Diagnosis and treatment of prostate adenoma

The most common urological pathology consulted by a urologist in men over 45 is prostate adenoma. The presence of this pathology significantly impairs the quality of life of men. One of the most frightening possible consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.

Surgical and medical methods of treatment are used to combat prostate adenoma. The most effective drugs or methods of surgery are selected by hospital specialists, taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of concomitant diseases. The surgical clinic has created comfortable conditions for the treatment of patients.

The reasons for the development of the disease

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

Prostate adenoma in men develops as a result of hormonal changes in the body associated with age-related changes. Testosterone levels (male hormone) gradually decrease with age, while the concentration of female sex hormone (estrogen), on the contrary, increases. This phenomenon is called male menopause.

The development of prostate adenoma may be due to the following risk factors:

• Until the patient's age - an enlarged prostate gland is extremely rare in men under the age of forty and after sixty years is diagnosed almost every second;
• Hereditary predisposition - if a prostate adenoma has been diagnosed in close blood relatives of a man, he has a huge risk of inheriting this disease in adulthood;
• Diabetes mellitus, cardiovascular diseases - a benign tumor (adenoma) of the prostate can be the result not only of these diseases themselves, but also of the harmful effects of drugs for their treatment (eg beta-blockers);
• Wrong lifestyle - the risk of developing prostate adenoma is increased in men with obesity, insufficient physical activity.

Symptoms

Prostate adenoma can be suspected when a man develops the following symptoms, which are most typical of this disease:

• increased urge to urinate;
• the appearance of the need for tension in the abdominal muscles to urinate;
• the presence of painful sensations, burning, slow flow of urine;
• discomfort and insufficient emptying of the bladder;
• increase the duration of the process of urination.

Prostate adenoma not only reduces the quality of life of men, but also leads to acute urinary retention, which requires the use of surgical treatments. To avoid surgery, many patients use special medications to treat prostate adenoma, eliminating symptoms and restoring normal prostate function. However, only a qualified specialist can offer the best treatment for prostatitis and prostate adenoma. You need to contact him when the first symptoms of the disease appear.

The treatment of prostate adenoma is individual for each patient. Medicines for the treatment of prostate adenoma, their dosage and duration of use are prescribed by your doctor. Taking medications for prostatitis and prostate adenoma can be not only ineffective but also dangerous. In view of the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in the elderly should be chosen taking into account the concomitant diseases.

Stages of disease development

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

• The first stage of the disease occurs with minimal urinary disorders. There may be a slight increase in its frequency, especially at night, and a slow stream of urine. The first stage can last from one year to 12 years or more.
• The second stage of prostate adenoma is characterized by more pronounced urinary disorders: intermittent urine flow, the appearance of the need for tension when urinating and a feeling of incomplete emptying of the bladder. Residual urine, which is retained in the bladder and urinary tract, causes an inflammatory process that is accompanied by pain, a burning sensation when urinating, pain in the lumbar region and above the pubis.
• The third stage is characterized by periodic or permanent involuntary urination, which forces the patient to use a bag of urine.

Complications

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

• Acute urinary retention - it is characterized by a sudden inability to empty the bladder and pain in the suprapubic region. In this condition, the patient needs urgent medical attention with catheterization or minor surgery;
• The appearance of urinary tract infections - stagnation of urine, which creates favorable conditions for the reproduction of pathogens, leads to the development of cystitis and pyelonephritis;
• The formation of stones in the bladder is also a consequence of stagnant urine;
• Damage to the bladder - with irregular emptying of the bladder, it stretches, the formation of protrusions (pockets) in the walls of the body, in which urine stagnates;
• Renal impairment - the increase in pressure in the ureters and bladder has a direct damaging effect on the kidneys, resulting in the development of renal failure.

Prostate adenoma and potency

Prostate adenoma and potency are closely related. The adenoma disrupts the structure of the glandular tissues, which in turn leads to damage to another, no less important organ - the testicles, which is responsible for the production of androgens. Thus, prostate adenoma can be a cause of impotence, requiring long and complex therapy.

Diagnosis

A simple and effective way to establish a preliminary diagnosis is to keep a diary of urination by the patient with fixation of quantitative and qualitative parameters: volumes of urine excreted, characteristics of fluid intake, imperative urge, nocturnal desire. The main method of physical examination in case of suspected prostate adenoma is digital rectal examination of the prostate to determine its enlargement and to exclude some other pathologies.

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

• General blood and urine tests;
• Biochemical blood tests for markers of kidney condition, urea and creatinine levels;
• PSA test (to rule out prostate cancer);
• Transrectal ultrasound examination (ultrasound);
• Uroflowmetry (to determine urine flow);
• Determination of the volume of residual urine (using ultrasound);
• Pelvic floor electromyography;
• Urethrocystoscopy;
• Excretory urography.

