Benign prostatic hyperplasia (BPH) or adenoma is a proliferation of the stromal component or epithelium of the prostate.The disease occurs in men over 40 years of age, less often at an earlier age.According to statistics, the probability of its development after 50 years is about 40%, and after 65 it is more than 75%.In fact, 90% of all men sooner or later develop the disease, so it is necessary to find out in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Driven
An adenoma is a benign formation and therefore does not harm the body.However, as the tissue grows, it blocks the lumen of the urinary canal, preventing the passage of urine.This is fraught 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, damage to the bladder and serious disorders of kidney function, including the development of kidney failure.Therefore, at the slightest appearance of symptoms, you must immediately make an appointment with a urologist, undergo a thorough examination and, based on the results, select the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be divided into three main stages, which are accompanied by various symptoms:
- I – characterized by more frequent compelling urge states, nocturia (increased volume of nocturnal diuresis), the first signs of incontinence and a sluggish flow of urine.The disease can persist in this stage for several years without progressing to a more severe form;
- II – more severe symptoms.The urinary stream may be interrupted, you often have to strain to urinate, which often leads to hernias and rectal prolapse.After using the toilet, a 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 occur, kidney stones appear and incontinence increases.General symptoms of intoxication may also occur - weakness, loss of appetite, nausea, constipation, constant dry mouth.
It is understood that similar symptoms are associated with some types of nerve disorders and cancer.An accurate diagnosis can only be made in a clinic after appropriate examination.
Treatment of the disease
Currently, prostate adenoma hyperplasia is a fairly well-studied disease.Treatment is not particularly difficult and can be carried out in different ways depending on the severity of the disease, its nature, speed and stage of development, the patient's age, his general 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, however, the effectiveness of which has not been proven by clinical studies, and in some cases such methods of treating prostate adenoma only complicate the course of the disease and have a negative effect on the patient's condition.
Non-drug methods
For mild or more serious symptoms of the disease that do not affect the quality of life, observational waiting, also known as active waiting, is used.It consists of regular monitoring of the condition without the use of medication.Behavioral therapy is also offered, including:
- Refusal to take anticholinesterase and diuretics without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- Physiotherapy, Kegel exercises and other activities to train the pelvic muscles;
- Reducing the consumption of diuretic products and liquids, especially three hours before bedtime.
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 predominance of congestion symptoms;
- Phosphodiesterase type V inhibitors – commonly used to treat impotence and its causes, but have also been shown to be effective in treating hyperplasia;
- Finasteride and other 5-alpha-reductase inhibitors – reduce the proliferation rate of prostate tissue and reduce its size.
These and other medications are usually used before surgery or in cases where it is contraindicated for some reason.
surgery
Surgical interventions are currently considered the “gold standard” and 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 erection.Their main advantage is the possibility of use at any stage of the disease.Several main types of surgical procedures are performed in our clinic.The decision about the treatment of a 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 in which an incision is made in the perineum or lower abdomen and inflamed glandular tissue is removed using various instruments.The main advantage of the method is that it is well studied and does not require 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 severe bleeding.In addition, due to the proximity of the prostate to the nerve nodes, there is always a risk of damage to them, which can lead to disruption of sexual and urinary functions.
Transurethral resection
Prostate adenoma TUR is a procedure to remove part of the prostate using an electroresection snare.Nowadays, it is one of the most preferred and frequently performed operations due to its low invasiveness.All instruments are inserted through the urethral canal without incisions, which means there is no blood loss, no scarring on the skin and the recovery time is only a few days.In addition, during the procedure, complete information about the condition of the urinary system is collected and any abnormalities identified are eliminated.
New in the treatment of prostate adenomas
Minimally invasive methods using advanced technologies and devices are considered promising.This includes:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP) – the operation is performed through small (up to 2 cm) incisions.Using a laparoscope, a laser fiber is inserted into the bladder and through its neck to the gland.The adenomatous tissue is removed through careful incisions with a high-precision and safe holmium crystal laser and then morcellated.This approach guarantees almost complete damage to healthy tissue and minimal blood loss;
- Transurethral photoselective vaporization - the method consists in completely burning out damaged tissue using focused laser radiation without damaging healthy cells.The procedure is performed through the urethral canal, which avoids cuts and scars, minimizes the number of relapses and shortens the recovery time to several days.
- Robotic laparoscopy – performed using the advanced Da Vinci robotic complex, equipped with the necessary tools and equipment for video recording.The control is carried out by an experienced surgeon at a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the operating 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 accurately as possible through small incisions of a few millimeters.
All of these methods have one significant drawback: expensive equipment and the need for experienced, qualified personnel to work with it.Therefore, such techniques cannot be used in every hospital.