Diagnosis and treatment of prostate adenoma

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

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

The reasons for the development of the disease

The occurrence 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, is gradually compressed and disturbances in the urination process appear.

Adenoma of the prostate in men develops as a result of hormonal changes in the body associated with age-related changes. The level of testosterone (male hormone) gradually decreases with age, while the concentration of the female sex hormone (estrogen), on the contrary, increases. This phenomenon is called male menopause.

The development of prostate adenoma can be caused by the following risk factors:

• By the age of the patient - an enlarged prostate gland is extremely rarely found in men under forty years old, and after sixty years it is diagnosed in almost every second;
• Hereditary predisposition - if a prostate adenoma was 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 result not only from these diseases themselves, but also from the harmful effects of drugs for their treatment (for example, beta-blockers);
• Wrong lifestyle - the risk of developing prostate adenoma is increased in men with obesity, insufficient physical activity.

Symptoms

Adenoma of the prostate can be suspected when a man develops the following symptoms, which are most typical for this disease:

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

Adenoma of the prostate leads not only to a decrease in the quality of life of men, but also to acute urinary retention in them, which requires the use of surgical methods of treatment. In order 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 suggest the best remedy for prostatitis and prostate adenoma. It is necessary to contact him when the first symptoms of the disease appear.

Treatment of prostate adenoma is individual for each patient. Drugs for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the attending physician. Taking remedies for prostatitis and prostate adenoma on your own 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 older people should be selected taking into account comorbidities.

Stages of development of the disease

Adenoma of the prostate is characterized by gradual development, which can be divided into three stages.

• The first stage of the disease proceeds with minimal urination disorders. There may be a slight increase in its frequency, especially at night, and a sluggish 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 disorders of urination: intermittent urine stream, the appearance of the need for straining 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, which is accompanied by pain, burning sensation when urinating, pain in the lumbar region and above the pubis.
• The third stage is characterized by periodic or constant involuntary discharge of urine, which forces the patient to use a urine bag.

Complications

In some men, prostate adenoma does not worsen the quality of life and proceeds without the development of 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. With such a condition, the patient requires emergency medical care with catheterization or a small operation;
• The occurrence of infections in the urinary tract - 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 organ, in which urine stagnates;
• Kidney damage - the increase in pressure in the ureters and bladder has a direct damaging effect on the kidneys, as a result of which renal failure develops.

Prostate adenoma and potency

Adenoma of the prostate and potency are closely interrelated. Adenoma disrupts the structure of the tissues of the gland, which, in turn, leads to damage to another, no less important organ - the testes, which is responsible for the production of androgens. Thus, prostate adenoma can be the cause of impotence, requiring long-term and complex therapy.

Diagnostics

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

Diagnosis of prostate adenoma in the hospital is carried out 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 the rate of urine flow);
• Determination of the volume of residual urine (using ultrasound);
• Pelvic floor electromyography;
• Urethrocystoscopy;
• Excretory urography.

Treatment

Treatment for prostate adenoma is aimed at relieving 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 examinations 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 addition to conservative treatment, which is the intake of the following drugs:

• Alpha blockers (Tamsulosin, Alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• Type 5 phosphodiesterase 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:

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

In addition, surgical intervention is necessary for patients in the absence of efficacy from drug treatment.

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

Drugs

There is a certain scheme according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. High efficiency of treatment is achieved due to the use of drugs of 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 restore sufficient urination.

What are the most effective and widely used pills for prostate adenoma? The list is headed by blockers of alpha1-adrenergic receptors. In addition, this list includes 5-alpha-reductase inhibitors, vitamins and minerals.

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

Treatment with drugs of the alpha1-adrenoceptor antagonist group

These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve the flow of urine. 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 the alpha1-adrenergic receptors of the muscles of the prostate gland, prostatic urethra and bladder. By reducing muscle tone, the outflow 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.

Antagonists of alpha-adrenergic receptors must be used constantly, so that a gradual decrease in irritation and obstruction in prostate adenoma can be achieved. The drug Tamsulosin in the treatment of prostate adenoma takes a well-deserved priority in the prescriptions of urologists.

The tablet form of the drug is considered more progressive, since due to the controlled release of tamsulosin, the active substance is in the body at a constant concentration. The drug enters the bloodstream evenly, thereby 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. Taking this drug is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary heart disease, so it can be prescribed to men with cardiac pathologies. A well-chosen dosage and compliance with all the rules for the use of drugs of the alpha-blocker group allow achieving a good therapeutic effect with almost complete absence of side effects.

