The most common urological pathology, which is addressed to the urologist, men over 45, is prostate adenoma.The presence of this pathology significantly worsens the quality of life of men.One of the most formidable possible consequences of the pathological process is the degeneration of benign prostate hyperplasia into a malignant tumor.
To combat the prostate adenoma, surgical and drug methods of treatment are used.Specialists of the hospital select the most effective drugs or methods of surgical intervention taking into account the stage of the disease, general condition and age of the patient, as well as the presence of related pathologies.In the surgery clinic, comfortable conditions for the treatment of patients have been created.
The causes of the development of the disease
The occurrence of adenoma is most often associated with age -related changes in the prostate, namely, a change in its structure and an increase in size.As a result of such changes, the urethra is gradually compressed, which is located in the thickness of the prostate gland and violations of the urination process appear.
Prostate adenoma in men develops due to hormonal restructuring of the body associated with age -related changes.The level of testosterone (male hormone) is gradually decreasing with age, while the concentration of female sex hormone (estrogen), on the contrary, increases.This phenomenon is called male menopause.
The development of prostate adenoma can be due to the following risk factors:
- The patient’s age - increased prostate iron is extremely rare in men under forty years old, and after sixty years is diagnosed in almost every second;
- Hereditary predisposition - if the prostate adenoma was diagnosed in close blood relatives of a man, he has a huge risk of inheriting this disease in adulthood;
- Diabetes mellitus, cardiovascular diseases-a benign tumor (adenoma) of prostate can occur as a result of not only these diseases themselves, but also the harmful effects of drugs for their treatment (for example, beta-blockers);
- The wrong way of life - the risk of developing prostate adenoma is increased in men with obesity, insufficient physical activity.
Symptoms
The adenoma of the prostate can be suspected when a man appears in the following symptoms that are most typical for this disease:
- duties of urination;
- the appearance of the need for the tension of abdominal muscles for urination;
- the presence of pain, burning, sluggish stream of urine;
- discomfort and insufficient emptying of the bladder;
- Increasing the duration of the urination process.
The prostate adenoma leads not only to a decrease in the quality of life of a man, but also to an acute delay in urination, which requires the use of surgical treatment methods.In order to avoid surgical intervention, many patients use special drugs for the treatment of prostate adenoma, eliminating symptoms and restoring the normal activity of the prostate.However, only a qualified specialist can suggest the best remedy for prostatitis and prostate adenoma.It is necessary to contact it when the first symptoms of the disease appear.
Treatment of prostate adenoma individually for each patient.Preparations for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the attending physician.Taking products from prostatitis and prostate adenoma independently can be not just an ineffective, but also a dangerous measure.Due to the presence in men of the older generation of some “personal” chronic diseases, drugs for the treatment of prostate adenoma should be selected taking into account the accompanying pathologies.
Stages of development of the disease
Prostate adenoma is characterized by gradual development, which can be divided into three stages.
- The first stage of the disease proceeds with minimal urination disorders.Its insignificant increase, especially at night, and a sluggish stream of urine, can be observed.The first stage can last from one year to 12 years or more.
- The second stage of the prostate adenoma is characterized by more pronounced urination disorders: the intermittence of the urine stream, the appearance of the need for straining during urination and a sense of incomplete emptying of the bladder.Residual urine, which lingers in the bladder and urinary tract, causes an inflammatory process that is accompanied by pain, burning sensation during urination, pain in the lower back and above the pubis.
- The third stage is characterized by periodic or constant involuntary urine release, which forces the patient to use the ureter.
Complications
In some men of the prostate adenoma, the quality of life does not worsen and proceeds without the development of complications.However, in some cases, the disease can cause the following negative consequences:
- The acute delay of urine - it is characterized by a sudden impossibility of emptying the bladder and pain in the right -handed region.With a similar condition, the patient needs emergency medical care with catheterization or a small operation;
- The occurrence of infections in the urinary tract is 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 urine stagnation;
- Damage to the bladder - with irregular emptying of the bladder, it is stretched, the formation of protrusions (pockets) in the walls of the organ, in which urine stagnates;
- Damage to the kidneys - increased pressure in the ureters and bladder has a direct damaging effect on the kidneys, as a result of which renal failure develops.
