Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease occurs in men over the age of 40, less often at a younger 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, forwhat you should know in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Dangers
Adenoma is a benign formation, therefore, by itself, it does not harm the body. However, as they grow, the formation tissues block the lumen of the urinary tract, preventing the passage of urine. This is due to a number of unpleasant complications and painful sensations, especially in the later stages. The emerging congestion leads to the formation of infections, bladder stones, damage to it, as well as serious disorders in the work of the kidneys, up to the development of failures. Therefore, at the slightest manifestation of symptoms, it is necessary to immediately make an appointment with a urologist, undergo a full 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 roughly divided into three main stages, accompanied by various symptoms:
- I - characterized by more frequent imperative urges, nocturia (an increase in the volume of nocturnal urine output), the first signs of incontinence, a slower stream. At this stage, the disease can remain for several years without developing a more serious form;
- II - more pronounced symptoms. The stream of urine can be interrupted, it is necessary to push frequently to urinate, which often leads to hernias and prolapse of the rectum. After going to the toilet, there is a feeling of dissatisfaction, incomplete emptying. 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 intoxication may also appear: weakness, poor appetite, nausea, constipation, persistent dry mouth.
It should be understood that similar symptoms are accompanied by some types of nervous disorders and cancer. An accurate diagnosis can only be made in the clinic after proper research is done.
Treatment of the disease
At the moment, prostate hyperplasia is a fairly well-studied disease. Its treatment does not present any particular difficulty 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 state of health and other factors.
In general, all methods are conventionally divided into pharmacological, non-pharmacological and surgical. There are also many recipes of alternative (traditional) medicine, even with the help 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 complicatethe course of the disease. , negatively affecting the patient's condition.
Non-pharmacological techniques
For mild symptoms or more severe symptoms that do not affect quality of life, watchful waiting, also called active waiting, is used. It consists of a regular monitoring of the disease without the use of medications. In addition, behavioral therapy is conducted, including:
- refusal to take anticholinesterase and diuretic drugs without further instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- physical therapy exercises, Kegel exercises and other actions aimed at training the pelvic muscles;
- reduce the use of diuretic and liquid products, in particular, three hours before bedtime.
The technique is used both independently and as a complement to pharmacotherapy.
Drug treatment
Various medications may be prescribed for severe to moderate symptoms, 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: commonly used in the treatment of impotence and its causes, but have been shown to be effective in treating hyperplasia;
- Finasteride and other 5-alpha-reductase inhibitors - reduce the rate of proliferation of prostate tissues, reduce their size.
These and other drugs are usually used before surgery or in cases where it is contraindicated for any reason.
Surgery
Today, surgical operations are considered the "gold standard" and the most effective treatment for prostate adenoma. With its help, you can achieve the complete removal of the prostate adenoma with minimal consequences for the body, maintaining normal urination and erection. Its main advantage is the ability to be applied at any stage of the disease. Several main types of surgical intervention are practiced in our clinic. The decision on how to treat prostate adenoma is made by the treating physician together with the patient after a thorough examination and examination.
Open adenomectomy
Open adenomectomy is a classic operation that involves an incision in the perineum or lower abdomen and the removal of the inflamed glandular tissue using various instruments. The main advantage of the method is its good knowledge and the absence of the need for special equipment, so it can be used in almost any clinic. However, due to the opening, the operation is often accompanied by heavy bleeding. In addition, due to the proximity of the prostate to the nerve ganglia, there is always the risk of damage causing alterations in sexual and urinary functions.
Transurethral resection
TURP for prostate adenoma is a procedure to remove part of the prostate gland using an electroresection loop. Today it is one of the most preferred operations and performed due to its low invasiveness. All instruments are brought into 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 about the state of the urinary system is collected and any abnormalities found are eliminated.
Novelty in the treatment of prostate adenoma
The most promising are minimally invasive methods that use advanced technologies and equipment. These include:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP): the operation is performed through small incisions (up to 2 cm). With the help of a laparoscope, a laser fiber is introduced into the bladder and through its neck it is brought into the gland. Adenomatous tissue is removed through gentle incisions made with an ultra-precise and safe holmium crystal laser, after which it is ground. This approach guarantees the almost complete absence of damage to healthy tissues and minimal blood loss;
- Transurethral photoselective vaporization: the method consists of the complete burning of damaged tissues using focused laser radiation without damaging healthy cells. The intervention is performed through the urethral canal, which excludes incisions and scars, allows you to achieve a minimum number of relapses, reduces the 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 shooting. The control is carried out by an experienced surgeon in a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the operative field. The robot's special algorithms smooth out all jerky and random operator movements, completely eliminating a human factor such as tremors. The use of the complex allows you to perform the operation as accurately and precisely as possible, through small incisions of several millimeters.
All these methods have a significant disadvantage: expensive equipment and the need for experienced qualified personnel to work with them. Therefore, these techniques may not be used in all hospitals.