Medicines of the group of reductase inhibitors (blockers)

The drugs of this pharmacological group (Finasteride, Dutasteride) help to alleviate the outflow of urine, and, consequently, to eliminate the main symptoms of the disease. A stable therapeutic effect occurs within 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, the maximum effectiveness is achieved after six months of therapy with these drugs.

Finasteride and Dutasteride are specific inhibitors of type 2 5-alpha reductase (a cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone). The growth of the prostate gland 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 prostatic hyperplasia;
• Improving the outflow of urine and eliminating the symptoms of prostate adenoma;
• Reducing the risk of developing acute urinary retention and the need for surgery.

Finasteride and Dutasteride have a pronounced antiandrogenic effect, i. e. help to reduce the level of male hormones in the blood. In addition, these drugs have a teratogenic effect, so they must 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 pain pills for exacerbation of the disease

The main purpose of drugs of 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 fight not only painful sensations arising during urination, but also with constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process decreases, the swelling of the prostate gland decreases, the body temperature is normalized, and unpleasant symptoms are also eliminated.

Non-opioid analgesics, produced in the form of tablets or suppositories, help to relieve pain syndrome during exacerbation of prostate adenoma. The most readily available of these is Metamizole sodium. However, this drug is intended rather for a single use, since it can only act on mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthesin and novocaine (Ikhtammol, Benzocaine, Tribenoside + Lidocaine) are effective.

Vitamin E 400

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

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 drugs on your own, without first consulting your doctor, since self-medication in this case may be not only ineffective, but also dangerous for men's health. Only a qualified specialist can tell you which pills for prostate adenoma are the most effective in each case, and which of them can cause negative consequences.

Operations

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

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

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

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

After them, complications occur less often, but these techniques are inferior to transurethral resection in efficiency, both clinically and economically.

Laparoscopic removal of prostate adenoma is used when the tumor has grown significantly, and it is problematic to remove it using transurethral resection. This operation is more difficult and is performed under general anesthesia. Through small incisions, the surgeon introduces special instruments into the body cavity, with which he removes the prostate adenoma. The operation is carried out according to the image from video cameras, which is displayed on the screen. The main advantages of the intervention are the minimal amount of blood loss and the low likelihood 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 of treating adenoma - laser enucleation. The intervention is carried out with large neoplasms. Excess tissue is removed using 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 violate the integrity of the cavities, does not cause unnecessary damage.

Laser vaporization is the destruction of the adenoma by laser vaporization. The urologist introduces a special device through the urethra, brings it to the neoplasm and acts on it pointwise with a strong green laser. The penetration depth of the laser and the accuracy of its hitting make it possible 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, an inevitable method of treating prostate adenoma is abdominal surgery - adenomectomy. It is performed when other methods cannot help the patient. During surgery, 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 surgery, the patient needs long-term rehabilitation.

Removal of prostate adenoma by transvesical (transvesical) adenomectomy consists in radical excision of hyperplastic prostate tissue through a longitudinal incision of the anterior abdominal wall and bladder. The operation is performed at 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 furacilin or another substance. Then it is 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.

Along the inner end of the installed urinary catheter, it determines the area of the bladder neck and around the opening of the urethra that appears in the field of view, stepping back from it by 0. 5-1 cm, makes an incision in the mucous membrane. After that, the operating urologist penetrates the thickness of the prostate with his finger, 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 towards the anterior abdominal wall. It becomes more accessible to manipulation. Thanks to this technique, the operation time is shortened and blood loss is reduced.

Then the surgeon performs hemostasis (stopping bleeding) of the removed adenoma bed and sutures the bladder, leaving a thin drainage in the wound. It is designed to flush its cavity from the formed blood clots. The urinary catheter, inserted before the start of 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 excised during the operation.

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

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

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

• Insufficient drainage of the bladder;
• Narrowing of his neck;
• Urinary infiltration of the peri-vesicular tissue;
• The formation of a "pre-bladder" (residual cavity in the place where the prostate adenoma was removed);
• Formation of narrowing of the lumen of the urethra;
• Urinary incontinence.

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

The consequences of the operation are less pronounced when the intervention is performed using a laparoscope. Laparoscopic prostate adenoma surgery is one of the less invasive options for surgical interventions on the prostate gland. This technique is used by hospital urologists if the patient has a sufficiently large prostate adenoma.

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