Diagnosis and treatment of prostate adenoma

The most common urological pathology advised by a urologist from men over 45 is prostate adenoma. The presence of this pathology significantly impairs the quality of life for men. One of the most frightening possible consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.

To combat prostate adenoma, surgical and medical methods of treatment are used. The most effective medications or methods of surgical intervention are chosen by the hospital specialists taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of contemporary diseases. The surgical clinic has created comfortable conditions for the treatment of patients.

Reasons for the development of the disease

The occurrence of an adenoma is most often associated with age-related changes in the prostate, namely, 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, is gradually compressed and disturbances appear in the process of urination.

Prostate adenoma in men develops as a result of hormonal changes in the body accompanied by age-related changes. The level of testosterone (male hormone) gradually decreases with age, while the concentration of 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:

• By the age of the patient - an enlarged prostate gland is extremely rarely found in men under forty years of age and after sixty years is diagnosed almost every second;
• Hereditary predisposition - if a prostate adenoma is diagnosed in a man's close blood relatives, he has a high risk of inheriting the 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 overweight men, insufficient physical activity.

Symptoms

Prostate adenoma can be suspected when a man develops the following symptoms, which are more typical for this disease:

• increased desire to urinate;
• the emergence of the need for abdominal muscle tension for urination;
• presence of painful sensations, burning, slow flow of urine;
• discomfort and insufficient emptying of the bladder;
• increasing the duration of the urination process.

Prostate adenoma leads not only to a decrease in the quality of life of men, but also to the acute retention of urine in them, which requires the use of surgical methods of treatment. In order to avoid surgery, many patients use special medications to treat prostate adenoma, eliminating the symptoms and restoring normal prostate function. However, only a qualified specialist can suggest the best medicine 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. Drugs 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 can be not only ineffective but also dangerous. In view of the presence of some chronic "personal" diseases in older men, medications for the treatment of prostate adenoma in older men should be selected taking into account concomitant diseases.

Stages of disease development

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

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

Complications

In some men, prostate adenoma does not worsen the quality of life and persists without developing complications. However, in some cases, the disease can cause the following negative consequences:

• Acute urinary retention - is characterized by a sudden inability to empty the bladder and pain in the suprapubic region. With such a condition, the patient requires urgent medical attention with catheterization or a minor operation;
• The appearance of infections in the urinary tract - urinary retention, 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 a consequence of stagnant urine;
• Bladder damage - with irregular emptying of the bladder, it stretches, forming extensions (pockets) in the walls of the organ, in which urine stagnates;
• Kidney damage - increased pressure in the urethra and bladder has a direct detrimental effect on the kidneys, as a result of which kidney failure develops.

Adenoma and potency of the prostate

Prostate adenoma and potency are closely related. Adenoma disrupts the structure of glandular tissue, which, in turn, leads to damage to another, no less important organ - the testes, which is responsible for the production of androgens. Thus, prostate adenoma can be the cause of impotence, which requires long-term and complex therapy.

Diagnosing

A simple and effective way to establish a preliminary diagnosis is to keep a diary of urination by the patient by fixing quantitative and qualitative parameters: volumes of excreted urine, characteristics of fluid intake, necessary stimulation, overnight push. The main method of physical examination for suspected prostate adenomas is a digital examination of the prostate colon to detect its enlargement and to rule out some other pathologies.

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

• General blood and urine tests;
• Biochemical blood tests for markers of kidney status, 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;
• Urethrocystoscopy;
• Excretory urography.

treatment

Treatment for prostate adenoma aims to alleviate the symptoms of the lower urinary tract, improve the quality of life of the patient and prevent the development of complications of the disease. Patients with mild symptoms that do not impair quality of life are often prescribed follow-up 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. During this period, attention has focused on non-drug therapy. The above methods may be an adjunct to conservative treatment, which is taking the following medications:

• Alpha blockers (Tamsulosin, Alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• Phosphodiesterase inhibitors of type 5 (Sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha blockers;
• Muscarinic receptor blockers or M-anticholinergics.

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

There are certain indications for the use of surgical treatment:

• Repeated urinary retention;
• Kidney failure, provoked 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 from medication treatment.

During conservative therapy or in the postoperative period, patients need continuous medical supervision with standard studies (determination of urine flow rate, ultrasound, PSA level analysis).

dope

There is a definite 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 drugs of the group of alpha-reductase inhibitors and alpha-blockers. These drugs for the treatment of prostate adenoma in men help 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? The list is headed by alpha1-adrenergic receptor 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 additives - dietary supplements, which increase the therapeutic effect of the drug and ensure a speedy recovery. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urination.

Drug treatment of the alpha1-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. Tamsulosin with the same name of the active substance, which is part of other drugs (Alfuzosin, Silodosin, etc. ), is a highly selective drug that has a selective effect on alpha1-adrenergic receptors of the muscles of the prostate gland, prostate urethraand the bladder. Due to the reduction of muscle tone, the excretion and secretion of urine 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 continuously in order to achieve a gradual reduction of irritation and obstruction in the prostate adenoma. The drug Tamsulosin in the treatment of prostate adenoma takes a well-deserved advantage in the prescriptions of urologists.

The tablet form of the drug is considered more progressive, as due to the controlled release of tamsulosin, the active substance is in the body in a constant concentration. The drug enters the bloodstream evenly, thus reducing the likelihood of developing the main side effect of the medication in the adrenergic blocking group - a sharp drop in blood pressure.

