Diagnosis and treatment of prostate adenoma

The most common urological pathology, which addresses the urologist, men over 45, is prostate adenoma.The presence of this pathology significantly exacerbates the quality of life of men.One of the most frightening consequences of the pathological process is the degeneration of benign prostate hyperplasia in a malignant tumor.

To combat prostate adenoma, surgical and treatment medication methods are used.Hospital specialists choose the most effective medicines or methods of surgical intervention taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of related pathologies.At the Surgery Clinic, comfortable conditions have been created for the treatment of patients.

Causes of the development of the disease

The appearance of adenoma is most often associated with age -related changes in the prostate, that is, a change in its structure and an increase in size.As a result of such changes, the urethra is gradually compressed, which is located in the thickness of the prostate gland and violations of the urination process appear.

Prostate adenoma in men develops due to the body's hormonal restructuring associated with age -related changes.The testosterone level (male hormone) is gradually decreasing with age, while the concentration of female sex hormone (estrogen), in contrast, increases.This phenomenon is called male menopause.

Prostate adenoma development may be due to the following risk factors:

• Patient age - prostate iron growth is extremely rare in men under forty years, and after sixty years is diagnosed almost every second;
• Hereditary predisposition - if the prostate adenoma was diagnosed in a man's close blood relatives, he has a great risk of inheriting this disease at an early age;
• Diabetes mellitus, cardiovascular disease-a benign tumor (adenoma) of the prostate can occur as a result of only these diseases themselves, but also the harmful effects of medicines for their treatment (for example, beta blockers);
• Wrong way of life - the risk of developing prostate adenoma has increased in overweight men, insufficient physical activity.

Symptoms

Prostate adenoma can be suspected when a person appears in the following symptoms that are most typical of the disease:

• urination tasks;
• the appearance of the need for abdominal muscle tension for urination;
• the presence of pain, burning, slow urine flow;
• insufficient bladder discomfort and emptying;
• Increasing the duration of the urination process.

Prostate adenoma leads not only to a decrease in the quality of life of a person, but also to an acute delay in urination, which requires the use of surgical treatment methods.To avoid surgical intervention, many patients use special medicines for the treatment of prostate adenoma, eliminating symptoms and restoring normal prostate activity.However, only a qualified specialist can suggest the best remedy for prostate and prostate adenoma.It is necessary to contact it when the first symptoms of the disease appear.

Treatment of prostate adenoma individually for each patient.Preparations for the treatment of prostate adenoma, their dose and duration of use are prescribed by the attending physician.Taking products from prostate and prostate adenoma independently can be not only an ineffective measure but also a dangerous measure.Due to the presence in men of the older generation of some chronic "personal" diseases, drugs for the treatment of prostate adenoma must be selected taking into account concomitant pathologies.

Stages of development of the disease

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

• The first stage of the disease continues with minimal urination disorders.Its insignificant growth, especially at night, and a slow flow of urine, can be observed.The first stage can last from one year to 12 years or more.
• The second phase of the prostate adenoma is characterized by more pronounced urination disorders: interruption of urine flow, the appearance of the need for strain during urination, and a feeling of incomplete bladder emptying.The remaining urine, which remains in the bladder and urinary tract, causes an inflammatory process associated with pain, burning sensation during urination, lower back pain and above pubis.
• The third stage is characterized by periodic or persistent involuntary urine release, which forces the patient to use the ureter.

Complications

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

• Acute urine delay - it is characterized by a sudden inability to empty the bladder and pain in the right region.With a similar condition, the patient needs urgent medical care with catheterization or a small surgery;
• The emergence of urinary tract infections is urinary stagnation, which creates favorable conditions for the reproduction of pathogens, leading to the development of cystitis and pyelonephritis;
• The formation of stones in the bladder - is also a consequence of urine stagnation;
• Bladder damage - with irregular bladder emptying, it is stretched, the formation of extensions (pockets) on the walls of the organ, in which urine stretches;
• Kidney damage - Increased pressure on the urethra and bladder has a direct pest pest effect on the kidneys, as a result of which kidney failure develops.

Adenoma and prostate power

Adenoma and prostate power are closely interconnected.Adenoma disrupts the structure of the gland tissue, which, in turn, leads to the loss of another, no less important organ - the testicles responsible for androgen products.Thus, prostate adenoma can cause impotence that requires prolonged and complex therapy.

