The most common urological condition with which a urologist is consulted by men over the age of 45 is prostate adenoma. The presence of this pathology significantly impairs the quality of life of men. One of the most formidable 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 drugs or surgical intervention methods are selected by the hospital's 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 surgical clinic created comfortable conditions for the treatment of 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 these changes, the urethra, which is located in the thickness of the prostate, is gradually compressed and disturbances in the urination process arise.
Prostate adenoma 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 may be due to the following risk factors:
- By the age of the patient - an enlarged prostate is extremely rarely found in men under the age of forty, and after sixty years it is diagnosed almost every second;
- Hereditary predisposition - if a prostate adenoma has been diagnosed in blood relatives close to a man, he is at great 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
Prostate adenoma can be suspected when a man develops the following symptoms, which are more typical for this disease:
- increased urge to urinate;
- the emergence of the need for tension in the abdominal muscles to urinate;
- the presence of painful sensations, burning, a slow stream of urine;
- discomfort and insufficient emptying of the bladder;
- 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 men, which requires the use of surgical methods of treatment. 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 you when the first symptoms of the disease appear.
The treatment of prostate adenoma is individual for each patient. Medicines for the treatment of prostate adenoma, its dosage and duration of use are prescribed by the attending physician. Taking drugs 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 elderly men, medications for the treatment of prostate adenoma in the elderly should be selected taking into account comorbidities.
Stages of development of the disease
Prostate adenoma 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 your frequency, especially at night, and a slow flow of urine. The first phase 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, appearance of need for effort when urinating and sensation 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, a 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 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 - is characterized by a sudden inability to empty the bladder and pain in the suprapubic region. With such a condition, the patient needs 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 urine stagnation;
- Bladder damage - with irregular emptying of the bladder, it distends, the formation of protrusions (pockets) on the walls of the organ, in which the urine is stagnant;
- Kidney damage - Increased pressure in the ureters and bladder has a direct harmful effect on the kidneys, resulting in the development of kidney failure.
Prostate adenoma and potency
Prostate adenoma and potency are closely related. The adenoma disrupts the structure of the gland's tissues, which in turn causes damage to another not less important organ - the testicles, which is responsible for the production of androgens. Thus, prostate adenoma can be the cause of impotence, requiring complex and long-term therapy.
Diagnosis
A simple and effective way to establish a preliminary diagnosis is to keep a urination diary by the patient with the setting of quantitative and qualitative parameters: volumes of excreted urine, characteristics of fluid intake, imperative cleft, nocturnal cleft. The main method of physical examination for suspected prostate adenoma is a digital rectal examination of the prostate to detect enlargement and exclude some other pathologies.
The 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 kidney condition markers, urea and creatinine levels;
- PSA test (to rule out prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Urofluxometry (to determine the rate of flow of urine);
- Determination of the volume of residual urine (by ultrasound);
- Electromyography of the pelvic floor;
- Urethrocystoscopy;
- Excretory urography.
Treatment
The treatment of prostate adenoma aims to relieve symptoms of the lower urinary tract, improve the quality of life of the patient and prevent the development of complications of the disease. Patients with mild symptoms that do not worsen quality of life are usually prescribed follow-up tactics with regular checkups by a urologist who monitors the course of the disease and gives recommendations on how to stop the growth of the prostate adenoma. During this period, attention is focused on non-drug therapy. The above methods can be an addition to conservative treatment, which is taking the following medications:
- Alpha blockers (Tamsulosin, Alfuzosin);
- 5-alpha reductase inhibitors (finasteride);
- Phosphodiesterase type 5 inhibitors (Sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha blockers;
- Muscarinic or M-anticholinergic receptor blockers.
For patients with advanced prostate adenoma, surgical treatment is recommended, which can be performed by several methods: transurethral excision, transurethral resection and prostate removal.
There are certain indications for the use of surgical treatment:
- Recurrent urinary retention;
- Renal failure caused by prostate adenoma;
- Bladder stones;
- Recurrent urinary tract infections;
- Recurrent hematuria.
In addition, surgical intervention is necessary for patients in the absence of effective 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 level).
Drugs
There is a certain scheme according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. The high efficiency of the treatment is achieved due to 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, in addition to restoring sufficient urination.
What are the most effective and widely used pills for prostate adenoma? The list is topped by alpha1-adrenergic receptor blockers. In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.
The drug therapy complex includes not just drugs. In the case of prostate adenoma, conservative treatment can be complemented with biologically active additives - dietary supplements, which enhance the therapeutic effect of medicines and guarantee a quick 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 urinary flow. Tamsulosin with the same name as 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 prostate muscles of the urethra and bladder. Due to the decrease in muscle tone, the flow and excretion of urine are facilitated. Tamsulosin, like all selective drugs, has a minimal number of side effects, does not affect vascular tone, and can be prescribed for patients with chronic hypertension.
Alpha-adrenergic receptor antagonists must be used constantly, so that a gradual decrease in irritation and obstruction in the prostate adenoma can be achieved. The drug Tamsulosin in the treatment of prostate adenoma has a well-deserved priority in the prescriptions of urologists.
The pill form of the drug is considered to be more progressive, since, due to the controlled release of tamsulosin, the active substance is in the body in 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 drop in blood pressure.
