Diagnosis and treatment of prostate adenoma

The most common urological pathology with which men over the age of 45 consult a urologist is prostate adenoma. The presence of this pathology significantly impairs the quality of life of men. One of the most terrible 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 surgical intervention are chosen 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 comorbidities. The surgery clinic has created pleasant conditions for the treatment of patients.

Reasons for disease development

The appearance of an adenoma is most often associated with age-related changes in the prostate, ie 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, gradually shrinks and disorders in the process of urination appear.

Prostate adenoma in men develops as a result of hormonal changes in the body associated with age-related changes. Testosterone (male hormone) levels gradually decline 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:

• By the age of the patient - an enlarged prostate is extremely rare in men under the age of forty, and after the age of sixty it is diagnosed almost every second;
• Hereditary predisposition - if a prostate adenoma is diagnosed in close 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 in these diseases, but also in the harmful effects of drugs for their treatment (for example, beta-blockers);
• Wrong way of life - 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 that are most typical of this disease:

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

Prostate adenoma 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 treatment methods. 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 cure 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. Medications for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the attending physician. Taking medications for prostatitis and prostate adenoma on your own can be not only ineffective but also dangerous. Given the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in older men should be selected taking into account comorbidities.

Stages of disease development

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

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

Complications

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

• Acute urinary retention - characterized by a sudden inability to empty the bladder and pain in the suprapubic region. In such a condition, the patient needs urgent medical help with catheterization or minor surgery;
• 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 bladder stones is also a consequence of stagnant urine;
• Damage to the bladder - with irregular emptying of the bladder, it stretches, creating protrusions (pockets) on the walls of the organs, in which the urine stands;
• Kidney damage - an increase in pressure in the ureters and bladder has a direct detrimental effect on the kidneys, resulting in the development of renal failure.

Prostate adenoma and potency

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

Diagnosis

A simple and effective way to establish a preliminary diagnosis is to keep a diary of urination by the patient while fixing quantitative and qualitative parameters: the amount of urine excreted, fluid intake characteristics, imperative urge, nocturnal urge. The main method of physical examination for suspected prostate adenoma is digital rectal examination of the prostate in order to detect its enlargement 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 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 amount of residual urine (using ultrasound);
• Pelvic floor electromyography;
• Urethrocystoscopy;
• Excretory urography.

Treatment

Treatment of prostate adenoma is aimed at alleviating the symptoms of the lower urinary tract, improving the quality of life of the patient and preventing the development of complications of the disease. Patients with mild symptoms that do not worsen the quality of life are often prescribed monitoring 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 drug-free therapy. These methods can be an adjunct to conservative treatment, which is the intake of 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 reported by several methods: transurethral excision, transurethral resection and prostate removal.

There are certain indications for the use of surgical treatment:

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

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

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

Drugs

There is a specific scheme according to which certain drugs are prescribed to treat prostatitis and prostate adenoma. High treatment efficiency is achieved by 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 most commonly used pills against prostate adenoma? The list is led by alpha1-adrenergic receptor blockers. In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.

The drug therapy complex does not only include drugs. In the case of prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements, which enhance the therapeutic effect of drugs and ensure 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 group of alpha1-adrenoceptor 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 of prostate muscle, prostate. ureters and bladder. Due to the reduction of 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.

Alpha-adrenergic receptor antagonists must be used continuously to achieve a gradual reduction in irritation and obstruction of the prostate adenoma. The drug 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 in the body is in constant concentration. The drug enters the bloodstream evenly, thus reducing the likelihood of 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 side effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary heart disease, so it can be prescribed to men with heart pathologies. A well-chosen dose 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 complete absence of side effects.

Drugs from the group of reductase inhibitors (blockers)

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 stop completely after three months. According to the results of clinical studies, the maximum efficiency is achieved after six months of therapy with these drugs.

Finasteride and dutasteride are specific inhibitors of 5-alpha reductase type 2 (a cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone). Prostate growth in BPH is directly related to this testosterone conversion. 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 outflow and eliminating symptoms of prostate adenoma;
• It reduces the risk of developing acute urinary retention and the need for surgery.

