Diagnosis and treatment of prostate adenoma.

The most common urological pathology with which a urologist is consulted by men over 45 years of age is prostate adenoma. The presence of this pathology significantly impairs the quality of life of men. One of the most formidable possible consequences of the disease 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 drugs or methods of surgical intervention are selected by hospital specialists taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of comorbidities. The surgery clinic has created comfortable conditions to treat 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 such changes, the urethra, which is located in the thickness of the prostate gland, gradually compresses, and disturbances appear in the urination process.

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 the 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:

• Because of the age of the patient, an enlarged prostate gland is extremely rarely found in men under the age of forty, and after the age of sixty it is diagnosed almost every second;
• Hereditary predisposition - if a prostate adenoma was diagnosed in close blood relatives of a man, he is at great risk of inheriting this disease in adulthood;
• Diabetes mellitus, cardiovascular diseases - a benign tumor (adenoma) of the prostate can result not only from these diseases themselves, but also from the harmful effects of drugs for their treatment (for example, beta-blockers);
• Wrong lifestyle - the risk of developing prostate adenoma increases in men with obesity, insufficient physical activity.

Symptoms

A prostate adenoma can be suspected when a man develops the following symptoms, which are the most typical of this disease:

• increased need to urinate;
• the appearance of the need to strain 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.

Adenoma of the prostate leads not only to a decrease in the quality of life of men, but also to acute urinary retention in them, which requires the use of surgical methods of treatment. To avoid surgery, many patients use special medications to treat prostate adenoma, eliminating symptoms and restoring normal prostate function. However, only a qualified specialist can suggest 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. Taking remedies for prostatitis and prostate adenoma on your own can be not only ineffective, but also dangerous. In view of the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in older people should be selected with comorbidities in mind.

Stages of development of the disease.

Prostate adenoma is characterized by gradual development, which can be divided into three stages.

• The first stage of the disease progresses with minimal urination disturbances. There may be a slight increase in its frequency, especially at night, and a slow stream 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 pronounced urination disorders: intermittent urine stream, the appearance of the need to strain when urinating, and a sensation of incomplete emptying of the bladder. Residual urine, which is retained 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 a periodic or constant involuntary discharge of urine, forcing the patient to use a urine bag.

Complications

In some men, the prostate adenoma does not worsen the quality of life and progresses 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 region. With such a condition, the patient requires emergency medical care with catheterization or a small operation;
• The appearance of urinary tract infections - urine stagnation, which creates favorable conditions for the reproduction of pathogens, leads to the development of cystitis and pyelonephritis;
• Stone formation in the bladder is also a consequence of urine stagnation;
• Damage to the bladder - with irregular emptying of the bladder, it stretches, the formation of bumps (bags) on the walls of the organ, in which urine stagnates;
• Kidney damage: increased pressure in the ureters and bladder has a direct harmful effect on the kidneys, as a result of which kidney failure develops.

Adenoma and prostate potency

Prostate adenoma and potency are closely related to each other. Adenoma alters the structure of the gland's tissues, which, in turn, damages another no less important organ: the testes, which are responsible for the production of androgens. Therefore, prostate adenoma can be the cause of impotence, which requires complex and long-term therapy.

Diagnostics

A simple and effective way to establish a preliminary diagnosis is to keep a diary of the patient's urination with the setting of quantitative and qualitative parameters: volumes of urine excreted, characteristics of fluid intake, imperative urgency, nocturnal urgency. The main method of physical examination for suspected prostate adenoma is a rectal examination of the prostate to detect its enlargement and exclude some other pathologies.

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

• General blood and urine tests;
• Biochemical blood tests for kidney disease markers, urea and creatinine levels;
• PSA test (to rule out prostate cancer);
• Transrectal ultrasound examination (ultrasound);
• Uroflowmetry (to determine the rate of urine flow);
• Determination of residual urine volume (by ultrasound);
• Electromyography of the pelvic floor;
• Urethrocystoscopy;
• Excretory urography.

