Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease occurs in men over 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. In fact, 90% of all men sooner or later face the disease, so you need to know in advance about the causes, risk factors, symptoms andmodern treatment of prostate adenoma.
Dangers
An adenoma is a benign growth, so it does not harm the body in itself. However, as it grows, the tissues of the formation block the lumen of the urinary tract, which prevents the passage of urine. This is due to a number of unpleasant complications and painful sensations, especially in the later stages. Occurring congestion leads to the formation of infections, stones in the bladder, damage to it, as well as serious disorders of the kidneys, up to the development of failure. Therefore, at the slightest manifestation of symptoms it is necessary to immediately make an appointment with a urologist, to undergo a thorough examination and based on its results to choose the most effective method of treatment of prostate adenoma.
Stages and symptoms
The course of the disease can be roughly divided into three main stages, accompanied by different symptoms:
- I - characterized by more frequent urges, nocturia (increased volume of nocturnal urination), the first signs of incontinence, slower flow. At this stage, the disease can remain for several years without developing into a more severe form;
- II - more pronounced symptoms. The flow of urine can be interrupted, it is necessary to press frequently for urination, which often leads to hernias and prolapse of the rectum. After visiting the toilet you feel dissatisfaction, incomplete emptying. The disease develops more actively, the transition to the next form takes relatively little time;
- III - due to the cumulative effect, the bladder dilates, its elasticity decreases, infections develop, kidney stones appear and incontinence increases. General symptoms of poisoning may also occur - weakness, loss of appetite, nausea, constipation, constant dry mouth.
It should be understood that such symptoms are accompanied by certain types of nervous disorders and cancer. An accurate diagnosis can be made in the clinic only after an appropriate examination.
Treatment of the disease
At present, prostate hyperplasia is a fairly well-studied disease. Its treatment does not create special difficulties and can be performed in different ways, depending on the severity of the disease, its type, speed and stage of development, the patient's age, his general health and other factors.
In principle, all methods are conditionally divided into medicinal, non-medicinal and surgical. There are many prescriptions from alternative (traditional) medicine, including with the help 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, adversely affectingthe patient's condition.
Non-drug techniques
For mild symptoms or more severe symptoms that do not affect quality of life, careful 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 diuretic drugs without further instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- physiotherapy exercises, Kegel exercises and other actions aimed at training the pelvic muscles;
- reduce the use of diuretics and fluids, in particular - three hours before bedtime.
The technique is used both alone and as an adjunct to drug therapy.
Medication treatment
A number of medications can be prescribed for severe to moderate symptoms, including:
- alfuzosin, tamsulosin and other alpha blockers;
- solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear predominance of symptoms caused by congestion;
- phosphodiesterase type V inhibitors - often used in the treatment of impotence and its causes, but have proven their effectiveness in the treatment of hyperplasia;
- finasteride and other 5-alpha-reductase inhibitors - reduce the rate of proliferation of prostate tissue, reduce its size.
These and other drugs are usually used before surgery or in cases where it is contraindicated for some reason.
Surgery
Today, surgery is 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 toIn our clinic, several basic types of surgery are practiced. 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 that involves an incision in the perineum or lower abdomen and removal of inflamed glandular tissue using various instruments. The main advantage of the method is its good knowledge and the lack of need for special equipment, so it can be used in almost any clinic. However, due to the openness, the operation is often accompanied by heavy bleeding. In addition, due to the proximity of the prostate to the nerve nodes, there is always a risk of damage leading to sexual and urinary disorders.
Transurethral resection
TURP of prostate adenoma is a procedure to remove part of the prostate gland using electroresection. Today it is one of the most preferred and frequently performed surgeries due to its low invasiveness. All instruments are brought to the formation through the urethral canal without any incisions, as a result of which there is no blood loss, no scarring on the skin and the recovery period is only a few days. In addition, complete information about the condition of the urinary system is collected during the procedure and any deviations are eliminated.
New in the treatment of prostate adenoma
The most promising are minimally invasive methods using modern technologies and equipment. They include:
- Holmium laser enucleation of prostate hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions. With the help of a laparoscope, a laser fiber is inserted into the bladder and brought to the gland through its neck. Adenomatous tissue is removed using gentle incisions made with an ultra-precise and safe holmium crystal laser and then thawed. This approach ensures almost complete damage to healthy tissues and minimal blood loss;
- transurethral photoselective evaporation - the method consists in complete combustion of damaged tissues with the help of focused laser radiation without damaging healthy cells. The intervention is performed through the urethral canal, which excludes any incisions and scars, allows you to achieve a minimum number of relapses, reduces recovery time to several days;
- robotic assisted laparoscopy - is performed using the advanced robotic complex "Da Vinci", equipped with the necessary tools and equipment for video recording. The control is performed by an experienced surgeon at a special terminal, and the image from the camera is displayed on a large monitor with high resolution, The robot's special algorithms smooth out all sudden and random movements of the operator, completely eliminating such a human factor as tremors. .
All these methods have a significant disadvantage - expensive equipment and the need for experienced qualified staff to work with it. Therefore, such techniques may not be used in every hospital.