Prostate adenoma and potency
Prostate adenoma and potency are closely interconnected.The adenoma disrupts the structure of the gland tissue, which, in turn, leads to the defeat of another, no less important organ - the testicles responsible for the products of androgens.Thus, the prostate adenoma can cause impotence that requires prolonged and complex therapy.
Diagnostics
A simple and effective way to establish a preliminary diagnosis is the patient by keeping a diary of urination with fixation of quantitative and qualitative parameters: volumes of dedicated urine, characteristics of the fluid consumed, imperative calls, night urge.The main physical method of examination in case of suspicion of the adenom of the prostate is a finger rectal examination of the prostate to identify its increase and exclude some other pathologies.
Diagnosis of prostate adenoma in the hospital is carried out using the following laboratory and instrumental methods:
- General blood and urine tests;
- Biochemical blood test for markers of the condition of the kidneys, urea and creatinine level;
- Analysis for the level of the dog (in order to exclude prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Urofloometry (to determine the speed of urine current);
- Determination of the volume of residual urine (using ultrasound);
- Pelvic bottom electromyography;
- Urethrocystoscopy;
- Excretory urography.
Treatment
Treatment of prostate adenoma is aimed at facilitating the symptoms of lower urinary tract, improve the patient’s quality and prevent the development of complications of the disease.Patients with poorly exposed symptoms who do not worsen the quality of life, often prescribe the tactics of dynamic observation with regular examinations with a urologist, which controls the course of the disease and gives recommendations on how to stop the growth of prostate adenoma.During this period, attention is focused on non -drug therapy. Thehertic methods can be an addition to conservative treatment, which is the intake of the following drugs:
- Alpha blockers (tamsulosin, alfuzosin);
- 5-alpha reductase inhibitors (finsteride);
- Type 5 phosphodesterase inhibitors (sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha blockers;
- Muscarine receptor blockers or m-cholinolytics.
Patients with prostate adenoma in an advanced stage are recommended to conduct surgical treatment, which can be performed by several methods: transurethral excision, transurethral resection and removal of the prostate.
There are certain indications for the use of surgical treatment:
- Repeated urine delay;
- Renal failure provoked by prostate adenoma;
- Stones in the bladder;
- Recurrent urinary tract infections;
- Repeating hematuria.
In addition, surgery is necessary for patients in the absence of effectiveness from drug treatment.
In the course of conservative therapy or in the postoperative period, patients need constant medical control with standard studies (determining the rate of urine current, ultrasound, analysis of the PSA level).
Drugs
There is a certain scheme according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma.High effectiveness of treatment is achieved thanks to the use of drugs of the 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, as well as to restore sufficient urination.
What are the most effective and widely used tablets from prostate adenoma?The list is headed by alpha1-adrenergic receptors blockers.In addition, this list includes inhibitors of 5-alpha reductase, vitamins and minerals.
The complex of drug therapy includes not only drugs.With prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements that enhance the therapeutic effect of drugs and provide an early recovery.Some of them include zinc.This macro element is directly involved in spermatogenesis and testosterone synthesis.Plant phytosterols normalize urination.
Treatment with drugs of the Antagonists group alpha1-adrenoceptors
These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improving the process of urine.Tamsulosin with the same name of the active substance, which is part of other drugs (alfuzosin, silodinos, etc.), is a highly-sequential drug that has a selective effect on alpha1-adrenergic receptors of the prostate muscles, the prostatic of the urethra and bladder.Thanks to a decrease in muscle tone, the outflow and urine release are facilitated.Tamsulosin, like all selective drugs, has a minimal number of side effects, does not affect the tone of blood vessels and can be prescribed to patients with chronic hypertension.
Antagonists of alpha-adrenergic receptors must be used constantly, so that you can achieve a gradual reduction in irritation and obstruction with prostate adenoma.The drug Tamsulosin in the treatment of prostate adenoma occupies a well -deserved priority in the purpose of urologists.
