus, prostate adenoma can be a cause of impotence, requiring long and difficult therapy.

Diagnosis

An easy and effective way to make a preliminary diagnosis is to keep a patient diary by fixing quantitative and qualitative parameters: excreted urine volumes, fluid intake characteristics, imperative requirement, night urge. A method of questionable physical examination of a prostate adenoma is to examine the digital rectum of the prostate to determine its enlargement and to rule out other pathologies.

Diagnosis of prostate adenoma is made in the hospital using the following laboratory and instrumental methods:

• General blood and urine tests;
• Biochemical blood tests for signs of kidney condition, urea and creatinine levels;
• PSA test (to rule out prostate cancer);
• Transrectal ultrasound examination (ultrasound);
• Uroflowmetry (to determine the speed of urine flow);
• Determination of residual urine volume (using ultrasound);
• Pelvic floor electromyography;
• Urethrocytoscopy;
• Excretory urography.

Treatment

Treatment of prostate adenoma aims to alleviate the symptoms of the lower urinary tract, improve the patient's quality of life and prevent the development of complications of the disease. Patients with mild symptoms that do not worsen their quality of life are often prescribed further tactics with regular examinations by a urologist who monitors the course of the disease and gives recommendations on how to stop the growth of prostate adenoma. The focus during this period is on non-drug therapy. The above methods can be added to conservative treatment, which is to take the following medications:

• Alpha blockers (tamsulosin, alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• 5 types of phosphodiesterase inhibitors (sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha blockers;
• Muscarin receptor blockers or M-anticholinergics.

For advanced patients with prostate adenoma, surgical treatment is recommended, which can be performed in several ways: transurethral resection, transurethral resection, and prostate removal.

There are some guidelines for using surgical treatment:

• Recurrent urinary retention;
• Renal failure, provoking prostate adenoma;
• Bladder stones;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgical intervention is necessary for patients in the absence of effective medical treatment.

During conservative therapy or in the postoperative period, patients need constant medical supervision with standard examinations (urine discharge determination, ultrasound, PSA level analysis).

drugs

There is a certain scheme according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. High efficacy of treatment is achieved due to the use of alpha-reductase inhibitors and drugs of the alpha-blocker group. These drugs for the treatment of prostate adenoma in men help 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? This list is headed by alpha 1-adrenoceptor blockers. 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 supplements - dietary supplements that enhance the therapeutic effect of the medication and ensure rapid recovery. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urine.

Treatment with drugs of the alpha 1-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. The active ingredient of the same name, tamsulosin, which is part of other drugs (alfuzosin, silodosin, etc. ), is a highly selective drug that has a selective action on alpha 1-adrenoceptors in the muscles of the prostate gland and bladder. Due to the reduction of muscle tone, urine flow and excretion are facilitated. Tamsulosin, like all selective medications, has minimal side effects, has no effect on vascular tone, and can be prescribed to patients with chronic hypertension.

Alpha-adrenoceptor antagonists should be used consistently to gradually reduce irritation and obstruction in prostate adenoma. The drug tamsulosin for the treatment of prostate adenoma takes a worthy priority in the prescriptions of urologists.

The tablet form of the drug is considered to be more progressive, since due to the controlled secretion of tamsulosin, the active substance is present in the body in constant concentrations. The drug enters the bloodstream evenly, thus reducing the likelihood of a major side effect of the drug in the adrenergic blocking group - a sharp decrease in blood pressure.

An equally effective drug with the active ingredient tamsulosin is urorec. Taking this drug has no side effects: orthostatic hypotension, tachycardia, increased heart rate in patients with coronary heart disease, so it can be prescribed to men with heart pathology. A well-chosen dose and adherence to all the rules of use of drugs of the group of alpha-blockers allow to achieve a good therapeutic effect in the almost complete absence of side effects.

Medications (reductants) of reductase inhibitors

Drugs of this pharmacological group (finasteride, dutasteride) help to alleviate urinary outflow and, consequently, eliminate the main symptoms of the disease. A stable therapeutic effect occurs within two or three weeks of starting the course. All symptoms completely disappear after three months. According to the results of clinical trials, maximum effectiveness is achieved after six months of therapy with these drugs.

Finasteride and dutasteride are specific inhibitors of type 2 5-alpha reductase (the cellular enzyme responsible for converting testosterone to dihydrotestosterone). The growth of the prostate gland in BPH is directly related to this conversion of testosterone. 5-alpha-reductase inhibitors block the production of intraprostatic dihydrotestosterone and significantly reduce its concentration in the blood.

Finasteride and dutasteride are used for the following purposes:

• Treatment and control of prostate hyperplasia;
• Improving urinary outflow and eliminating the symptoms of prostate adenoma;
• Reduce the risk of developing acute urinary retention and the need for surgery.

Finasteride and dutasteride have pronounced antiandrogenic action, e. g. ი. Helps 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 medicines it is possible to stop the growth of the prostate and avoid the need for surgical treatment.

Antispasmodics and pain pills for disease exacerbation

The main purpose of antispasmodic and analgesic action in exacerbation of prostate adenoma is to alleviate the general condition of the patient and eliminate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) (diclofenac, ibuprofen) have anti-inflammatory and analgesic effects. They contribute not only to the painful sensations arising during urination, but also to the constant pain in the bump and perineum. Thanks to the action of nonsteroidal anti-inflammatory drugs, the inflammatory process is reduced, the prostate gland is reduced, the body temperature is normalized and unpleasant symptoms are eliminated.