Treatment

Treatment of prostate adenoma is aimed at relieving the symptoms of the lower urinary tract, improving the patient's quality of life and preventing the development of complications of the disease. Patients with mild symptoms that do not worsen the quality of life are often prescribed follow-up tactics with regular check-ups by a urologist who monitors the course of the disease and gives recommendations on how to stop the growth of prostate adenoma. During this period, attention is focused on non-drug therapy. The above methods can be an adjunct to conservative treatment, which is taking the following drugs:

• Alpha-blockers (Tamsulosin, Alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• Phosphodiesterase type 5 inhibitors (Sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha-blockers;
• Muscarinic receptor blockers or M-anticholinergics.

For patients with advanced prostate adenoma, surgical treatment is recommended, which can be performed by several methods: transurethral excision, transurethral resection and removal of the prostate.

There are certain indications for the use of surgical treatment:

• Periodic urinary retention;
• Renal failure provoked by prostate adenoma;
• Bladder stones;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgery is required for patients in the absence of efficacy of drug treatment.

During conservative therapy or in the postoperative period, patients need constant medical monitoring with standard tests (determination of urine flow rate, ultrasound, PSA level analysis).

Drugs

There is a specific regimen for prescribing specific drugs to treat prostatitis and prostate adenoma. High efficiency of treatment is achieved thanks to the use of drugs from the group of alpha-reductase inhibitors and alpha-blockers. 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 pills for prostate adenoma? The list is topped by alpha1-adrenergic receptor blockers. In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.

The complex of drug therapy includes not only drugs. In prostate adenoma, conservative treatment can be supplemented with biologically active supplements - nutritional supplements that enhance the therapeutic effect of drugs and provide rapid recovery. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urination.

Treatment with drugs from the alpha1-adrenoceptor group of antagonists

These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve urine flow. Tamsulosin with the same name of the active substance, which is part of other drugs (Alfuzosin, Silodosin, etc. ), is a highly selective drug that has a selective effect on alpha1-adrenergic receptors on the muscles of the prostate, prostatic urethra and bladder. Due to the reduction of muscle tone, the flow and excretion of urine is facilitated. Tamsulosin, like all selective drugs, has a minimal number of side effects, does not affect vascular tone and can be prescribed to patients with chronic hypertension.

Alpha-adrenergic receptor antagonists should be used continuously to achieve a gradual reduction in irritation and obstruction in prostate adenoma. Tamsulosin in the treatment of prostate adenoma has a well-deserved priority in the prescriptions of urologists.

The tablet form of the drug is considered more progressive, because due to the controlled release of tamsulosin, the active substance is in the body at a constant concentration. The drug enters the bloodstream evenly, thus reducing the likelihood of developing the main side effect of drugs in the adrenergic blocking group - a sharp decrease in blood pressure.

An equally effective drug with the active ingredient tamsulosin is Urorek. The use of this drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, increased incidence of angina attacks in patients with coronary heart disease, so it can be prescribed to men with heart disease. Well-chosen dosage and compliance with all the rules for the use of drugs from the group of alpha-blockers allow to achieve a good therapeutic effect with almost no side effects.

Drugs from the group of reductase inhibitors (blockers)

Drugs from this pharmacological group (Finasteride, Dutasteride) help to relieve the flow of urine and therefore to eliminate the main symptoms of the disease. A stable therapeutic effect is manifested within two to three weeks after the start of the course. All symptoms stop completely after three months. According to the results of clinical trials, the maximum effectiveness is achieved after six months of therapy with these drugs.

Finasteride and dutasteride are specific inhibitors of type 2 alpha-alpha reductase (a cellular enzyme responsible for the transformation of testosterone to dihydrotestosterone). Prostate growth in BPH is directly related to this conversion of testosterone. Thanks to 5-alpha-reductase inhibitors, the production of intraprostatic dihydrotestosterone is blocked and its concentration in the blood is significantly reduced.

Finasteride and dutasteride are used for the following purposes:

• Treatment and control of prostate hyperplasia;
• Improving urine flow and eliminating the symptoms of prostate adenoma;
• Reduce the risk of developing acute urinary retention and the need for surgery.

Finasteride and Dutasteride have a pronounced antiandrogenic effect, ie they help to reduce the level of male hormones in the blood. In addition, these drugs have a teratogenic effect, so they should be taken with caution. With the help of modern drugs it is possible to stop the growth of the prostate and prevent the need for surgical treatment.

Antispasmodics and painkillers to exacerbate the disease

The main purpose of drugs with antispasmodic and analgesic action in exacerbation of prostate adenoma is to alleviate the general condition of the patient and eliminate pain. Non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen) have anti-inflammatory and analgesic effects. They help to combat not only the painful sensations that occur during urination, but also the constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, the swelling of the prostate gland is reduced, the body temperature is normalized and the unpleasant symptoms are also eliminated.

Non-opioid analgesics, produced in the form of tablets or suppositories, help relieve pain syndrome during exacerbation of prostate adenoma. The most readily available of these is metamizole sodium. However, this medicine is intended for single use only, as it can only work in mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthesia and novocaine (Ikhtammol, Benzocaine, Tribenoside + Lidocaine) are effective.

Vitamin E 400

Tocopherol acetate or vitamin E are often included in the complex treatment of prostate adenoma as an antioxidant, radioprotective agent and an indispensable link in the reproductive processes. Vitamin E in a dose of 400 mg urologists prescribe to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

The treatment of such a serious chronic disease as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medications on your own without first consulting your doctor, as self-medication in this case can be not only ineffective but also dangerous to men's health. Only a qualified professional can tell you which prostate adenoma pills are most effective in each case and which of them can cause adverse effects.