Troubleshooting

A simple and effective way to create a preliminary diagnosis is the patient keeping a diary of urination by fixing quantitative and qualitative parameters: dedicated urine volumes, consumed fluid characteristics, indispensable calls.The main physical method of examination in case of suspicion of prostate adenoma is a rectal examination of the prostate finger to identify its growth and exclude some other pathologies.

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

• General blood and urine tests;
• Biochemical blood test for kidney, urea and creatinine markings;
• Dog level analysis (to exclude prostate cancer);
• Ultrasound transectal examination (ultrasound);
• Urofloometry (to determine the speed of urine current);
• Determination of the volume of the remaining urine (using ultrasound);
• Lower pelvic electromography;
• Urethrocystoscopy;
• Excreting urography.

Treatment

Treatment of prostate adenoma is aimed at alleviating the symptoms of the low urinary tract, improve the patient's quality and prevent the development of complications of the disease.Patients with poorly exposed symptoms, which do not exacerbate the quality of life, often prescribe dynamic observation tactics with regular examinations with a urologist who controls the course of the disease and gives recommendations on how to stop the increase in prostate adenoma.During this period, the attention is focused on not -drug therapy.Slatet methods can be an addition to conservative treatment, which is the following medication:

• Alpha blocker (tamsulosin, alfuzosin);
• 5-alpha reductase inhibitors (finsteride);
• Type 5 phosphodesterase inhibitors (sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha blockers;
• Muscarine receptor blockers or m-kolinolytics.

Patients with prostate adenoma at an advanced stage are recommended to perform surgical treatment, which can be performed with several methods: transurethral excision, transurethral resection and prostate removal.

There are several indications for the use of surgical treatment:

• Repeated urine delay;
• Kidney failure provoked by prostate adenoma;
• Stones in the bladder;
• Repeated urinary tract infections;
• Recurrence of hematuria.

Moreover, surgery is needed for patients in the absence of effectiveness from the treatment of medication.

In the course of conservative therapy or in the post -surgery period, patients need continuous medical examination with standard studies (determination of the rate of urine current, ultrasound, PSA level analysis).

drug

There is a certain scheme according to which specific medicines for the treatment of prostate and prostate adenoma have been prescribed.The high effectiveness of treatment is achieved thanks to the use of alpha and alpha-blockers inhibitors.These drugs for the treatment of prostate adenoma in men help to eliminate the main symptoms of the disease as well as to restore sufficient urination.

What are the most effective and widely used tablets by prostate adenoma?The list is driven by alpha1-adrenergic receptors.Moreover, this list includes inhibitors of 5-alpha reductase, vitamins and minerals.

The drug therapy complex includes not only medication.With prostate adenomas, conservative treatment can be supplemented with biologically active additives - dietary supplements that increase the therapeutic effect of medication and provide an early recovery.Some of them include zinc.This macro element is directly involved in spermatogenesis and testosterone synthesis.Plant phytosterols normalize urination.

Treatment with Antagonists Alpha1-Adrenoceptors

These drugs for the treatment of prostate and prostate adenoma provide relaxation of the smooth muscle of the urinary system and improve the urine process.Tamsulosin with the same name of the active substance, which is part of other drugs (Alfuzosin, silodinos, etc.), is a very long drug that has a selective effect on alpha1-adrenergic prostate muscles, prostatic urethra and bladder.Thanks to a decrease in muscle tone, the flow and release of urine are eased.Tamsulosin, like all selective medicines, has a minimal number of side effects, does not affect the tone of blood vessels and can be prescribed to patients with chronic hypertension.

Antagonists of alpha-adrenergic receptors should be used continuously in order to achieve a gradual decrease in irritation and obstruction with prostate adenoma.Tamsulosin of the drug in the treatment of prostate adenoma occupies a well -reserved advantage in the purpose of urologists.

The form of the drug tablet is considered more progressive, as due to the controlled release of the tamsulosin, the active substance is in the body in constant concentration.Medicine enters the blood flow evenly, thus providing a decrease in the likelihood of developing the main lateral effects of adreneehobocators group - a sharp decrease in blood pressure.

