Diagnosis and treatment of prostate adenoma

The most common urological pathology is prostate adenoma, which is referred to a urologist by men over 45 years of age. The presence of this pathology significantly worsens the quality of life of men. One of the most frightening consequences of the pathological process is the transformation of benign prostatic hyperplasia into a malignant tumor.

Surgical and medical treatments are used to treat prostate adenoma. The most effective drugs or surgical interventions are selected 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 co-morbidities. The surgery clinic has comfortable conditions for the treatment of patients.

Causes of the disease

The formation of an adenoma is most often associated with age-related changes in the prostate, ie changes in structure and increase in size. As a result of such changes, the urethra, located in the thickness of the prostate gland, gradually shrinks, and there are disturbances in the process of urination.

In men, prostate adenoma develops as a result of hormonal changes associated with age-related changes in the body. Testosterone (male hormone) levels gradually decrease with age, while the concentration of female sex hormone (estrogen) increases. This phenomenon is called male menopause.

The development of prostate adenoma may be due to the following risk factors:

• Depending on the age of the patient - an enlarged prostate gland is very rare in men under forty years of age and is diagnosed almost every second after sixty years;
• Hereditary predisposition - if a man is diagnosed with prostate adenoma in close blood relatives, the risk of hereditary infection in adulthood is high;
• Diabetes mellitus, cardiovascular disease - 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 (eg, beta-blockers);
• Wrong lifestyle - obesity, low physical activity increases the risk of developing prostate adenoma in men.

Symptoms

Prostate adenoma can be suspected when a man develops the following symptoms, which are most characteristic of this disease:

• increased urination;
• appearance of the need for tension of the abdominal muscles for urination;
• presence of painful sensations, burning, slow urination;
• discomfort and insufficient emptying of the bladder;
• increase the duration of urination.

Prostate adenoma not only reduces the quality of life of men, but also leads to acute urinary retention, which requires the use of surgical treatment. To avoid surgery, many patients use special medications to treat prostate adenoma, relieve symptoms, and restore normal prostate function. However, only a qualified specialist can offer the best remedy for prostatitis and prostate adenoma. It is necessary to contact him at the first symptoms of the disease.

Treatment of prostate adenoma is individual for each patient. Medications, doses and duration of use for the treatment of prostate adenoma are determined by the attending physician. Taking medications for prostatitis and prostate adenoma alone 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 the elderly should be selected taking into account co-morbidities.

Stages of disease development

Prostate adenoma is characterized by a gradual development that can be divided into three stages.

• The first stage of the disease continues with minimal urination. There may be a slight increase in frequency, especially at night, and a slow urine flow. The first stage can last from one to 12 years or more.
• The second stage of prostate adenoma is characterized by more pronounced urination: intermittent urination, the need for tension during urination, and a feeling of incomplete emptying of the bladder. Residual urine stored in the bladder and urinary tract causes an inflammatory process, which is accompanied by pain, burning sensation when urinating, pain in the lower back and pubis.
• The third stage is characterized by periodic or continuous forced urine flow that forces the patient to use the bladder.

Complications

In some men, prostate adenoma does not worsen the quality of life and continues without developing complications. However, in some cases, the disease can lead to the following negative consequences:

• Acute urinary retention - characterized by inability to empty the bladder and pain in the suprapubic region. In this case, the patient needs urgent medical attention with catheterization or a small operation;
• Occurrence of urinary tract infections - stagnation of urine, which creates favorable conditions for the proliferation of pathogens, leads to the development of cystitis and pyelonephritis;
• The formation of stones in the bladder is also the result of stagnant urine;
• Bladder damage - extends to the irregular emptying of the bladder, the formation of protrusions (pockets) in the walls of the body, where urine stagnates;
• Kidney damage - Increased pressure in the bladder and bladder has a direct damaging effect on the kidneys, resulting in the development of kidney failure.

Prostate adenoma and strength

Prostate adenoma and potential are closely related. Adenoma disrupts the structure of glandular tissue, which in turn damages another less important organ responsible for the production of androgens - the testicles. Thus, prostate adenoma can be the cause of impotence, requiring long-term and complex therapy.

Diagnostics

A simple and effective way to make an initial diagnosis is to keep a diary of the patient with the determination of quantitative and qualitative parameters: the volume of urine excreted, the characteristics of fluid intake, imperative desire, night call. The main physical examination method for suspected prostate adenoma is digital rectal examination to detect prostate enlargement and rule out some other pathologies.