The tablet form of the drug is considered more progressive, since due to the controlled release of tamsulosin, the active substance is in the body in constant concentration.The medicine enters the bloodstream evenly, thereby ensuring a decrease in the likelihood of developing the main side effects of the drugs of the adrenaehobocators group - a sharp decrease in blood pressure.
An equally effective drug with the acting substance tamsulosin is a lesson.Taking this drug is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, an increase in angina attacks in patients with coronary heart disease, so it can be prescribed for men with heart pathologies.Properly selected dosage and compliance with all the rules on the use of drugs of the Alpha-blockers group allow you to achieve a good therapeutic effect in the almost complete absence of side effects.
Medicines of the group of inhibitors (blockers) reductase
The drugs of this pharmacological group (finsteride, dutasteride) contribute to alleviating the outflow of urine, and, therefore, the elimination of the main symptoms of the disease.A stable therapeutic effect occurs already two to three weeks after the start of the course.All symptoms are completely stopped after three months.According to the results of clinical studies, maximum efficiency is achieved after six months of therapy with these drugs.
Finasteride and dutasteride are specific inhibitors of 5-alpha reductase of the 2nd type (cell enzyme responsible for the transformation of testosterone into dihydrotestosterone).The growth of the prostate with prostate adenoma is directly related to a similar transformation of testosterone.Thanks to 5-alpha reductase inhibitors, the products of intra-industrial dihydrotestosterone are blocked and its concentration in the blood is significantly reduced.
Finsteride and dutasteride are used for the following purposes:
- Treatment and control of prostate hyperplasia;
- Improving the outflow of urine and eliminating symptoms of prostate adenoma;
- Reducing the risk of developing acute urinary retention and the need to conduct surgical intervention.
Finasteride and dutasteride have a pronounced antiandrogenic effect, i.e.contribute to a decrease in the level of male hormones in the blood.In addition, these drugs have a teratogenic effect, so they need to be taken with caution.With the help of modern drugs, you can stop the growth of the prostate and prevent the need for surgical treatment.
Antispasmodics and analgesic tablets with an exacerbation of the disease
The main prescription of antispasmodic and analgesic effects with exacerbation of the prostate adenoma is to relieve the general condition of the patient and eliminate the pain syndrome.The anti -inflammatory and analgesic effect is exerted by non -steroidal anti -inflammatory drugs (diclofenac, ibuprofen).They help to fight not only with painful sensations that occur in the process of urination, but also with constant pain in the groin and perineum.Due to the action of non -steroidal anti -inflammatory drugs, the inflammatory process decreases, swelling of the prostate gland decreases, body temperature is normalized, and unpleasant symptoms are eliminated.
Neopioid analgesics produced in the form of tablets or candles help to stop the pain syndrome with exacerbation of prostate adenoma.The most affordable of them is sodium metamizole.However, this drug is intended more for one -time use, since it can only affect a weak pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesin and novocaine (ichtammol, benzocaine, tribenoside + lidocaine) are effective.
Vitamin E 400
Tocopherol Acetate or vitamin E is often part of the complex treatment of prostate adenoma as an antioxidant, radioprotective agent and an indispensable link in reproductive processes.Vitamin E in a dosage of 400 mg urologists are prescribed to patients with disorders of erectile function and spermatogenesis associated with the adenoma of the prostate gland.
Treatment of such a serious chronic disease as a prostate adenoma should be prescribed and controlled by a urologist.It is strictly prohibited to take certain drugs independently, without a preliminary consultation with the attending physician, since self -medication in this case can be not only ineffective, but also dangerous for male health.Only a qualified specialist can suggest which tablets from prostate adenoma are the most effective in each case, and which of them can cause negative consequences.
Operations
Hospital urologists masterfully perform classic and minimally invasive surgical interventions, use innovative methods of surgical treatment of prostate adenoma.Each patient is selected that operation that suits him more.
The generally recognized standard in the surgical treatment of prostate adenoma is transurethral resection of the prostate.The operation is highly effective.After the intervention, patients get rid of infravyzical obstruction (narrowing of the urethra) and associated symptoms.The rehabilitation period is short.During or after surgery, bleeding may develop, the “water intoxication” syndrome.