An equally effective medicine with the tamsulosin action substance is a lesson.Taking this medicine is not associated with the following undesirable effects: orthostatic hypotension, tachycardia, an increase in angina attacks in patients with coronary heart disease, so it can be prescribed for men with heart pathology.Properly selected dosage and compliance with all rules on the use of alpha-blocking group medicines allow you to achieve a good therapeutic effect in the almost complete lack of side effects.

Inhibitory group medicines (blockers) reductase

The drugs of this pharmacological group (finsteride, dutasteride) contribute to alleviating the flow of urine, and, therefore, the elimination of the main symptoms of the disease.A stable therapeutic effect occurs already two to three weeks after the start of the course.All symptoms are completely stopped after three months.According to the results of clinical studies, maximum efficiency is achieved after six months of therapy with these drugs.

Finasteride and dutasteride are specific inhibitors of the 2-type 5-alpha reductase (cellular enzymes responsible for converting testosterone into dihydrotestosterone).Prostate growth with prostate adenoma is directly associated with a similar testosterone transformation.Thanks to 5-alpha reductase inhibitors, intra-industrial dihydrotestosterone products are blocked and its concentration in the blood has been significantly reduced.

Finsteride and Dutasteride are used for the following purposes:

• Treatment and control of prostate hyperplasia;
• Improving urine flow and elimination of prostate adenoma symptoms;
• Reduce the risk of developing acute urine retention and the need to perform surgical interventions.

Finasteride and dutasteride have a pronounced antiandrogenic effect, ie.contribute to a decrease in male hormone levels in the blood.Moreover, these medicines have a teratogenic effect, so they must be taken carefully.With the help of modern medicines, you can stop the prostate growth and prevent the need for surgical treatment.

Antispasmodics and analgesic tablets with an irritation of the disease

The main recipe of antispasmodic and analgesic effects with prostate adenoma irritation is to relieve the patient's overall condition and eliminate pain syndrome.The anti -inflammatory and analgesic effect is exerted by non -steroidal anti -inflammatory drugs (Diclofenac, ibuprofen).They help to fight not only with painful sensations that occur in the urination process, but also with constant pain in the groin and perineum.Due to the action of non -steroidal anti -inflammatory drugs, the inflammatory process decreases, swelling of the prostate gland decreases, body temperature is normalized, and unpleasant symptoms are eliminated.

Neopoidal analgesics produced in the form of tablets or candles help to stop pain syndrome with prostate adenoma irritation.The most affordable of them is sodium metamizole.However, this medicine is aimed at using a time, as it can only affect a poor pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesia and novocaine (Ichtammol, benzocain, tribenoside + lidocaine) are effective.

Vitamin E 400

Tocopherol acetate or vitamin E is often part of the complex treatment of prostate adenoma as an antioxidant, radioprotective agent and an indispensable link in reproductive processes.Vitamin E at a dose of 400 mg urologists is prescribed to patients with erectile function disorders and spermatogenesis associated with adenoma of the prostate gland.

Treatment of such a serious chronic disease as a prostate adenoma should be prescribed and controlled by a urologist.Restion is strictly forbidden to take certain medicines independently, without a preliminary consultation with the attending physician, as self -medication in this case can be not only ineffective but also dangerous to male health.Only a qualified specialist can suggest which prostate adenoma tablets are the most effective in each case, and which of them can cause negative consequences.

OPERATION

Hospital urologists skillfully perform classical and minimal invasive surgical intervention, use innovative methods of prostate adenoma surgical treatment.Patiento patient is chosen that surgery that suits them the most.

The generally known standard in the surgical treatment of prostate adenoma is transurethral reservation of the prostate.The operation is very effective.After the intervention, patients get rid of infravismal barriers (narrowing of the urethra) and associated symptoms.The rehabilitation period is short.During or after surgery, bleeding can develop, "water intoxication" syndrome.

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

• Stenting;
• Balloon dilatation;
• Hyperthermia;
• Thermotherapy;
• Ultrasonic ablation, laser and needle;
• Interstitial coagulation.

After them, complications arise less frequently, but these methods are inferior to transurethral resection in terms of effectiveness, both in clinical and economic.

