Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease occurs in men over 40 years, less often at an earlier 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, so you need to know in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
The Risks
Adenoma is a benign formation, therefore, in itself, does not harm the body. However, as it grows, the forming tissues block the lumen of the urinary tract, which prevents the passage of urine. This is due to a number of unpleasant complications and painful sensations, especially in the later stages. The overload shown leads to the formation of infections, bladder stones, its damage, as well as serious disorders in kidney function, up to 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 roughly divided into three main stages, accompanied by different symptoms:
- I - is characterized by more frequent necessary stimuli, nocturia (an increase in the volume of nocturnal urine output), the first signs of incontinence, a slower flow. At this stage, the disease may remain for several years without developing into a more severe form;
- II - more pronounced symptoms. The flow of urine can be interrupted, it is necessary to be pushed often to urinate, which often leads to hernia and prolapse of the rectum. After visiting the toilet, there is a feeling of dissatisfaction, incomplete emptying. The disease develops more actively, the transition to the other form requires relatively little time;
- III - due to the cumulative effect, the bladder stretches, its elasticity decreases, infections develop, kidney stones appear and continental incontinence increases. General symptoms of poisoning may also occur - weakness, loss of appetite, nausea, constipation, persistent dry mouth.
It should be understood that similar symptoms are accompanied by several types of nervous disorders and cancer. An accurate diagnosis can be made in the clinic only after conducting proper research.
Treatment of the disease
At present, prostate hyperplasia is a fairly well-studied disease. Its treatment does not cause any particular difficulty and can be carried out in different ways, depending on the severity of the disease, its type, speed and stage of development, 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 prescriptions from alternative (traditional) medicine, including 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 complicate the course ofdisease, adversely affecting the patient's condition.
Non-medicated techniques
For mild symptoms or more severe symptoms that do not affect quality of life, vigilant waiting is also used, also called active waiting. It consists of regular monitoring of the condition without the use of medication. Behavioral therapy is also performed, including:
- refusal to take anticholinesterase and diuretic drugs without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- physiotherapy exercises, Kegel exercises and other actions aimed at training the pelvic muscles;
- reducing the use of diuretics and fluids, in particular - three hours before going to bed.
The technique is used both independently and as an adjunct to drug therapy.
Medication treatment
A number of medications can 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 congestion-induced symptoms;
- phosphodiesterase type V inhibitors - commonly used in the treatment of impotence and its causes, but have been proven to be effective in the treatment of hyperplasia;
- finasteride and other 5-alpha-reductase inhibitors - reduce the rate of proliferation of prostate tissue, reduce its size.
These and other medications are usually used before surgery or in cases where it is contraindicated for any reason.
Surgery
Today, surgery is considered the "gold standard" and the most effective treatment for prostate adenoma. With their help, you can achieve complete removal of prostate adenoma with minimal consequences for the body, while maintaining normal urination and collection. Their main advantage is the ability to apply at any stage of the disease. In our clinic, several main types of surgical intervention are practiced. The decision on how to treat prostate adenoma is made by the attending physician along with the patient after an examination and thorough examination.
Open adenomectomy
Open adenomectomy is a classic operation that involves an incision in the perineum or lower abdomen and the removal of inflamed gland tissue using various instruments. The main advantage of the method is its good knowledge and lack of need for special equipment, so it can be used in almost any clinic. However, due to the opening, surgery is often accompanied by extensive bleeding. In addition, due to the proximity of the prostate to the nerve nodes, there is always the risk of damage leading to impaired sexual and urinary functions.
Transurethral resection
Prostate adenoma TURP is a procedure to remove part of the prostate gland using an electrosurgical loop. Today it is one of the most preferred and frequently performed surgeries due to its low invasiveness. All instruments are brought into formation through the urethral canal without any incision, as a result of which there is no blood loss, no wound on the skin and the recovery period is only a few days. In addition, during the procedure, complete information about the condition of the urinary system is collected and any abnormalities found are eliminated.
New in the treatment of prostate adenoma
Most promising are minimally invasive methods using advanced technology and equipment. This includes:
- Holmium laser nucleation 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 inserted into the bladder and through its neck is delivered to the gland. Adenomatous tissue is removed using soft incisions made with an ultra-precise and safe holmium crystal laser, after which it is marl. This approach guarantees almost complete absence of healthy tissue damage and minimal blood loss;
- transurethral photoselective evaporation - the method consists of the complete burning of damaged tissue using focused laser radiation without damaging healthy cells. The intervention is performed through the urethral canal, which excludes any incisions and wounds, allows you to achieve a minimum number of recurrences, reduces the recovery time to several days;
- robotic-assisted laparoscopy - performed using the advanced robotic complex "Da Vinci", equipped with the tools and equipment needed for video filming. The control is performed by an experienced surgeon in a special terminal and the image from the camera is displayed on a large high-resolution monitor, which significantly expands the field of operation. The robot's special algorithms smooth out all sharp and random movements of the operator, completely eliminating such a human factor as vibrations. The use of the compound allows you to perform the operation as accurately and precisely as possible, through small incisions, a few millimeters.
All of these methods have a significant disadvantage - expensive equipment and the need for experienced staff to work with it. Therefore, such techniques may not be used in every hospital.