Benign prostatic hyperplasia (BPH) or adenoma is a growth of the stromal component or epithelium of the prostate.The disease occurs in men over 40 years old, less often at a younger age.According to statistics, the probability of its development after the age of 50 is approximately 40% and more than 75% after the age of 65. In fact, 90% of all men sooner or later face the disease, so it is necessary to know in advance the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Dangers
An adenoma is a benign formation, so in itself it does not harm the body.However, as the tissues grow, they block the lumen of the urinary canal, 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, bladder stones, damage to the bladder, and serious disturbances in the functioning of the kidneys, including 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 its results, choose the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be divided into three main stages, accompanied by various symptoms:
- I – characterized by more frequent imperative impulses, nocturia (increased volume of nocturnal urine output), the first signs of incontinence and a slower flow.The disease can remain in this stage for several years without developing a more severe form;
- II – more severe symptoms.The flow of urine can be interrupted, often having to strain to urinate, which often causes hernias 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 develop, kidney stones appear, and incontinence increases.General symptoms of poisoning may also appear: weakness, lack of appetite, nausea, constipation and constant dry mouth.
It is worth understanding that similar symptoms are accompanied by some types of nervous disorders and cancer.An accurate diagnosis can only be made in a clinic after proper investigations have been carried out.
Treatment of the disease
Currently, prostate adenoma hyperplasia is a fairly well studied disease.Its treatment is not particularly difficult and can be carried out in various ways, depending on the severity of the disease, its type, speed and stage of development, the age of the patient, his general health and other factors.
In general, all methods are conventionally divided into medicinal, non-medicinal and surgical.There are also many recipes of alternative (traditional) medicine, which include the use of various herbal preparations, but their effectiveness has not been proven by clinical trials, and in some cases, these methods of treating prostate adenoma only complicate the course of the disease and negatively affect the patient's condition.
Non-pharmacological 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 used.It consists of regular monitoring of the condition without the use of medications.Behavioral therapy is also provided, including:
- refusal to take anticholinesterases and diuretics without additional instructions from the treating physician;
- mandatory complete emptying of the bladder before bedtime;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- Reduce consumption of diuretic products and liquids, particularly three hours before bedtime.
The technique is used both independently and as an adjunct to drug therapy.
Pharmacological treatment
For severe to moderate symptoms, patients may be prescribed several 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: typically used in the treatment of impotence and its causes, but have also been shown to be effective 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 medications are used, as a rule, before surgery or in cases where it is contraindicated for some reason.
Surgery
Currently, surgical operations are considered the "gold standard" and the most effective treatment for prostate adenoma.With its help, it is possible to achieve complete removal of prostate adenoma with minimal consequences for the body, maintaining normal urination and erection.Its 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 treating doctor together with the patient after a thorough examination and examination.
Open adenomectomy
Open adenomectomy is a classic operation that involves making an incision in the perineum or lower abdomen and removing the inflamed glandular tissue using several instruments.The main advantage of the method is that it is well studied 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 heavy bleeding.In addition, due to the proximity of the prostate to the nerve ganglia, there is always a risk of damaging them, which leads to impaired sexual and urinary functions.
transurethral resection
Prostate adenoma TUR is a procedure to remove part of the prostate gland using an electroresection loop.Nowadays it is one of the most preferred and frequently performed operations due to its low invasiveness.All instruments are brought to the training through the urethral canal without any cuts, as a result of which there is no blood loss, no scars remain on the skin, and the recovery period is only a few days.In addition, during the procedure, complete information about the state of the urinary system is collected and any abnormalities found are eliminated.
Novelty in the treatment of prostate adenoma.
Minimally invasive methods using advanced technologies and equipment are considered the most promising.These include:
- Holmium laser enucleation of prostate hyperplasia (HoLEP): the operation is performed through small incisions (up to 2 cm).Using a laparoscope, a laser fiber is inserted into the bladder and through its neck to the gland.The adenomatous tissue is removed through careful incisions made with an ultra-precise and safe holmium crystal laser, after which it is fragmented.This approach guarantees an almost complete absence of damage to healthy tissue and minimal blood loss;
- Transurethral photoselective vaporization: the method involves completely burning damaged tissues using focused laser radiation without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates possible incisions and scars, allows a minimum number of relapses and reduces recovery time to several days;
- Robot-assisted laparoscopy: performed using the advanced Da Vinci robotic complex, equipped with the necessary tools and equipment for video recording.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 surgical field.The robot's special algorithms smooth out all sudden and random movements of the operator, completely eliminating the human factor such as shaking.The use of the complex allows you to perform the operation as accurately and accurately as possible, through small incisions of a few millimeters.
All of these methods have one major disadvantage: expensive equipment and the need for qualified and experienced personnel to work with them.Therefore, these techniques cannot be used in all hospitals.