An equally effective medication with the active ingredient tamsulosin is Urorek. The use of this medicine 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 for men with cardiac disorders. A well-chosen dosage and compliance with all rules for the use of drugs in the group of alpha blockers allows a good therapeutic effect to be achieved with almost no side effects.
Medicines from the group of reductase inhibitors (blockers)
The drugs in this pharmacological group (Finasteride, Dutasterida) help to relieve urinary flow 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 cease completely after three months. According to the results of clinical studies, 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 to 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;
- Improve urine flow and eliminate 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, that is, they help to 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 analgesics for disease exacerbation
The main purpose of antispasmodic and analgesic drugs in exacerbating prostate adenoma is to relieve the patient's general condition and eliminate pain. Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help to combat not only the painful sensations that arise during urination, but also the constant pain in the groin and perineum. Thanks to the action of the non-steroidal anti-inflammatory drugs, the inflammatory process decreases, the swelling of the prostate decreases, the body temperature is normalized and the unpleasant symptoms are also eliminated.
Non-opioid analgesics, produced in the form of pills or suppositories, help to relieve pain syndrome during exacerbation of prostate adenoma. The most readily available is metamizole sodium. However, this medication is more for a single use, since it can only act on mild pain syndrome. In addition, painkillers with lidocaine, benzocaine, anesthesia 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 at a dosage of 400 mg urologists prescribe for patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.
The treatment of a serious chronic disease such as prostate adenoma should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medications on your own, without first consulting the doctor, as self-medication in this case can be not only ineffective, but also dangerous to man's health. Only a qualified specialist can tell you which prostate adenoma pills are most effective in each case and which ones can have negative consequences.
Operations
The hospital's urologists masterfully perform classic and minimally invasive surgical interventions, apply innovative methods of surgical treatment of prostate adenoma. Each patient is selected for the operation that best suits them.
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 the obstruction of the bladder outlet (narrowing of the urethra) and associated symptoms. The rehabilitation period is short. During or after the operation, bleeding, the "water intoxication" syndrome of the body, can occur.
Alternative methods of treating prostate adenoma include the following surgical interventions:
- Stenting;
- Balloon dilation;
- 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 clinical and economic efficacy.
Laparoscopic removal of the 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 performed according to the image of the video cameras, which is displayed on the screen. The main advantages of the intervention are the minimum 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 to treat the adenoma - laser enucleation. The intervention is performed with large neoplasms. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor is separated, divided into small parts 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, it 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, takes it to the neoplasia and acts on it punctually with a strong green laser. The depth of penetration of the laser and the accuracy of its adjustment allow to avoid damage to the surrounding areas. The method is minimally invasive, bloodless, fast and effective. Its only disadvantage is the inability to remove tumor tissue for histological examination.
In some situations, an unavoidable 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 and manually, with surgical instruments, removes the adenoma. As a result of the operation, significant blood loss can occur and complications can occur. After surgery, the patient needs long-term rehabilitation.
The removal of prostate adenoma by the transvesical (transvesical) adenomectomy method consists of radical excision of the hyperplastic tissue of the prostate through a longitudinal incision of the anterior abdominal wall and the bladder. The operation is performed in the advanced stages of the disease, when the tumor reaches a large size, the bladder is stretched due to its overflow with accumulated urine, and renal failure develops.
The bladder is pre-catheterized and filled with a sterile solution of furacillin or another substance. Then, it is isolated and taken in two places on special supports, for which the organ wall is raised. The surgeon dissects the formed fold and opens the bladder.
Along the inner edge 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 vision, starting from it by 0. 5-5 cm, makes an incision in the mucous membrane. Then, the surgical urologist penetrates the thickness of the prostate with his finger, between the tumor capsule and the adenomatous nodules, excreting these. At the same time, with the finger of the other hand, 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 operating time is shortened and blood loss is reduced.
Then, the surgeon performs hemostasis (stopping the bleeding) of the removed adenoma bed and sutures the bladder, leaving a fine drainage in the wound. It is designed to clean your cavity from the formed blood clots. The urinary catheter, inserted before the start of the operation, is not removed for 7 to 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 the 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 function of the bowel, manifested by constipation.
To avoid complications, after the operation in the hospital, the patient receives early activation. The following undesirable consequences of surgery to remove prostate adenoma can occur:
- Insufficient drainage of the bladder;
- Narrowing of the neck;
- Urinary infiltration of peri-vesicular tissue;
- The formation of a "pre-bladder" (residual cavity at the site of removal of the prostate adenoma);
- Formation of narrowing of the lumen of the urethra;
- Urinary incontinence.
This negatively affects the quality of life of patients and prolongs the recovery time for proper urination.
The consequences of the operation are less pronounced when the intervention is performed with a laparoscope. Laparoscopic prostate adenoma surgery is one of the least invasive options for surgical interventions on the prostate. This technique is used by hospital urologists if the patient has a sufficiently large prostate adenoma.
If the prostate size of a patient with an adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. However, for 10% of patients who need surgery, this option is not suitable, as the gland reaches a size greater than 120 cm3. Laparoscopic surgery to remove the adenoma of the prostate with urolithiasis, inguinal hernia, diverticula of the bladder, ankylosis of the joints of the lower extremities is not performed. In this case, the decision about the possibility of the operation is made jointly by the urologist, andrologist, abdominal surgeon and other hospital specialists.