Treatment

Treatment of prostate adenoma aims to relieve lower urinary tract symptoms, improve the quality of life of the patient and prevent the development of complications of the disease. Patients with mild symptoms that do not worsen quality of life are often prescribed follow-up tactics with regular examinations by a urologist who monitors the course of the disease and provides recommendations on how to stop the growth of the prostate adenoma. During this period, the focus is on non-drug therapy. The above methods can be an addition to 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 blockers;
• Muscarinic or anticholinergic receptor blockers M.

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

There are certain indications for the use of surgical treatment:

• Recurrent urinary retention;
• Renal failure, caused by prostate adenoma;
• Stones in the bladder;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgical intervention is necessary for patients in the absence of efficacy of drug treatment.

During conservative therapy or in the postoperative period, patients need constant medical supervision with standard studies (determination of urine flow, 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 efficiency of treatment is achieved due to the use of drugs from the group of alpha-reductase inhibitors and alpha-blockers. These drugs for the treatment of prostate adenoma in men help to eliminate the main symptoms of the disease, as well as to restore sufficient urination.

What are the most effective and used pills for prostate adenoma? The list is headed by alpha1-adrenergic receptor blockers. Additionally, 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 additives - dietary supplements, which enhance the therapeutic effect of drugs and ensure rapid recovery. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urination.

Treatment with drugs from the group of alpha1 adrenergic receptor antagonists.

These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve the flow of urine. Tamsulosin with the same name as the active principle, 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, prostate glandurethra and bladder. Due to the decrease in muscle tone, urine output and excretion 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 constantly so that a gradual decrease in irritation and obstruction in the prostate adenoma can be achieved. The drug Tamsulosin in the treatment of prostate adenoma has a deserved priority in the prescriptions of urologists.

The tablet form of the drug is considered more progressive, since due to the controlled release of tamsulosin, the active substance is in the body in a constant concentration. The drug enters the bloodstream evenly, which reduces the likelihood of developing the main side effect of drugs in the adrenergic blocking group - a sharp decrease 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 heart pathologies. A well-chosen dose and compliance with all the rules for the use of drugs of the alpha-blocker group allow to achieve a good therapeutic effect with an almost complete absence of side effects.

Medicines from the group of reductase inhibitors (blockers)

Drugs of this pharmacological group (Finasteride, Dutasteride) help to alleviate urine output and, consequently, 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 disappear completely after three months. According to the results of clinical studies, maximum efficacy is achieved after six months of therapy with these drugs.

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

Finasteride and Dutasteride are used for the following purposes:

• Treatment and control of prostatic hyperplasia;
• Improve urine output and eliminate prostate adenoma symptoms;
• Reduce the risk of developing acute urinary retention and the need for surgery.

Finasteride and dutasteride have a pronounced antiandrogenic effect, that is, 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 drugs, it is possible to stop the growth of the prostate and prevent the need for surgical treatment.

Antispasmodics and analgesics for exacerbation of the disease.

The main objective of antispasmodic and analgesic drugs in exacerbation of prostate adenoma is to relieve the general condition of the patient and eliminate pain. Nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen) have anti-inflammatory and pain-relieving effects. They help to combat not only painful sensations that arise during urination, but also constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process decreases, the swelling of the prostate gland decreases, the body temperature is normalized, and unpleasant symptoms are also eliminated.

Non-opioid pain relievers, produced in the form of tablets or suppositories, help relieve pain syndrome during exacerbation of prostate adenoma. The most readily available of these is metamizole sodium. However, this drug is intended rather for single use, as it can only act on mild pain syndrome. Also, pain relievers 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, radioprotective agent, and an irreplaceable link in reproductive processes. Vitamin E in a dose of 400 mg urologists prescribe to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

The treatment of a chronic disease as serious as prostate adenoma must be prescribed and controlled by a urologist. It is strictly forbidden to take certain drugs on your own, without first consulting your doctor, since self-medication in this case can be not only ineffective, but also dangerous for men's health. Only a qualified specialist can tell you which prostate adenoma pills are the most effective in each case and which of them can have negative consequences.

Operations

Hospital urologists masterfully perform classic and minimally invasive surgical interventions, apply innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the operation that suits him best.