Finasteride and Dutasteride have a pronounced antiandrogenic effect, ie. help reduce the levels 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 painkillers to worsen the disease

The main purpose of antispasmodic and analgesic drugs in exacerbation of prostate adenoma is to alleviate the general condition of the patient and eliminate pain. Nonsteroidal 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 with constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, prostate swelling is reduced, body temperature is normalized, and unpleasant symptoms are eliminated.

Non-opioid analgesics, produced in the form of tablets or suppositories, help alleviate the pain syndrome during the worsening of prostate adenoma. The simplest of these is metamizole sodium. However, this medicine is intended for single use only, as it can only work on mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthetic and novocaine (ichthamol, benzocaine, tribenoside + lidocaine) are effective.

Vitamin E 400

Tocopherol acetate or vitamin E are often involved in the complex treatment of prostate adenoma as an antioxidant, a radioprotective agent, and an indispensable link in reproductive processes. Vitamin E in a dose of 400 mg is prescribed by urologists 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 supervised by a urologist. It is strictly forbidden to take certain medications alone, without prior consultation with a doctor, because self-medication in this case can be not only ineffective, but also dangerous to men's health. Only a qualified specialist can tell you which pills against prostate adenoma are the most effective in each case, and which of them can cause negative consequences.

Operations

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

A generally accepted standard in the surgical treatment of prostate adenoma is transurethral resection of the prostate. The operation is very effective. After the intervention, patients resolve the obstruction at the exit of the bladder (narrowing of the urethra) and the associated symptoms. The rehabilitation period is short. Bleeding, the body's "water intoxication" syndrome, can develop during or after surgery.

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

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

After them, complications occur less frequently, but these techniques are inferior to transurethral resection in terms of efficacy, both clinically and economically.

Laparoscopic removal of prostate adenoma is used when the tumor has grown significantly, and it is problematic to remove it by 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 the video camera 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 of treating adenoma - laser enucleation. The intervention is performed in large neoplasms. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor separates, divides into small pieces, and then secretes. The method is considered minimally invasive. It has a number of significant advantages: it does not violate the integrity of cavities, it does not cause unnecessary damage.

Laser evaporation is the destruction of adenomas by laser evaporation. The urologist inserts a special device through the urethra, brings it to the neoplasm and acts on it at a point with a strong green laser. The depth of penetration of the laser and the accuracy of its impact make it possible to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and efficient. 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 and manually, using surgical instruments, removes the adenoma. Significant blood loss and complications can occur as a result of surgery. After the operation, the patient needs long-term rehabilitation.

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

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

Along the inner end of the installed urinary catheter determines the area of the bladder neck and around the opening of the urethra that appears in the field of view, deviating from it by 0, 5-1 cm, makes an incision in the mucous membrane. After that, the operative urologist penetrates the thickness of the prostate with his finger, enters between the tumor capsule and the adenomatous nodes, and secretes the latter. At the same time, with the finger of the other hand, which was previously inserted into the patient's rectum, the doctor feeds the gland towards 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) of the removed adenoma bed and sutures the bladder, leaving a thin drain in the wound. It is designed for rinsing the cavity from formed blood clots. The urinary catheter, inserted before the start of the operation, is not removed for 7-10 days. A new part of the urethra is formed around it instead of the prostatic part of the urethra that was excised 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 neoplasm layer;
• 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 side effects of prostate adenoma removal surgery may occur:

• Insufficient bladder drainage;
• Narrowing of the neck;
• Urine infiltration into peri-vesicular tissue;
• Formation of a "pre-bladder" (residual cavity at the site of prostate adenoma removal);
• Formation of urethral lumen narrowing;
• Urinary incontinence.

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

The consequences of surgery are less pronounced when the intervention is performed using a laparoscope. Laparoscopic prostate adenoma surgery 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 an 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, because the gland reaches a size larger than 120 cm3. Laparoscopic surgery to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticulum, ankylosis of the joints of the lower extremities is not performed. In this case, the decision on the possibility of surgery is made jointly by a urologist, andrologist, abdominal surgeon and other hospital specialists.