Diagnosis and treatment of prostate adenoma

The most common urological pathology in which a urologist is consulted by men over 45 years of age is prostatic adenoma. The presence of this pathology considerably affects the quality of life of men. One of the most formidable possible 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 methods of surgical intervention are selected by specialists in the hospital 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 comfortable conditions for treating 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 its size. As a result of such changes, the urethra, located in the thickness of the prostate, is gradually compressed, and disturbances in the process of urination appear.

Adenoma of the prostate 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:

• At the age of the patient - an enlarged prostate is extremely rare in men under the age of forty, and after sixty it is diagnosed almost every second;
• Hereditary predisposition - if a prostate adenoma has been diagnosed in close relatives of a man, there is a huge risk of inheriting this disease in adulthood;
• 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 (for example, beta blockers);
• Poor lifestyle - the risk of developing prostate adenoma is increased in obese men, with insufficient physical activity.

Symptoms

A prostate adenoma can be suspected when a man develops the following symptoms, which are most typical of this disease:

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

Adenoma of the prostate 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 methods of treatment. In order to avoid surgery, many patients use special drugs to treat prostate adenoma, eliminate symptoms, and restore 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. Drugs for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the attending physician. Taking remedies for prostatitis and prostate adenoma alone can be not only ineffective, but also dangerous. In view of the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in older people should be selected taking into account the 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 proceeds with minimal disturbance of urination. There may be a slight increase in its frequency, especially at night, and a slow flow of urine. The first stage can last from a year to 12 years or more.
• The second stage of prostate adenoma is characterized by more pronounced urination disorders: intermittent urine stream, appearance of the need to strain during urination and a feeling 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 during urination, pain in the lumbar region and above the pubis.
• The third stage is characterized by an involuntary periodic or constant flow of urine, which forces the patient to use a urine bag.

Complications

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

• Acute urinary retention - it is characterized by a sudden inability to empty the bladder and pain in the suprapubic area. With such a condition, the patient requires emergency medical care with catheterization or a small operation;
• The appearance 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 stagnant urine;
• Damage to the bladder - with irregular emptying of the bladder, it stretches, the formation of protrusions (pockets) in the walls of the organ, in which urine stagnates;
• Kidney damage - increased pressure in the ureters and bladder has a direct adverse effect on the kidneys, as a result of which kidney failure develops.

Prostate adenoma and potency

Prostate adenoma and potency are closely related. The adenoma disrupts the structure of the tissues of the gland, which, in turn, damages another, no less important organ - the testes, which is responsible for the production of androgens. Thus, prostate adenoma can be the cause of impotence, requiring complex and long-term therapy.

Diagnostic

A simple and effective way to establish a preliminary diagnosis is to keep a diary of the patient's urination with the establishment of quantitative and qualitative parameters: volumes of urine excreted, characteristics of fluid intake, craving, nighttime urge. The main method of physical examination for a suspected prostate adenoma is a digital rectal examination of the prostate to detect its enlargement and rule out certain other conditions.

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

Treatment

Treatment of prostate adenoma is aimed at relieving symptoms of the lower urinary tract, improving the patient's quality of life, and preventing the development of complications of the disease. Patients with mild symptoms that do not worsen quality of life are often prescribed follow-up tactics with regular check-ups by a urologist who monitors the course of the disease and gives recommendations on how to stop the growth. prostate adenoma. During this period, attention is focused on non-drug treatment. The above methods can be an addition to conservative therapy, which consists of taking the following drugs:

• Alpha blockers (tamsulosin, alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• Phosphodiesterase type 5 (sildenafil) inhibitors;
• Combinations of 5-alpha reductase inhibitors and alpha-blockers;
• Muscarinic or anticholinergic receptor blockers M.

For patients with advanced prostatic 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;
• Kidney failure, caused by an adenoma of the prostate;
• Bladder stones;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgery is required for patients in the absence of effectiveness of drug therapy.

During conservative treatment or in the postoperative period, patients need constant medical supervision with standard studies (determination of urine output, ultrasound, analysis of the level of PSA).

Drugs

There is a certain scheme that specific drugs are prescribed for the treatment of prostatitis and prostate adenoma. High effectiveness of treatment is achieved through 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 and restore sufficient urination.

What are the most effective and widely used pills for prostate adenoma? The list is headed by alpha1-adrenergic receptor blockers. Also, this list includes 5-alpha reductase inhibitors, vitamins and minerals.

The complex of drug therapy includes not only drugs. In case of prostate adenoma, conservative treatment can be supplemented with biologically active additives - food 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 the synthesis of testosterone. Plant phytosterols normalize urination.

Treatment with drugs from the group of alpha1-adrenergic receptor antagonists

These drugs for the treatment of prostatitis and prostate adenoma relax the smooth muscles of the urinary system and improve the flow of urine. The active substance tamsulosin of the same name, 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 muscles of the prostate, prostatic urethra andbladder. Due to the decrease in muscle tone, the flow 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 for patients with chronic hypertension.

Alpha-adrenergic receptor antagonists should be used continuously, so that a gradual decrease in irritation and obstruction of the prostate adenoma can be achieved. The drug Tamsulosin in the treatment of prostate adenoma occupies a well-deserved priority in the prescriptions of urologists.