The generally accepted standard in the surgical treatment of prostate adenoma is transurethral resection of the prostate. The operation is very efficient. After the intervention, patients remove the bladder outlet obstruction (narrowing of the urethra) and associated symptoms. The rehabilitation period is short. During or after the operation, bleeding may develop, the syndrome of "water intoxication" of the body.

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

• Stent placement;
• Balloon dilation;
• Hyperthermia;
• Thermotherapy;
• Ultrasound, laser and needle ablation;
• Interstitial coagulation.

After them, complications occur less frequently, but these techniques are inferior to transurethral resection in terms of effectiveness, both clinically and economically.

Laparoscopic removal of prostate adenoma is used when the tumor has grown significantly and it is problematic to remove it by 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 carried out according to the image from the video cameras, which is displayed on the screen. The main advantages of the intervention are the minimal loss of blood and the low probability of complications. After the operation, 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: laser enucleation. The intervention is carried out with large neoplasms. Excess tissue is removed with a laser. The operation is done through the urethra. The tumor separates, divides into small parts, and is then excreted. The method is considered minimally invasive. It has a number of significant advantages: it does not violate the integrity of the cavities, it does not cause unnecessary damage.

Laser vaporization is the destruction of the adenoma by laser vaporization. The urologist inserts a special device through the urethra, brings it closer to the neoplasm and acts punctually with a powerful green laser. The depth of penetration of the laser and the precision of its impact prevent damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the impossibility of taking tumor tissue for histological examination.

In some situations, an 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 surgical instruments, removes the adenoma. As a result of the operation, significant blood loss can occur and complications can develop. After surgery, the patient needs long-term rehabilitation.

The removal of the prostate adenoma by the transvesical (transvesical) adenomectomy method consists of the radical excision of the hyperplastic prostatic 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 overstretched due to its overflow of accumulated urine, and kidney failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furacilin or another substance. Then it is isolated and taken in two places on special supports, for which the wall of the organ is raised. The surgeon dissects the formed fold and opens the bladder.

Along the inner end of the installed urinary catheter, determine the area of the bladder neck and around the opening of the urethra that appears in the field of vision, starting from it at 0. 5-1 cm, makes an incision inthe mucosa. membrane. After that, the surgical urologist penetrates the thickness of the prostate with his finger, enters it between the tumor capsule and the adenomatous nodes, excretes the latter. At the same time, with the finger of the other hand, which is previously inserted into the rectum of the patient, the doctor feeds the gland towards the anterior abdominal wall. It becomes more accessible to manipulation. Thanks to this technique, the operating time is shortened and blood loss is reduced.

The surgeon then performs hemostasis (stopping the bleeding) of the removed adenoma bed and sutures the bladder, leaving a thin drain in the wound. It is designed to cleanse your cavity from formed blood clots. The urinary catheter, which is inserted before the start of the operation, is not removed for 7 to 10 days. A new section of the urethra forms around it instead of the prostatic part of the urethra removed during the operation.

Transvesical adenomectomy is one of the most traumatic techniques used for prostate adenoma. It is accompanied by the risk of developing the following complications:

• Bleeding from the neoplasm bed;
• Congestive pneumonia;
• Violation of the motor evacuation function of the intestine, manifested by constipation.

To avoid complications, after the operation in the hospital, the patient receives early activation. The following undesirable consequences can occur from surgery to remove prostate adenoma:

• Insufficient drainage of the bladder;
• Narrowing of your neck;
• Urinary infiltration of peri-vesicular tissue;
• The formation of a "pre-bladder" (residual cavity in the place where the prostate adenoma was removed);
• Formation of narrowing of the lumen of the urethra;
• Urinary incontinence

This negatively affects the quality of life of patients and lengthens the recovery time for proper urination.

The consequences of the operation are less pronounced when the intervention is performed with a laparoscope. Laparoscopic prostate adenoma surgery is one of the least invasive options for prostate gland surgery. This technique is used by hospital urologists if the patient has a large enough prostate adenoma.

If the size of the prostate gland in 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, since the gland reaches a size of more than 120 cm3. Laparoscopic surgery is not performed to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticula, lower extremity joint ankylosis. In this case, the decision about the possibility of the operation is made collectively by the urologist, andrologist, abdominal surgeon, and other hospital specialists.