Operations

The urologists of the hospital masterfully perform classic and minimally invasive surgical interventions, apply innovative methods for surgical treatment of prostate adenoma. Each patient is selected for the operation that suits him best.

The generally accepted standard for surgical treatment of prostate adenoma is transurethral resection of the prostate. The operation is highly effective. After the intervention, patients get rid of the obstruction of the bladder outlet (narrowing of the urethra) and the associated symptoms. The rehabilitation period is short. Bleeding, the body's "water intoxication" syndrome, may develop during or after surgery.

Alternative methods of treating prostate adenoma include the following surgeries:

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

Complications subsequently occur less frequently, but these techniques are inferior to transurethral resection in terms of effectiveness, both clinically and economically.

Laparoscopic removal of a prostate adenoma is used when the tumor has grown significantly and is difficult to remove using transurethral resection. This operation is more difficult and is performed under general anesthesia. Through small incisions, the surgeon inserts special instruments into the body cavity to remove the prostate adenoma. The operation is performed according to the image from camcorders that is displayed on the screen. The main advantages of the intervention are the minimal amount of blood loss and the low probability of complications. After the operation, the patient does not need long-term rehabilitation.

When there are signs of prostate adenoma in men, doctors use a high-tech method to treat adenoma - laser enucleation. The intervention is performed with large neoplasms. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor is separated, divided into small pieces and then excreted. The method is considered minimally invasive. It has a number of significant advantages: it does not damage the integrity of the cavities, does not cause unnecessary damage.

Laser evaporation is the destruction of an adenoma by laser evaporation. The urologist inserts a special device through the urethra, leads it to the neoplasm and acts on it with a strong green laser. The depth of penetration of the laser and the accuracy of its impact allow to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the inability to take 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 the operation, the surgeon uses a scalpel to access the prostate gland and manually, using surgical instruments, removes the adenoma. As a result of the operation, significant blood loss may occur and complications may develop. After the operation, the patient needs long-term rehabilitation.

Removal of prostate adenoma by the method of transvesical (transvesical) adenomectomy consists in radical excision of hyperplastic prostate tissue by longitudinal incision of the anterior abdominal wall and bladder. The operation is performed in the advanced stages of the disease, when the tumor reaches a large size, the bladder is overstretched due to its overflow with accumulated urine and renal failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furacillin or another substance. It is then isolated and taken in two places on special holders, for which the wall of the organ is lifted. The surgeon dissects the formed fold and opens the bladder.

At the inner end of the installed urinary catheter, it defines the area of the bladder neck and around the opening of the urethra, which appears in the visual field, deviating from it by 0, 5-1 cm, makes an incision in the mucous membrane. Then the operative urologist penetrates with his finger into the thickness of the prostate, enters it between the tumor capsule and the adenomatous nodes, excretes the latter. At the same time, with the finger of the other hand, which is previously inserted into the patient's rectum, the doctor feeds the gland to the anterior abdominal wall. It becomes more accessible for manipulation. Thanks to this technique, the operation time is shortened and blood loss is reduced.

The surgeon then performs hemostasis (stopping the bleeding) on the removed adenoma bed and sutures the bladder, leaving a thin drain in the wound. It is designed to rinse its cavity from blood clots. The urinary catheter placed before the operation is not removed for 7-10 days. A new section of the urethra is formed around it instead of the prostatic part of the urethra cut out during the operation.

Transvesical adenomectomy is one of the most traumatic of all the techniques used for prostate adenoma. It is accompanied by a risk of developing the following complications:

• Bleeding from the bed of the tumor;
• Congestive pneumonia;
• Impaired motor-evacuation function of the intestine, manifested by constipation.

To avoid complications, the patient is given early activation after the operation in the hospital. The following side effects of prostate adenoma removal surgery:

• Insufficient bladder drainage;
• Narrowing of his neck;
• Infiltration of urine into the surrounding vesicular tissue;
• The formation of a "pre-bladder" (residual cavity at the site where the prostate adenoma is removed);
• Formation of narrowing of the lumen of the urethra;
• Urinary incontinence.

This negatively affects the quality of life of patients and prolongs the recovery time for adequate urination.

The consequences of the operation are less pronounced when the intervention is performed with the help of a laparoscope. Laparoscopic surgery for prostate adenoma is one of the less invasive options for prostate surgery. This technique is used by hospital urologists if the patient has a large enough prostate adenoma.

If the size of the prostate gland of a patient with adenoma does not exceed 120 cm3, transurethral resection of prostate adenoma is recommended. But for 10% of patients who need surgery, this option is not suitable, as the gland reaches a size above 120 cm3. Laparoscopic surgery to remove prostate adenoma with urolithiasis, inguinal hernia, diverticula of the bladder, ankylosis of the joints of the lower extremities is not performed. In this case, the decision about the possibility of surgery is made collectively by the urologist, andrologist, abdominal surgeon and other hospital specialists.