Diagnosis of prostate adenoma in the hospital is made using the following laboratory and instrumental methods:

• General blood and urine tests;
• Biochemical blood tests for kidney status, urea and creatinine levels;
• PSA test (to rule out prostate cancer);
• Transrectal ultrasound examination (ultrasound);
• Uroflowmetry (to determine the speed of urine flow);
• Determination of residual urine volume (using ultrasound);
• Electromyography of the pelvic floor;
• Urethrocystoscopy;
• Excretory urography.

Treatment

Treatment of prostate adenoma aims to eliminate the symptoms of the lower urinary tract, improve the patient's quality of life and prevent complications of the disease. Patients with mild symptoms that do not worsen the quality of life are often prescribed follow-up tactics by a urologist who monitors the progress of the disease and makes recommendations to stop the growth of prostate adenoma. During this period, the focus was on non-pharmacological treatment. The above methods can be added to conservative treatment with 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, several surgical treatments are recommended: transurethral excision, transurethral resection, and prostate removal.

There are certain indications for the use of surgical treatment:

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

In addition, patients may need surgery if drug treatment is ineffective.

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

Drugs

There is a specific scheme in which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. High efficacy of treatment is achieved due to the use of alpha-reductase inhibitors and alpha-blockers. For the treatment of prostate adenoma in men, these drugs help to eliminate the main symptoms of the disease, as well as restore urinary excretion.

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 drug therapy complex does not cover only drugs. In the case of prostate adenoma, conservative treatment can be supplemented with dietary supplements - biologically active additives that increase the therapeutic effect of drugs and ensure rapid recovery. Some have zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urinary excretion.

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 urine flow. Tamsulosin, which is active with the same substance as 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. urinary tract and bladder. Due to the decrease in muscle tone, it is easier to urinate and excrete urine. 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 should be used regularly to achieve a gradual reduction in irritation and obstruction in prostate adenoma. In the treatment of prostate adenoma, the drug Tamsulosin is a worthy priority in the prescriptions of urologists.

The tablet form of the drug is considered more advanced because the active substance is in a constant concentration in the body due to the controlled release of tamsulosin. The drug enters the bloodstream evenly, thereby reducing the likelihood of developing the main side effect of drugs in the group of adrenergic blockers - a sharp drop in blood pressure.

Urorek is an equally effective drug with the active ingredient tamsulosin. Taking this drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, increased angina in patients with coronary heart disease, so it can be prescribed to men with heart disease. A well-chosen dosage and compliance with all the rules for the use of drugs of the alpha-blocker group allow you to achieve a good therapeutic effect with almost complete side effects.

Drugs belonging to the group of reductase inhibitors (blockers)

Drugs of this pharmacological group (Finasteride, Dutasteride) help to reduce urine flow and, consequently, 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 effectiveness is achieved after six months of treatment with these drugs.

Finasteride and Dutasteride are specific inhibitors of type 2 5-alpha reductase (a cellular enzyme responsible for the conversion of testosterone to dihydrotestosterone). Prostate enlargement 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 prostate hyperplasia;
• Improving urine flow and eliminating the symptoms of prostate adenoma;
• Reducing the risk of developing acute urinary retention and surgical intervention.

Finasteride and Dutasteride have a pronounced antiandrogenic effect, ie. helps reduce the level of male hormones in the blood. In addition, these drugs have a teratogenic effect, so they should 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 that have antispasmodic and analgesic effects in the exacerbation of prostate adenoma is to alleviate the general condition of the patient and relieve pain. Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help to cope not only with the painful sensations that occur during urination, but also with persistent pain in the groin and perineum. The effect of non-steroidal anti-inflammatory drugs reduces the inflammatory process, reduces swelling of the prostate gland, normalizes body temperature and eliminates unpleasant symptoms.

Non-opioid analgesics, produced in tablet or suppository form, can help relieve pain syndrome during an exacerbation of prostate adenoma. The easiest of these is metamizole sodium. However, this drug is intended for single use because it can only be effective in mild pain syndrome. In addition, analgesics with lidocaine, benzocaine, anesthetic and novocaine (Ixtammol, 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 substance and an indispensable link in reproductive processes. Urologist prescribes vitamin E in a dose of 400 mg to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

Treatment of a serious chronic disease such as prostate adenoma should be prescribed and monitored by a urologist. It is forbidden to take certain medications alone without first consulting your doctor, because in this case, self-medication is not only ineffective, but also dangerous for men's health. Only a qualified specialist can tell you which pills for prostate adenoma are most effective in each situation and which can cause negative consequences.