The tablet form of the drug is considered more gradual, because due to the controlled release of tamsulosin, the active substance is found in the body in a constant concentration. The drug evenly enters the bloodstream, reducing the likelihood of developing the main side effect of drugs of 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 artery disease, therefore it can be prescribed to men with heart disease. Properly chosen dosage and observance of all the rules for the use of drugs of the alpha-blocker group allows to achieve a good therapeutic effect with an almost complete absence of side effects.

Medicines from the group of reductase inhibitors (blockers)

Drugs of this pharmacological group (Finasteride, Dutasteride) help to relieve the flow of urine and, therefore, 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 stopped completely after three months. According to the results of clinical studies, 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 converting testosterone into dihydrotestosterone). The growth of the prostate 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 prostatic hyperplasia;
• Improve the flow of urine and eliminate the symptoms of prostate adenoma;
• Reduce the risk of developing acute urinary retention and the need for surgery.

Both finasteride and dutasteride have a pronounced antiandrogenic effect, ie. i. e. help 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 avoid the need for surgical treatment.

Antispasmodics and analgesics for exacerbation of the disease

The main purpose of drugs with antispasmodic and analgesic action in the exacerbation of prostate adenoma is to relieve the general condition of the patient and eliminate pain. Nonsteroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. They help to fight not only the painful sensations that arise during urination, but also the constant pain in the groin and perineum. Thanks to the action of nonsteroidal anti-inflammatory drugs, the inflammatory process decreases, the swelling of the prostate decreases, body temperature is normalized, and unpleasant symptoms are also eliminated.

Non-opioid pain relievers, produced in the form of tablets or suppositories, help relieve pain syndrome during exacerbation of prostate adenoma. Metamizole sodium is the most readily available. However, this medicine is more intended for single use, as it can only work on mild pain syndrome. In addition, pain relievers with lidocaine, benzocaine, anesthesin 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 irreplaceable link in reproductive processes. Vitamin E in a dose of 400 mg, urologists prescribe to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

Treatment of a chronic disease as serious as prostate adenoma should be prescribed and supervised by a urologist. It is strictly forbidden to take certain drugs on your own, without first consulting your doctor, since self-medication in this case can be 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 case, and which can have negative consequences.

Operations

Hospital urologists brilliantly perform classic and minimally invasive surgical procedures, 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 very efficient. After the procedure, patients get rid of the bladder outlet obstruction (urethral stricture) and associated symptoms. The rehabilitation period is short. During or after the operation, bleeding may develop, the syndrome of "water intoxication" of the body.

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

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

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

Laparoscopic ablation of the 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, with which he removes the prostate adenoma. The operation is performed according to the image from the video cameras, which is displayed on the screen. The main advantages of the procedure 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 an advanced method of treating the adenoma - laser enucleation. The intervention is carried out with large neoplasms. The excess tissue is removed using 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 important advantages: it does not violate the integrity of the cavities, 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, brings it to the neoplasm and acts on it punctually with a powerful green laser. The depth of penetration of the laser and the precision of its impact prevent damage to neighboring areas. The method is minimally invasive, bloodless, quick and efficient. Its only drawback 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, using 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.

Removal of prostate adenoma by the method of transvesical (transvesical) adenomectomy consists of radical excision of hyperplastic prostate tissue through a longitudinal incision of the anterior abdominal wall and bladder. The operation is carried out in the advanced stages of the disease, when the tumor reaches a large size, the bladder is overloaded due to its overflow of accumulated urine, and renal failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furacilin or other substance. Then it is isolated and taken in two places on special stands, for which the organ wall is lifted. The surgeon dissects the formed fold and opens the bladder.

Along the inner end of the installed urinary catheter, it determines the area of the neck of the bladder and around the opening of the urethra that appears in the field of view, starting from 0. 5-1 cm, madean incision in the mucous membrane. After that, the operating urologist penetrates the thickness of the prostate with his finger, enters it between the tumor capsule and the adenomatous nodes, excretes the latter. At the same time, with the finger of the other hand, which is previously inserted into the patient's rectum, the doctor feeds the gland to 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 thin drainage in the wound. It is designed to flush its cavity of formed blood clots. The urinary catheter, inserted before the start of the operation, is not removed for 7-10 days. A new section of the urethra is formed around it instead of the prostatic part of the urethra which 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 the risk of developing the following complications:

• Bleeding from the bed of the neoplasm;
• 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 activated early. The following unwanted consequences of surgery to remove the prostate adenoma may occur:

• Insufficient drainage of the bladder;
• Narrowing of his neck;
• Urinary infiltration of peri-vesicular tissue;
• The formation of a "pre-bladder" (residual cavity where the prostate adenoma was removed);
• Formation of a narrowing of the lumen of the urethra;
• Urinary incontinence.

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

The consequences of the operation are less pronounced when the operation is performed using a laparoscope. Laparoscopic surgery for prostate adenoma is one of the least invasive options for prostate surgery. This technique is used by hospital urologists if the patient has a sufficiently large prostate adenoma.

If the size of the prostate of a patient with adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients requiring surgery, this option is not suitable, since the gland reaches a size of more than 120 cm3. Laparoscopic surgery to remove prostate adenoma with urolithiasis, inguinal hernia, bladder diverticula, ankylosis of the joints of the lower extremities is not performed. In this case, the decision on the possibility of the operation is taken collectively by the urologist, andrologist, abdominal surgeon and other specialists of the hospital.