Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease occurs in men older than 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
Adenoma is a benign formation, so it does not harm the body by itself. However, as they grow, the formation tissues block the lumen of the urinary system, preventing the passage of urine. This is due to a series of unpleasant complications and painful sensations, especially in the later stages. New congestions lead to the formation of infections, stones in the bladder, damage to it, as well as serious disorders of kidney function, all the way 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, select 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:
- And - I am characterized by more frequent imperative urges, nocturia (increase in the volume of nocturnal urine output), the first signs of incontinence, slower flow. At this stage, the disease may remain for several years without progressing to a more severe form;
- II - more pronounced symptoms. Urine flow can be interrupted, it is necessary to push urination often, which often leads to hernia and rectal prolapse. 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 expands, its elasticity decreases, infections develop, kidney stones appear and incontinence increases. General symptoms of poisoning may also occur - weakness, lack of appetite, nausea, constipation, persistent dry mouth.
It should be understood that similar symptoms accompany some types of nervous disorders and cancer. An accurate diagnosis can be made in the clinic only after conducting appropriate research.
Treatment of diseases
Currently, prostate hyperplasia is a fairly well-studied disease. Its treatment does not cause special 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 drugs, non-medical 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, negatively affecting the patient's condition.
Drug-free techniques
For mild symptoms or more severe symptoms that do not affect quality of life, awake waiting is used, also called active waiting. It consists of regular monitoring of the condition without the use of medication. Also, behavioral therapy is performed, which includes:
- refusal to take anticholinesterase and diuretics without further instructions from a doctor;
- obligatory complete emptying of the bladder before bedtime;
- physiotherapy exercises, Kegel exercises and other actions aimed at training the pelvic muscles;
- reducing the use of diuretics and fluids, especially - three hours before bedtime.
The technique is used both independently and as an adjunct to drug therapy.
Drug 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 - commonly used in the treatment of impotence and its causes, but have been shown to be effective 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 medications 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 to apply at any stage of the disease. Several main types of surgical intervention are practiced in our clinic. The decision on how to treat a prostate adenoma is made by the doctor 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 a variety of instruments. The main advantage of the method is 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 heavy bleeding. In addition, due to the proximity of the prostate to the nerve nodes, there is always a risk of damage leading to impairment of sexual and urinary functions.
Transurethral resection
TURP prostate adenoma is a procedure to remove part of the prostate using an electroresection loop. Today, it is one of the most desirable and most frequently performed surgeries due to its low invasiveness. All instruments are brought to formation through the urethral canal without any incisions, resulting in no blood loss, no scars on the skin, and a recovery period of only a few days. In addition, during the procedure, complete information about the condition of the urinary system is collected and any abnormalities found are removed.
New in the treatment of prostate adenoma
The most promising are minimally invasive methods that use advanced technologies and equipment. These include:
- Holmium laser enucleation of prostate hyperplasia (HoLEP) - the operation is performed through small incisions (up to 2 cm). With the help of a laparoscope, the laser fiber is introduced into the bladder and leads to the gland through its neck. Adenomatous tissue is removed with mild incisions made with an ultra-precise and safe crystal holmium laser, after which it is morcelated. This approach guarantees almost complete absence of damage to healthy tissues and minimal blood loss;
- transurethral photoselective evaporation - the method consists in complete combustion of damaged tissues using focused laser radiation without damaging healthy cells. The intervention is performed through the urethral canal, which excludes all incisions and scars, enables the achievement of a minimum number of recurrences, reduces the recovery time to a few days;
- robotic laparoscopy - performed using an 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 in high resolution, which significantly expands the operative field. Special robot algorithms smooth out all sharp and random movements of the operator, completely eliminating such a human factor as trembling. The use of the complex allows you to perform the operation as accurately and precisely as possible, through small, a few millimeters, incisions.
All these methods have a significant drawback - expensive equipment and the need for experienced qualified staff to work with it. Therefore, such techniques should not be used in every hospital.