An equally effective medicine with the active ingredient tamsulosin is Urorek. Taking this drug is not associated with the following adverse effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary heart disease, so it can be prescribed to men with cardiac pathology. A well-chosen dose and compliance with all rules for the use of drugs of the alpha-blocking group allow to achieve a good therapeutic effect with almost complete absence of side effects.

Reductase inhibitor group drugs

Drugs of this pharmacological group (Finasteride, Dutasteride) help in facilitating the excretion of urine and, consequently, in the elimination of the main symptoms of the disease. A lasting therapeutic effect occurs within two or three weeks after starting the course. All symptoms completely stop after three months. According to the results of clinical studies, maximum effectiveness 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 transforming testosterone into dihydrotestosterone). Prostate gland enlargement in BPH is directly related to this testosterone conversion. Thanks to 5-alpha-reductase inhibitors, the production of intraprostatic dihydrotestosterone is blocked and its concentration in the blood is significantly reduced.

Finasteride and Dutasteride are used for the following purposes:

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

Finasteride and Dutasteride have a pronounced antiandrogenic effect, d. m. th. help lower 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 prevent the need for surgical treatment.

Antispasmodics and pain pills to make the disease worse

The main purpose of drugs of antispasmodic and analgesic action in the aggravation of prostate adenoma is to alleviate the general condition of the patient and eliminate pain. Non-steroidal anti-inflammatory drugs (NSAIDs) (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help to fight not only the painful sensations that arise during urination, but also with constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, the swelling of the prostate gland is reduced, the body temperature is normalized and the unpleasant symptoms are also eliminated.

Non-opioid analgesics, 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 medicine is intended for single use only, as it can only act on mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthesia and novocaine (Ikhtammol, Benzocaine, Tribenoside + Lidocaine) are effective.

Vitamin E 400

Tocopherol acetate or vitamin E is often involved in the complex treatment of prostate adenoma as an antioxidant, radioprotective agent and an irreplaceable link in the reproductive processes. Vitamin E in a dose of 400 mg urologists prescribe to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

Treatment of such a serious chronic disease as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medications on your own, without first consulting your doctor, as self-medication in this case can be not only ineffective, but also dangerous to men's health. Only a qualified specialist can tell you which prostate adenoma pills are most effective in each case, and which ones can cause adverse effects.

operations

Hospital urologists skillfully perform classical and minimally invasive surgical interventions, apply innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the surgery 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 get rid of the blockage of the bladder outlet (narrowing of the urethra) and the accompanying symptoms. The rehabilitation period is short. During or after surgery, bleeding may develop, the body's "water intoxication" syndrome.

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

• Stenting;
• Balloon expansion;
• Hyperthermia;
• Thermotherapy;
• Ultrasound, laser and needle removal;
• 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 a prostate adenoma is used when the tumor has grown significantly and it is problematic to remove it using 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 performed according to the image from the video cameras, which is displayed on the screen. The main advantages of the intervention are the minimal amount of blood loss and the low likelihood of complications. After surgery, 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 nucleation. The intervention is performed with large neoplasms. Excess tissue is removed using a laser. The operation is performed through the urethra. The tumor divides, divides into small pieces and is then removed. The method is considered minimally invasive. It has a number of important advantages: it does not compromise the integrity of the cavities, it does not cause unnecessary damage.

Laser evaporation is the destruction of the adenoma by laser evaporation. The urologist introduces a special device through the urethra, brings it to the neoplasm and acts on it roughly with a strong green laser. The depth of penetration of the laser and the accuracy of its stroke make it possible to avoid damaging neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the inability to obtain tumor tissue for histological examination.

In some situations, an unavoidable method of treating a prostate adenoma is abdominal surgery - adenomectomy. It is performed when other methods cannot help the patient. During the operation, the surgeon uses a scalpel to enter 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.

Removal of prostate adenoma by the method of transveseous (transveseous) adenomectomy consists of radical incision of prostatic hyperplastic tissue through a longitudinal incision of the anterior abdominal wall and bladder. The operation is performed in the advanced stages of the disease, when the tumor reaches a large size, the bladder stretches excessively due to its overfilling with accumulated urine and kidney failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furacillin or another substance. It is then isolated and taken in two places in special holders, for which the organ wall is erected. The surgeon dissects the formed formation and opens the bladder.

Along the inner edge of the urinary catheter installed, it defines the area of the bladder neck and around the opening of the urethra that appears in the field of view, moving away from it by 0, 5-1 cm, makes an incision in the membranous mucosa. After that, the operative urologist penetrates the thickness of the prostate with his finger, enters it between the tumor capsule and the adenomatous nodes, removes 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 towards the anterior abdominal wall. It becomes more accessible for manipulation. Thanks to this technique, the operation time is shortened and the blood loss is reduced.

The surgeon then performs hemostasis (stopping bleeding) of the removed adenoma bed and sutures the bladder, leaving a thin drain on the wound. It is created to remove its cavity from the formed blood clots. The urinary catheter, inserted before the start of the operation, is not removed for 7-10 days. A new section of the urethra forms around it instead of the prostate portion of the urethra cut during surgery.

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

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

To avoid complications, after the operation in the hospital, the patient is activated early. The following undesirable consequences of surgery to remove a prostate adenoma may occur:

• Insufficient bladder drainage;
• Narrowing of his neck;
• Urinary infiltration of peri-vesicular tissue;
• Formation of a "pre-bladder" (the cavity left at the site where the prostate adenoma was removed);
• Formation of narrowing of the urethral lumen;
• Urinary incontinence.

This negatively affects the quality of life of patients and prolongs the recovery time for adequate urination.

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

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