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 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 encounter the disease, so it is necessary to know in advance about 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 block the lumen of the urinary canal, which prevents 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 it, as well as serious disturbances in the functioning of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, you must immediately make an appointment with a urologist, undergo a thorough examination and, based on its results, choose the most effective method of treating prostate adenoma.
Stages and symptoms
The course of the disease can be 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, and a more sluggish stream.The disease may remain at this stage for several years without developing to a more severe form;
- II – more severe symptoms.The stream of urine may be interrupted, you must often strain to urinate, which often leads to hernias and prolapse of the rectum.After visiting the toilet, there remains a feeling of dissatisfaction and 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, 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 appropriate research has been carried out.
Treatment of the disease
At the moment, prostate adenoma hyperplasia 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, speed and stage of development, the patient’s age, his general health and other factors.
In general, all methods are conventionally divided into medicinal, non-medicinal 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 such methods of treating prostate adenoma only complicate the course of the disease, negatively affecting the patient’s condition.
Non-drug 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 medications.Behavioral therapy is also provided, including:
- refusal to take anticholinesterase and diuretic drugs without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before bed;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reducing the consumption of diuretic products and liquids, in particular three hours before going to bed.
The technique is used both independently and as an addition to drug therapy.
Drug 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 used, as a rule, before surgery or in cases where it is contraindicated for some reason.
Surgery
Surgical operations are currently 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.Their main advantage is the possibility of use at any stage of the disease.Our clinic practices several main types of surgical interventions.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 gland tissue using various instruments.The main advantage of the method is that it is well studied and there is no need for 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.In addition, due to the close location of the prostate to the nerve nodes, there is always a risk of damage to them, leading to disruption of sexual and urinary functions.
Transurethral resection
TUR of prostate adenoma 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 formation through the urethral canal without any incisions, as a result of which there is no blood loss, there are no scars 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 abnormalities found are eliminated.
New in the treatment of prostate adenoma
Minimally invasive methods using advanced technologies and equipment are considered the most promising.These include:
- Holmium laser enucleation of prostate hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions.Using a laparoscope, a laser fiber is inserted into the bladder and through its neck to the gland.The adenomatous tissue is removed using careful incisions made with an ultra-precise and safe holmium crystal laser, after which it is morcellated.This approach guarantees almost complete absence of damage to healthy tissue and minimal blood loss;
- transurethral photoselective vaporization - the method consists in completely burning out damaged tissues using focused laser radiation without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates any incisions and scars, allows for a minimum number of relapses, 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 at a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the surgical field.Special robot algorithms smooth out all sudden and random movements of the operator, completely eliminating the human factor such as tremor.Using 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 with it.Therefore, such techniques cannot be used in every hospital.