Benign prostatic hyperplasia (BPH) or adenoma is an enlargement of the stromal component or epithelium of the prostate. The disease occurs in men over 40, 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 years. In fact, 90% of all men sooner or later face the disease, so you need to know the causes in advance. , risk factors, symptoms and modern treatment of prostatic adenoma.
Dangers
Adenoma is a benign formation, therefore, by itself it does not harm the body. However, as they grow older, the formation tissues block the lumen of the urinary tract, which prevents the passage of urine. This is due to a number of unpleasant complications and painful sensations, especially in the later stages. Emerging congestion leads to the formation of infections, stones in the bladder, damage to the bladder, as well as serious disturbances in the work of the kidneys, up to the development of insufficiency. Therefore, at the slightest manifestation of symptoms, it is necessary to immediately make an appointment with a urologist, undergo a comprehensive examination and, based on its results, choose the most effective method of treating adenoma of theprostate.
Stages and symptoms
The course of the disease can be roughly divided into three main stages, accompanied by various symptoms:
- I - characterized by more frequent imperative urges, nocturia (increased volume of nocturnal diuresis), the first signs of incontinence, slower flow. At this stage, the disease can persist for several years without progressing to a more severe form;
- II - more pronounced symptoms. The urine stream may be interrupted, it is necessary to push frequently to urinate, which often results in hernias and prolapse of the rectum. After visiting the toilet, 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 stretches, its elasticity decreases, infections develop, 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 certain types of nervous disorders and cancer. An accurate diagnosis can only be made in the clinic after proper research has been carried out.
Treatment of the disease
At present, prostatic hyperplasia is a fairly well-studied disease. Its treatment does not pose any particular difficulties and can be carried out in different ways, depending on the severity of the disease, its type, speed and stage of development, the patient's age, general health and other factors. .
In general, all methods are conventionally divided into drug, non-drug and surgical. There are also many recipes from alternative (traditional) medicine, including using various herbal preparations, but their effectiveness has not been proven by clinical trials and in some cases suchProstate adenoma treatment methods only complicate the course of the disease. , negatively affecting the patient's condition.
Non-drug techniques
For mild symptoms or more severe symptoms that do not affect quality of life, watchful waiting, also known as active waiting, is used. It consists of regular monitoring of the condition without the use of drugs. In addition, behavior therapy is performed, including:
- refusal to take anticholinesterases and diuretics without further instructions from the attending physician;
- compulsory complete emptying of the bladder before bedtime;
- physiotherapy exercises, Kegel exercises and other actions aimed at training the pelvic muscles;
- reduce the use of diuretic products and fluids, in particular - three hours before going to bed.
The technique is used both independently and in addition to drug therapy.
Medical treatment
A number of medications may 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 they are contraindicated for some reason.
Surgery
Today, surgical operations are considered the "gold standard" and the most effective treatment for prostate adenoma. With their help, you can achieve complete elimination of prostate adenoma with minimal consequences for the body, maintaining normal urination and erection. Their main advantage is the possibility of applying at any stage of the disease. In our clinic, several major types of surgical procedures are performed. The decision on how to treat prostate adenoma is made by the attending physician 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 the removal of the 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, so it can be used in almost any clinic. However, due to the opening, the operation is often accompanied by heavy bleeding. In addition, due to the proximity of the prostate to the nerve ganglia, there is always a risk of lesions leading to impaired sexual and urinary functions.
Transurethral resection
TURP of prostate adenoma is a procedure to remove part of the prostate using an electroresection loop. Today it is one of the most preferred and frequently performed operations due to its low invasiveness. All the instruments are brought to the formation through the urethral canal without any incision, which can prevent blood loss, no scarring on the skin, and the recovery period is only a few days. In addition, during the procedure, complete information about the state of the urinary system is collected and any detected abnormalities are eliminated.
New in the treatment of prostate adenoma
The most promising are minimally invasive methods using advanced technology and equipment. These include:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP) - the operation is performed through small incisions (up to 2 cm). Using a laparoscope, a laser fiber is introduced into the bladder and through its neck is brought to the gland. The adenomatous tissue is removed using gentle incisions made with an ultra-precise and safe holmium crystal laser, after which it is broken up. This approach guarantees an almost complete absence of damage to healthy tissue and minimal blood loss;
- Transurethral photoselective vaporization - the method involves completely burning damaged tissue using focused laser radiation without damaging healthy cells. The intervention is carried out through the urethral canal, which excludes any incision and scar, allows to achieve a minimum number of relapses, reduces the recovery time to several days;
- Robot-assisted laparoscopy - performed using the advanced robotic complex "Da Vinci", equipped with the tools and equipment necessary for video shooting. The check is carried out by an experienced surgeon on a special terminal, and the image from the camera is displayed on a large screen in high resolution, which significantly expands the operating field. Special robot algorithms smooth out any sudden and random movements of the operator, completely eliminating a human factor such as tremors. The use of the complex allows you to perform the operation as precisely and precisely as possible, through small incisions of several millimeters.
All of these methods have a significant drawback - expensive equipment and the need for experienced qualified personnel to work with them. Therefore, these techniques may not be used in all hospitals.