Laparoscopic removal of prostate adenoma is used when the tumor has increased significantly, and it is problematic to remove it using transurethral resection.This operation is more complicated, performed under anesthesia.Through small incisions, the surgeon presents special tools in the body cavity, which performs the removal of prostate adenoma.The operation is performed according to the image of video cameras, which appears on the screen.The main advantages of intervention are the minimum volume of blood loss, a slight probability 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 for the treatment of adenoma - laser enucleation.The intervention is performed with large neoplasm sizes.Excess fabrics are removed using a laser.The surgery is performed through the urethra.The tumor is divided, divided into small parts and then appears.The method is considered minimally invasive.There are a number of important advantages: it does not violate the integrity of the cavities, it does not cause unnecessary damage.

Laser vaporization consists of destroying adenoma with laser evaporation.Through the urethra, the urologist presents a special device, is brought to the neoplasm and accurately affects it with a strong green laser.The depth of the laser penetration and the accuracy of its hit can avoid damage to neighboring areas.The method is minimal, bloodless, fast and effective.Its only disadvantage is the inability to obtain a tumor tissue for histological examination.

In some situations, the inevitable method of treating prostate adenoma is abdominal surgery - adenomectomy.It is performed when other methods cannot help the patient.During surgery, one -scalp surgeon carries access to the prostate gland and by hand, using surgical instruments, removes adenoma.As a result of surgery, significant blood loss can occur, complications develop.After surgery, the patient needs prolonged rehabilitation.

Removal of prostate adenoma by the (excessive) custody adenomectomy method consists in the root removal of the hyperplaced prostate tissue through the longitudinal cutting of the anterior abdominal wall and bladder.The surgery is performed in the advanced stages of the disease, when the tumor reaches large sizes, the bladder is reversed due to its overflow of accumulated urine, and renal failure develops.

The bladder is predetermined and filled with a sterile solution of furatsilin or other substance.It is then allocated and taken in two places on special properties, for which they grow the wall of the organ.The surgeon dissects formed folding and performs the bladder opening.

From the inner end of the set urinary catheter, it determines the bladder neck area and around the urethra holes that appeared in the vision field, drawing 0.5-1 cm from it, makes the mucous membrane mucosa.After that, the operating urologist penetrates a finger into the prostate thickness, enters it between the tumor capsule and the adenomatous joints, and hesitates the latter.At the same time, the doctor gives the gland to the front of the patient in the patient's rectum in the rectum in the anterior abdominal wall.It becomes more affordable for manipulation.Thanks to this technique, the time of operation is reduced and blood loss decreases.

The surgeon then performs hemostasis (stopping bleeding) of the distant adenoma bed and sews the bladder, leaving a thin drainage in the wound.It is created to wash its cavity from the resulting blood clots.The urinary catheter, presented before the operation begins, is not extracted for 7-10 days.Around it, a new section of the urethra is formed instead of the side in the course of the prostatic part of the urethra.

The cuspular adenomectomy refers to the most traumatic of all the methods used for the adenoma of the prostate gland.It is associated with the risk of developing the following complications:

• Bleeding from the house of neoplasm;
• Stagnant pneumonia;
• Damaged function of intestinal motor evacuation, manifested by constipation.

To avoid complications, after hospital surgery, the patient is performed early activation.The following undesirable operations of operations may occur to remove prostate adenoma:

• Insufficient bladder drainage;
• Narrowing of his neck;
• Urinary infiltration of near tissue;
• The formation of "prenatal" (the remaining cavity in the place where the prostate adenoma was removed);
• Formation of narrowing of the urethra lumen;
• Incontinence of urine.

This adversely affects the quality of life of patients and prolongs the restoration of adequate urination.

The consequences of the operation are less pronounced when the intervention is performed using a laparoscope.Laparoscopic surgery to remove prostate adenoma is one of the least invasive options for surgical intervention in the prostate gland.Hospital urologists use this technique if the patient has a fairly large prostate adenoma.

If the patient's prostate gland with an adenoma does not exceed 120 cm3, recommended for transurethral prostate adenoma resection.But 10% for patients who need surgery, this option is not appropriate, as iron reaches more than 120 cm3.Laparoscopic surgery to remove prostate adenoma during uarolitiasis, inguinal hernia, bladder diverticula and ankylosis joints of the lower extremities are not performed.In this case, the decision on the possibility of having an operation is made collegial by a urologist, andrologist, a abdominal surgeon and other hospital specialists.