Non-opioid analgesics, produced in the form of tablets or suppositories, contribute to pain syndrome during exacerbation of prostate adenoma. The most readily available of these is sodium metamizole. However, this drug is intended for single use, as it can only act on moderate pain syndrome. In addition, analgesics of lidocaine, benzocaine, anesthesia and novocaine (Ihtamol, 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 an indispensable link in the reproductive processes. Vitamin E at a dose of 400 mg urologist prescribes to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

Treatment of a serious chronic disease such as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain drugs arbitrarily, without consulting a doctor, as in this case self-employment can be not only ineffective, but also dangerous to men's health. Only a qualified specialist can tell you which abia is most effective in each case of prostate adenoma and which of them can lead to negative consequences.

ᲝOperations

Hospital urologists skillfully perform classical and minimally invasive surgical interventions, using innovative methods of surgical treatment of prostate adenoma. Each patient will be selected for the surgery that suits him / her best.

The generally accepted standard for surgical treatment of prostate adenoma is transurethral resection of the prostate. The operation is very effective. After the intervention, patients get rid of bladder outlet obstruction (narrowing of the urethra) and related symptoms. The rehabilitation period is short. Bleeding, or "water intoxication" syndrome, may develop during or after surgery.

Alternative methods of treating prostate adenoma include the following surgical interventions:

• Stenting;
• Bladder enlargement;
• Hyperthermia;
• Thermotherapy;
• Ultrasound, laser and needle ablation;
• Interstitial coagulation.

After them, complications occur less frequently, but this technique lags behind 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 its removal using transurethral resection is problematic. This operation is more complicated and is performed under general anesthesia. With a small incision, the surgeon inserts special tools into the body cavity to remove a prostate adenoma. The operation is performed according to the image of the video camera that 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 the operation, the patient no longer needs prolonged rehabilitation.

When there are signs of prostate adenoma in men, doctors use a high-tech method of adenoma treatment - laser enucleation. The intervention is carried out with large neoplasms. Excess tissue is removed using a laser. The operation is performed through the urethra. The tumor is isolated, divided into small parts and then separated. The method is considered minimally invasive. It has a number of important advantages: it does not break the integrity of the cavities, does not cause unnecessary damage.

Laser evaporation is the destruction of an adenoma by laser steam. The urologist inserts a special device through the urethra, brings it to the neoplasm and acts on it point by point with a powerful green laser. The depth of penetration of the laser and the accuracy of its stroke allow to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the inability to take histological examination of tumor tissue.

In some situations, the inevitable method of treating a prostate adenoma is abdominal surgery - adenomectomy. It is held when other methods cannot help the patient. During the operation, the surgeon uses a scalpel to reach the prostate gland and manually, using surgical instruments, removes the adenoma. Significant blood loss and complications can result from surgery. The patient needs long-term rehabilitation after surgery.

Removal of a prostate adenoma by the method of transverse (transverse) adenomectomy consists of a radical excision of the prostatic hyperplastic tissue with a 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 stretched due to accumulation of accumulated urine, and renal failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furacillin or another substance. It is then insulated and taken in two places on special clamps, for which the body wall is raised. The surgeon makes the resulting fold and opens the bladder.

Along the inner end of the urinary catheter, it defines the neck area of the bladder and around the opening of the urethra, which appears in the field of view, moves away from it by 0. 5-1 cm, creates an incision in the mucosa after garsia, operative urologist reaches the thickness of the prostate with a finger. And between the adenomatous nodes, separating the latter. At the same time, with the finger of the other hand, which is previously inserted into the patient's rectum, the doctor feeds the gland to the anterior wall of the abdomen. This makes it more accessible for manipulation. Thanks to this technique, the operation time is reduced and blood loss is reduced.

The surgeon then performs removal of the removed adenoma bed (stopping the bleeding) and explains the bladder, leaving a thin drainage of the wound. It is created from a thrombus formed for its cavity rash. An urinary catheter inserted before surgery does not open for 7-10 days. A new section of the urethra forms around it instead of the prostate portion that was excised during the operation.

Transverse adenomectomy is one of the most traumatic of all the techniques used in prostate adenoma. It carries the risk of developing the following complications:

• Bleeding from a bed of neoplasms;
• Congestive pneumonia;
• Impairment of intestinal motor-evacuation function, manifested by constipation.

To avoid complications, the patient is given early activation after surgery in the hospital. The following side effects of surgery to remove a prostate adenoma may occur:

• Insufficient drainage of the bladder;
• Neck strain;
• Urinary infiltration of peri-vesicular tissue;
• Formation of a "pre-bladder" (at the site of removal of a residual hollow prostate adenoma);
• Formation of narrowing of the urethral lumen;
• ᲨHard incontinence.

This adversely affects the quality of life of patients and continues to restore adequate urination.

The results of the operation are less pronounced 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 large enough prostate adenoma.

If the size of the prostate gland of a patient with adenoma does not exceed 120 cm 3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients who need surgery, this option is not suitable since the gland size reaches more than 120 cm3. Laparoscopic surgery was not performed to remove a prostate adenoma, urolithiasis, inguinal hernia, bladder diverticula, ankylosis of the lower extremity joints. In this case, the decision on the possibility of surgery is made jointly by a urologist, andrologist, abdominal surgeon and other specialists of the hospital.