Benign prostatic hyperplasia (BPH) or adenoma is a growth of the stromal component or epithelium of the prostate.The disease occurs in men over 40 years of age, less often at an early 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 encounter the disease, so it is necessary to know in advance the causes, risk factors, symptoms and modern treatment of prostate adenoma.
Dangers
An adenoma is a benign formation, so in itself it does not harm the body.However, as the tissues grow, they obstruct the lumen of the urinary canal, preventing the passage of urine.This is associated with a number of unpleasant complications and painful sensations, especially in the later stages.The resulting congestion leads to the formation of infections, stones in the bladder, damage to the bladder, as well as serious disturbances in the functioning of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, it is necessary to immediately make an appointment with a urologist, undergo a thorough examination and, based on the results, choose the most effective method of treating prostate adenoma.
Phases and symptoms
The course of the disease can be divided into three main phases, accompanied by various symptoms:
- I – characterized by more frequent imperative impulses, nocturia (increased volume of nocturnal diuresis), first signs of incontinence and a slower flow.The disease can remain in this stage for several years without evolving into a more serious form;
- II – more serious symptoms.The flow of urine can be interrupted, it is necessary to often strain to urinate, which often leads to the appearance of hernias and prolapse of the rectum.After visiting the toilet, a feeling of dissatisfaction and incomplete emptying remains.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, constant dry mouth.
It is worth understanding that similar symptoms are accompanied by some types of nervous disorders and cancer.An accurate diagnosis can only be made in a clinic after carrying out appropriate research.
Treatment of the disease
At the moment, hyperplasia of prostatic adenoma is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in various ways, depending on the severity of the disease, its type, the 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 medicinal, non-medicinal and surgical.There are also many recipes of alternative (traditional) medicine, including the use of various herbal preparations, but their effectiveness has not been proven by clinical studies, and in some cases such methods of treating prostate adenoma only complicate the course of the disease, negatively affecting the patient's condition.
Non-pharmacological methods
For mild symptoms of the disease or for more serious ones that do not affect the quality of life, watchful waiting, also called active waiting, is used.It consists of regular monitoring of the condition without the use of drugs.Behavioral therapy is also provided, including:
- refusal to take anticholinesterase and diuretic drugs without further instructions from the attending physician;
- mandatory complete emptying of the bladder before bedtime;
- physical therapy, Kegel exercises, and other activities designed to train the pelvic muscles;
- reduce the consumption of diuretic products and liquids, especially three hours before bedtime.
The technique is used both independently and in addition to drug therapy.
Pharmacological treatment
For severe to moderate symptoms, patients may be prescribed a number of medications, 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 - usually used in the treatment of impotence and its causes, but have also proven effective in the treatment of hyperplasia;
- finasteride and other 5-alpha reductase inhibitors: reduce the rate of proliferation of prostate tissue and reduce its size.
These and other drugs are usually used before surgery or in cases where it is contraindicated for some reason.
Surgery
Surgical interventions are currently considered the “gold standard” and most effective treatment for prostate adenoma.With their help, you can achieve complete removal of the prostate adenoma with minimal consequences for the body, maintaining normal urination and erection.Their main advantage is the possibility of use at any stage of the disease.Our clinic practices several main types of surgeries.The decision on how to treat prostate adenoma is made by the attending physician together with the patient after a thorough examination and examination.
Open adenomectomy
Open adenomectomy is a classic operation that involves making an incision in the perineum or lower abdomen and removing inflamed glandular tissue using various instruments.The main advantage of the method is that it is well-studied and does not require special equipment, so it can be used in almost any clinic.However, due to the open nature of the operation, it is often accompanied by extensive bleeding.Furthermore, due to the proximity of the prostate to the nerve nodes, there is always the risk of damaging them, resulting in disruption of sexual and urinary functions.
Transurethral resection
Prostate adenoma TUR 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 to the training through the urethral canal without any incision, as a result of which there is no blood loss, there are no scars on the skin and the recovery period is a few days.In addition, during the procedure, comprehensive information about the state of the urinary system is collected and any anomalies found are eliminated.
News in the treatment of prostatic adenoma
Minimally invasive methods using advanced technologies and equipment are considered the most promising.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 inserted into the bladder and through the neck to the gland.The adenomatous tissue is removed through careful incisions made with an ultra-precise and safe holmium crystal laser, after which it is morcellated.This approach guarantees the almost total absence of damage to healthy tissues and minimal blood loss;
- transurethral photoselective vaporization: the method involves completely burning damaged tissue using focused laser radiation without damaging healthy cells.The surgery is performed through the urethral canal, which eliminates any incisions and scars, allows a minimum number of recurrences and reduces recovery time to several days;
- robot-assisted laparoscopy - performed using the advanced Da Vinci robotic complex, equipped with the necessary tools and equipment for video recording.The control is performed by an experienced surgeon on a special terminal, and the camera image is displayed on a large high-resolution monitor, which significantly expands the operating field.Special algorithms of the robot attenuate all sudden and random movements of the operator, completely eliminating the human factor such as tremor.The use of the complex allows you to perform the operation as accurately and accurately as possible, through small incisions of a few millimeters.
All these methods have a significant disadvantage: expensive equipment and the need for experienced, qualified personnel to work on it.Therefore, such techniques cannot be used in all hospitals.