Benign prostatic hyperplasia (BPH) or adenoma is an increase in the stromal component or epithelium of the prostate. The disease occurs in men over 40 years of age, less frequently 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 it is necessaryknow in advance about the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Adenoma is a benign formation, therefore, by itself, it does not harm the body. However, as it grows, the tissues in the formation block the light from the urinary tract, which prevents the passage of urine. This is due to a series of unpleasant complications and painful sensations, especially in the later stages. Emerging congestion leads to the formation of infections, gallstones in the bladder, damage to the bladder, in addition to serious disturbances in the functioning of the kidneys, even the development of insufficiency. Therefore, at the slightest manifestation of symptoms, it is necessary to immediately appoint the urologist, carry out a thorough examination and, based on the results, choose the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be divided into three main phases, accompanied by several symptoms:
- I - characterized by more frequent imperative impulses, nocturia (increased volume of nocturnal urine output), first signs of incontinence, slower flow. At this stage, the disease can remain for several years without developing into a more severe form;
- II - more pronounced symptoms. The flow of urine can be interrupted, it is necessary to push frequently to urinate, which often leads to hernias and prolapsed rectum. After going to the bathroom, there is a feeling of 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 elongates, its elasticity decreases, infections appear, 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 adequate research has been carried out.
At present, prostate hyperplasia is a well-studied disease. Its treatment does not cause particular difficulties and can be carried out in various ways, depending on the severity of the disease, its type, speed and stage of development, the patient's age, his general state of health and other factors.
In general, all methods are conventionally divided into medicated, non-medicated and surgical. There are also many alternative (traditional) medicine recipes, including with the help of various herbal preparations, but their effectiveness has not been proven by clinical trials, and in some cases these methods of treating prostate adenoma only complicate the course of the disease. , negatively affecting the patient's condition.
For mild or more severe symptoms that do not affect quality of life, watchful waiting, also called active waiting, is used. It consists of regular monitoring of the condition without the use of medication. In addition, behavioral therapy is performed, including:
- refusal to take anticholinesterases and diuretics without further instructions from the treating 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 liquids, in particular - three hours before going to bed.
The technique is used both independently and as an adjunct to drug therapy.
Several 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 to treat impotence and its causes, but have been shown to be effective in treating 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 for some reason they are contraindicated.
Today, surgical operations are 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. Its main advantage is the possibility of application at any stage of the disease. In our clinic, several main types of surgical intervention are practiced. The decision on how to treat the prostate adenoma is made by the treating physician together with the patient after a thorough examination and examination.
Open adenomectomy is a classic operation that involves an incision in the perineum or lower abdomen and removal of 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, and it can be used in almost all clinics. However, due to the opening, the operation is usually accompanied by extensive bleeding. Furthermore, due to the proximity of the prostate to nerve nodules, there is always a risk of damage leading to impaired sexual and urinary functions.
Prostate adenoma TURP 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 into formation through the urethral canal without any incisions, so there is no blood loss, no skin scarring, and the recovery period is just 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 Prostate Adenoma Treatment
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 incisions (up to 2 cm). With the help of a laparoscope, a laser fiber is introduced into the bladder and, through your cervix, is taken to the gland. The adenomatous tissue is removed through smooth incisions made with an ultra-precise and safe holmium crystal laser, after which it is morcellated. This approach ensures an almost complete absence of damage to healthy tissue and minimal blood loss;
- Transurethral photoselective vaporization - the method consists of the complete burning of damaged tissues by means of focused laser radiation, without damaging healthy cells. The intervention is performed through the urethral canal, which excludes any incisions and scars, allows to reach a minimum number of relapses, reduces the recovery time to several days;
- Robotic-assisted laparoscopy - performed using the advanced "Da Vinci" robotic complex, equipped with the necessary tools and equipment for video shooting. Control is performed by an experienced surgeon on a special terminal, and the camera image is displayed on a large monitor at high resolution, which significantly expands the operative field. Special robot algorithms smooth out all the sharp and random movements of the operator, completely eliminating a human factor like tremors. The use of the complex allows the operation to be carried out with the greatest possible precision and accuracy, through small incisions of several millimeters.
All of these methods have a significant drawback - expensive equipment and the need for qualified and experienced personnel to work with them. Therefore, such techniques cannot be used in all hospitals.