Benign prostatic hyperplasia (BPH) or adenoma is an overgrowth of the stromal component or epithelium of the prostate.The disease occurs in men over 40 years of age, less often at earlier ages.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 face this disease sooner or later, 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 in itself.However, as the tissues grow, they block the lumen of the urethra, which prevents the passage of urine.This is associated with a number of unpleasant complications and painful sensations, especially in the later stages.The resulting blockage leads to infections, the formation of stones in the bladder, its damage, as well as serious disturbances in the work of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, you should immediately make an appointment with a urologist, undergo a comprehensive 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 imperative urges, nocturia (increased volume of nocturnal diuresis), early signs of urinary incontinence and slower flow.The disease can remain at this stage for several years without progressing to a more severe form;
- II - more severe symptoms.The flow of urine can be interrupted, you often have to strain to urinate, which often leads to hernias and rectal prolapse.After visiting 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 occur, stones form in the kidneys, and urinary retention increases.Common symptoms of poisoning may also appear - weakness, loss of appetite, nausea, constipation, constant dry mouth.
It is worth understanding that similar symptoms are accompanied by some nervous diseases and types of cancer.An accurate diagnosis can only be made in the clinic after appropriate research.
Treatment of the disease
Currently, hyperplasia of the prostate adenoma is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in different ways depending on the severity, type, speed and stage of development of the disease, the patient's age, general health and other factors.
In general, all methods are conventionally divided into drug, non-drug and surgical.There are many recipes using alternative (traditional) medicine, including various herbal preparations, but their effectiveness has not been proven by clinical trials, and in some cases, such methods of prostate adenoma treatment only complicate the course of the disease and negatively affect the patient's condition.
Non-drug methods
Watchful waiting, also called active waiting, is used for mild symptoms of the disease or more serious symptoms that do not affect quality of life.It consists of regular monitoring of the condition without the use of drugs.Behavioral therapy is also provided, including:
- refusal to take anticholinesterase and diuretic drugs without additional instructions from the attending physician;
- forced complete emptying of the bladder before going to bed;
- physiotherapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reduce the consumption of diuretic products and fluids, especially three hours before bedtime.
The technique is used both independently and in addition to drug therapy.
Drug treatment
For severe to moderate symptoms, patients may be prescribed a number of medications, including:
- alfuzosin, tamsulosin and other alpha blockers;
- solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear preference for symptoms caused by congestion;
- phosphodiesterase type V inhibitors - usually 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 rate of proliferation of prostate tissue and reduce its size.
These and other drugs, as a rule, are used before surgery or in cases where there are contraindications for some reason.
Surgery
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 prostate adenoma with minimal consequences for the body, maintaining normal urination and erection.Their main advantage is the ability to use at any stage of the disease.In our clinic, several main types of surgical intervention are applied.The decision on how to treat prostate adenoma is made by the attending physician together with the patient after a thorough examination and examination.
Open adenomectomy
Open adenomectomy is a classic operation in which an incision is made in the perineum or lower abdomen, and the 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 fact that the operation is open, it is often accompanied by extensive bleeding.In addition, due to the proximity of the prostate gland to nerve nodes, there is always a risk of their damage, which leads to sexual and urinary dysfunction.
Transurethral resection
TUR of prostate adenoma is a procedure to remove part of the prostate gland by electroresection.Today, it is one of the most popular and frequently performed operations due to its low invasiveness.All instruments are inserted through the urethral canal without any incisions, resulting in no blood loss, no scarring, and recovery time of only a few days.In addition, during the procedure, complete information about the state of the urinary system is collected and detected abnormalities are eliminated.
New in the treatment of prostate adenoma
Minimally invasive methods using advanced technologies and equipment are considered the most promising.These include:
- Holmium laser enucleation of prostate 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 into the gland.Adenomatous tissue is removed using careful incisions made with an ultra-precise and safe holmium crystal laser, followed by morcellation.This approach guarantees almost complete absence of healthy tissue damage and minimal blood loss;
- transurethral photoselective vaporization - the method consists in completely burning damaged tissues using focused laser radiation without damaging healthy cells.The intervention is carried out through the urethral canal, which eliminates any cuts and scars, allows a minimum number of relapses and reduces the recovery time to a few days;
- robot-assisted laparoscopy - performed using an advanced Da Vinci robot 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 with high precision, which greatly expands the surgical field.Special robot algorithms smooth out all sudden and random movements of the operator, completely eliminating the human factor such as vibration.The use of the complex allows you to perform the operation as precisely 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.