Operations

The urologists of the hospital skillfully perform classic and minimally invasive surgeries, apply innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the most suitable operation for him.

Transurethral resection of the prostate is the generally accepted standard in the surgical treatment of prostate adenoma. The operation is very efficient. After the intervention, patients get rid of bladder outlet obstruction (narrowing of the urethra) and related symptoms. Rehabilitation period is short. Bleeding may develop during or after surgery, a "water intoxication" syndrome of the body.

Alternative methods of prostate adenoma include the following surgical interventions:

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

After them, complications are less, but these methods are less effective than transurethral resection, both clinically and economically.

Laparoscopic removal of a prostate adenoma is used when the tumor has grown significantly and is difficult to remove 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 that remove the prostate adenoma. The operation is performed according to the image taken from the video cameras displayed on the screen. The main advantages of the intervention are minimal blood loss and low probability of complications. After the operation, the patient does not need long-term rehabilitation.

When men have symptoms of prostate adenoma, doctors use a high-tech method of treating adenoma - laser enucleation. The intervention is performed 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 removed. The method is considered minimally invasive. It has a number of important advantages: it does not break the integrity of the gaps, does not cause unnecessary damage.

Laser evaporation is the destruction of an adenoma by laser evaporation. The urologist brings a special device from the urethra, brings it to the neoplasm and moves in this direction with a powerful green laser. The depth of penetration of the laser and the accuracy of the shot prevent damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. The only drawback is the inability to remove the tumor tissue for histological examination.

In some cases, an unavoidable treatment for prostate adenoma is abdominal surgery - adenomectomy. Other methods are performed when they cannot help the patient. During the operation, the surgeon reaches the prostate gland using a scalpel and manually removes the adenoma using surgical instruments. Significant blood loss may occur as a result of the operation and complications may develop. After the operation, the patient needs long-term rehabilitation.

Removal of a prostate adenoma by transvesical adenomectomy consists of a radical incision of hyperplastic prostate tissue through a longitudinal incision in the anterior abdominal wall and bladder. In the advanced stages of the disease, when the tumor reaches a large size, the bladder becomes very elongated and kidney failure develops because it is filled with accumulated urine.

Urine is pre-catheterized and filled with a sterile furacillin solution or other substance. It is then isolated and taken in two places in special holders where the organ wall is lifted. The surgeon removes the wrinkle and opens the bladder.

Along the inner end of the established urinary catheter, it creates an incision in the mucous area around the neck of the bladder and the opening of the urethra visible in the field of vision, extending 0. 5-1 cm from it. membrane. The urologist then operates, penetrates the thickness of the prostate with his finger, enters between the tumor capsule and the adenomatous nodules, and secretes the latter. At the same time, with the finger of the other hand, which previously entered the patient's rectum, the doctor feeds the gland to the anterior wall of the abdominal cavity. 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, placing a thin drain on the wound. Formulated to clear cavities of blood clotsThe urinary catheter inserted before the operation is not removed for 7-10 days. Instead of the prostate part of the urethra removed during the operation, a new urethra is formed around it.

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

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

To prevent complications, the patient is given early activation after surgery in the hospital. Prostate adenoma removal may have the following undesirable consequences:

• Adequate drainage of the bladder;
• Tightening of the neck;
• Urinary infiltration of peri-vesicular tissue;
• The formation of a "shell sac" (residual space at the site of removal of the prostate adenoma);
• Occurrence of narrowing of the lumen of the urethra;
• Urinary excretion.

This adversely affects the quality of life of patients and prolongs the recovery period of adequate urinary excretion.

The results of the operation are less noticeable when using an intervention laparoscope. Laparoscopic prostate adenoma surgery is one of the less invasive options for prostate surgery. This method is used by hospital urologists if the patient has a large enough prostate adenoma.

Transurethral resection of the prostate adenoma is recommended if the size of the prostate gland in a patient with adenoma does not exceed 120 cm3. However, this option is not suitable for 10% of patients in need of surgery, because the gland reaches a size of more than 120 cm3. Laparoscopic surgery is not performed to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticulum, ankylosis of the joints of the lower extremities. In this case, the decision on the possibility of surgery is generally made by a urologist, andrologist, abdominal surgeon and other hospital specialists.