Benign prostatic hyperplasia (BPH) or adenoma is an increase in the stromal or epithelial component of the prostate.The disease appears in men over 40 years old, 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.
The Risks
Adenoma is a benign formation, so it does not harm the body by itself.However, as the tissue grows, it blocks the lumen of the urinary tract, which prevents the passage of urine.This is accompanied by a number of unpleasant complications and painful sensations, especially in the later stages.The resulting blockage leads to the formation of infections, stones in the bladder, its damage, as well as serious disturbances in the functioning of the kidneys, including the development of failure.Therefore, at the slightest manifestation of symptoms, you should immediately make an appointment with a urologist, undergo a complete examination and, based on its results, choose the most effective method for treating prostate adenoma.
Stages and symptoms
The course of the disease can be divided into three main stages, accompanied by different symptoms:
- I – is characterized by more frequent imperative urges, nocturia (increased volume of nocturnal diuresis), the first signs of incontinence and a slower flow.The disease can remain at this stage for several years without developing into a more severe form;
- II – more severe symptoms.The flow of urine can be interrupted, you often have to strain to urinate, which often leads to hernia 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 other 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 the appropriate research has been carried out.
Treatment of the disease
At the moment, hyperplasia of the prostate adenoma is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in different ways, depending on the severity of the disease, its type, the speed and stage of development, the age of the patient, his general health and other factors.
In general, all methods are conventionally divided into medicinal, non-medicinal and surgical.There are also many prescriptions from alternative (traditional) medicine, including the use of 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 in regular monitoring of the condition without the use of medications.Behavioral therapy is also offered, including:
- refusal to take anticholinesterase and diuretic drugs without additional instructions from the attending physician;
- mandatory complete emptying of the bladder before sleep;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reducing the consumption of diuretic products and liquids, especially 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 variety of medications, including:
- alfuzosin, tamsulosin and other alpha blockers;
- solifenacin, M-anticholinergics, muscarinic receptor blockers - with a clear predominance of symptoms caused by congestion;
- Type V phosphodiesterase 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 any 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 the prostate adenoma with minimal consequences for the body, while 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 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 bottom of the abdomen and removing the inflamed tissue of the gland 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 associated with extensive bleeding.In addition, due to the close location of the prostate to the nerve nodes, there is always a risk of their damage, 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 most frequent operations due to its low invasiveness.All instruments are brought into formation through the urethral canal without any incision, as a result of which there is no blood loss, there are no marks on the skin and the recovery period is only a few days.In addition, during the procedure, complete information on the condition of the urinary system is collected and any detected anomalies are eliminated.
New in the treatment of prostate adenoma
Minimally invasive methods using advanced technology and equipment are considered the most promising.These include:
- Holmium laser enucleation of prostate 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 its neck into the gland.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 tissues and minimal blood loss;
- photoselective transurethral vaporization - the method consists in the complete burning of damaged tissue using focused laser radiation without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates any cuts and scars, allows a minimal number of relapses and reduces the recovery time to a few 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 high-resolution monitor, 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 vibration.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 and qualified personnel to work with it.Therefore, such techniques cannot be used in every hospital.