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 old, 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 and modern treatment of adenomaprostate.
Dangers
Adenoma is a benign formation, therefore, by itself, it does not harm the body. However, growing, 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. The emerging congestion leads to the formation of infections, stones in the bladder, damage to it, as well as serious disorders in the work 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, undergo a thorough examination and, based on its results, choose the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be roughly divided into three main stages, accompanied by various symptoms:
- I - characterized by more frequent imperative urges, nocturia (an increase in the volume of nocturnal urine output), the first signs of incontinence, a more sluggish stream. At this stage, the disease can remain for several years without developing to a more severe form;
- II - more pronounced symptoms. The stream of urine can be interrupted, it is necessary to often push to urinate, which often leads to hernias and rectal prolapse. After visiting the toilet, there is a feeling of dissatisfaction, incomplete emptying. The disease develops more actively, the transition to the next form takes a relatively short time;
- III - due to the cumulative effect, the bladder stretches, its elasticity decreases, infections develop, kidney stones appear, and incontinence increases. General symptoms of poisoning may also appear - weakness, lack of appetite, nausea, constipation, persistent dry mouth.
It should be understood that similar symptoms are accompanied by some types of nervous disorders and cancer. An accurate diagnosis can only be made in the clinic after conducting appropriate research.
Treatment of the disease
At the moment, hyperplasia of prostate adenoma is a fairly well-studied disease. Its treatment does not cause any particular difficulties and can be performed in various 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 general, all methods are conventionally divided into drug, non-drug and surgical. There are also many recipes 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, negatively affecting the patient's condition.
Non-drug techniques
For mild symptoms or more severe symptoms that do not affect quality of life, watchful waiting, also called active waiting, is used. It consists in regular monitoring of the condition without the use of medications. Also, behavioral therapy is carried out, including:
- refusal to take anticholinesterase and diuretic drugs without additional 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;
- reducing the use of diuretic products and fluids, in particular - three hours before going to bed.
The technique is used both independently and as an adjunct to drug therapy.
Drug treatment
A number of medications may 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;
- type V phosphodiesterase inhibitors - commonly used in the treatment of impotence and its causes, but have proven to be effective in the treatment of hyperplasia;
- finasteride and other 5-alpha-reductase inhibitors - reduce the rate of proliferation of prostate tissues, reduce its size.
These and other drugs are usually used before surgery or in cases where it is contraindicated for some reason.
Surgery
Today, surgical operations are considered the "gold standard" and the most effective treatment for prostate adenoma. With their help, it is possible to achieve complete removal of prostate adenoma with minimal consequences for the body, maintaining normal urination and erection. Their main advantage is the ability to apply at any stage of the disease. In our clinic, several main types of surgical intervention 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 the inflamed glandular tissue using various instruments. The main advantage of the method is its good knowledge and the absence of the need for special equipment, so it can be used in almost any clinic. However, due to the openness, the operation is often accompanied by extensive bleeding. In addition, due to the proximity of the prostate to the nerve nodes, there is always a risk of damage leading to impaired sexual and urinary functions.
Transurethral resection
TURP of prostate adenoma is a procedure to remove part of the prostate gland using an electroresection loop. Today it is one of the most preferred and frequently performed operations 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, there are no scars on the skin, and the recovery period is only a few days. In addition, during the procedure, complete information about the state of the urinary system is collected and any abnormalities found are eliminated.
New in the treatment of prostate adenoma
The most promising are minimally invasive methods using advanced technologies and equipment. These include:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions. With the help of a laparoscope, a laser fiber is introduced into the bladder and through its neck is brought to the gland. Adenomatous tissue is removed using gentle incisions made with an ultra-precise and safe holmium crystal laser, after which it is morcellated. This approach guarantees almost complete absence of damage to healthy tissues and minimal blood loss;
- transurethral photoselective vaporization - the method consists in the complete burning of damaged tissues using 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 the recovery time to several days;
- robot-assisted laparoscopy - performed using the advanced robotic complex "Da Vinci", equipped with the necessary tools and equipment for video filming. The control is carried out by an experienced surgeon on a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the operating field. Special algorithms of the robot smooth out all sharp and random movements of the operator, completely eliminating such a human factor as tremors. The use of the complex allows you to perform the operation as accurately and accurately as possible, through small, several millimeters, incisions.
All these methods have a significant disadvantage - expensive equipment and the need for experienced qualified personnel to work with it. Therefore, such techniques may not be used in every hospital.