Benign prostatic hyperplasia (BPH) or adenoma is a growth of the stromal component or epithelium of the prostate.The disease occurs in men older than 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. Namely, 90% of all men sooner or later encounter the disease, so it is necessary to know in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Dangers
Adenoma is a benign formation, so it does not harm the body by itself.However, as the tissues grow, they block the lumen of the urethra, preventing the passage of urine.It 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, stones in the bladder, its damage, as well as serious disorders in the work of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, you must immediately make an appointment with a urologist, undergo a thorough examination and, based on its results, choose the most effective method of prostate adenoma treatment.
Stages and symptoms
The course of the disease can be divided into three main stages, accompanied by different symptoms:
- I - characterized by more frequent urges, nocturia (increased volume of nocturnal diuresis), first signs of incontinence and slower flow.The disease can remain in this stage for several years without developing into a more severe form;
- II – more severe symptoms.The stream of urine can be interrupted, you often have to strain to urinate, which often leads to hernia and prolapse of the rectum.After going to the toilet, the 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, 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 the clinic after appropriate research.
Treatment of diseases
At the moment, adenoma hyperplasia of the prostate is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in different ways, depending on the severity of the disease, its type, speed and degree of development, age of the patient, general state of health and other factors.
In general, all methods are conventionally divided into medical, non-medical and surgical.There are also many recipes from alternative (traditional) medicine, including the use 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 of the disease, negatively affecting the patient's condition.
Methods without drugs
For mild symptoms of the disease or for severe 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 drugs.Behavioral therapy is also provided, including:
- refusal to take anticholinesterase and diuretics without additional instructions from the doctor;
- mandatory complete emptying of the bladder before going to sleep;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reducing the consumption of diuretic products and fluids, especially three hours before going to bed.
The technique is used both independently and as an adjunct to drug therapy.
Drug treatment
For severe to moderate symptoms, patients may be prescribed a range of medications, including:
- alfuzosin, tamsulosin and other alpha blockers;
- solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear dominance of symptoms caused by congestion;
- phosphodiesterase type V inhibitors - usually 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 drugs are usually used before surgery or in cases where it is contraindicated for some reason.
Operation
Surgical operations are currently considered the "gold standard" and the most effective treatment for prostate adenoma.With their help, you can achieve complete removal of the prostate adenoma with minimal consequences for the body, maintaining normal urination and erection.Their 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 the method of treatment of prostate adenoma is made by the attending physician together with the patient after a detailed 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 tissue of the gland with various instruments.The main advantage of the method is that it is well studied and there is no need for 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 extensive bleeding.In addition, due to the proximity of the prostate to nerve nodes, there is always a risk of their damage, which leads to sexual and urinary function disorders.
Transurethral resection
TUR prostate adenoma is a procedure to remove part of the prostate using an electroresection loop.Today, it is one of the most preferred and most frequently performed operations due to its low invasiveness.All instruments are brought to the formation through the urethral canal without any incisions, due to 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 on the state of the urinary system is collected and all abnormalities found are eliminated.
New in the treatment of prostate adenoma
Minimally invasive methods using advanced technologies and equipment are considered the most promising.This includes:
- Holmium laser enucleation of prostate hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions.With the laparoscope, the laser fiber is inserted into the bladder and through its neck to the gland.Adenomatous tissue is removed through careful incisions made with an ultra-precise and safe holmium crystal laser, after which it is morcellated.This approach guarantees almost complete absence of damage to healthy tissue and minimal blood loss;
- transurethral photoselective vaporization - the method consists in the complete burning of damaged tissues using focused laser radiation without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates incisions and scars, allows for a minimal number of recurrences and shortens the recovery time to a few days;
- robot-assisted laparoscopy - performed using the advanced Da Vinci robotic complex, equipped with the necessary tools and equipment for video recording.Control is performed by an experienced surgeon on a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the surgical field.Special robotic algorithms smooth out all sudden and random movements of the operator, completely eliminating the 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 a few millimeters.
All these methods have a significant drawback - expensive equipment and the need for experienced, qualified personnel to work with it.Therefore, such techniques cannot be used in every hospital.