Alternative methods of treating prostate adenoma include the following surgical interventions:
- Stenting;
- Balloon dilatation;
- Hyperthermia;
- Thermotherapy;
- Ultrasonic, laser and needle ablation;
- Interstitial coagulation.
After them, complications arise less often, but these methods are inferior to transurethral resection in terms of effectiveness, both in clinical and economically.
The laparoscopic removal of the prostate adenoma is used when the tumor has grown significantly, and it is problematic to remove it using transurethral resection.This operation is more complicated, carried out under anesthesia.Through small incisions, the surgeon introduces special tools into the body cavity, which performs the removal of prostate adenoma.The operation is carried out according to the image from video cameras, which is displayed on the screen.The main advantages of the intervention are the minimum volume of blood loss, a small probability of complications.After surgery, the patient does not need long -term rehabilitation.
When there are signs of prostate adenoma in men, doctors use a high -tech method for treating adenoma - laser enucleation.Intervention is carried out with large sizes of the neoplasm.Excess fabrics are removed using a laser.The operation is carried out through the urethra.The tumor is separated, divided into small parts, and then displayed.The method is considered minimally invasive.It has a number of significant advantages: it does not violate the integrity of the cavities, does not cause unnecessary damage.
Laser vaporization consists in destroying the adenoma by laser evaporation.Through the urethra, the urologist introduces a special device, is brought to the neoplasm and pointarily affects it with a strong green laser.The depth of the laser penetration and the accuracy of its hit can avoid damage to neighboring areas.The method is minimal, bloodless, fast and effective.Its only disadvantage is the inability to take a tumor tissue for histological examination.
In some situations, the inevitable method of treating prostate adenoma is the abdominal surgery - adenomectomy.It is performed in the case when other methods cannot help the patient.During surgery, the surgeon with a scalpel carries access to the prostate gland and manually, using surgical instruments, removes the adenoma.As a result of the operation, significant blood loss may occur, complications develop.After surgery, the patient needs prolonged rehabilitation.
Removal of the prostate adenoma by the method of custody (transluccal) adenomectomy consists in radical excision of the hyperplashed tissues of the prostate through the longitudinal incision of the anterior abdominal wall and bladder.The operation is carried out at the advanced stages of the disease, when the tumor reaches large sizes, the bladder is overturned due to its overflow of accumulated urine, and renal failure develops.
The bladder is pre -catheterized and filled with a sterile solution of furatsilin or other substance.Then it is allocated and taken in two places to special holdings, for which they raise the wall of the organ.The surgeon dissects the formed fold and performs the opening of the bladder.
By the inner end of the established urinary catheter, it determines the area of the neck of the bladder and around the urethra holes that appeared in the field of view, retreating 0.5-1 cm from it, makes the mucous membrane of the mucous membrane.After that, the operating urologist penetrates a finger into the thickness of the prostate, enters it between the tumor capsule and adenomatous nodes, and heses the latter.At the same time, the doctor gives the gland to the front of the patient in the rectum of the patient in the rectum in the front abdominal wall.It becomes more affordable for manipulation.Thanks to this technique, the time of operation is reduced and blood loss is reduced.
Then the surgeon performs hemostasis (stopping bleeding) of the bed of the remote adenoma and sutures the bladder, leaving a thin drainage in the wound.It is designed to wash its cavity from the resulting blood clots.The urinary catheter, introduced before the start of the operation, is not taken out for 7-10 days.Around it, a new section of the urethra is formed instead of the sidelled in the course of the prostatic part of the urethra.
Cuspular adenomectomy refers to the most traumatic of all the methods used for the prostate gland adenoma.It is accompanied by the risk of developing the following complications:
- Bleeding from the lodge of the neoplasm;
- Stagnant pneumonia;
- Impaired motor-evacuation function of the intestine, manifested by constipation.
To avoid complications, after surgery in the hospital, the patient is carried out early activation.The following undesirable consequences of operations to remove prostate adenoma may occur:
- Insufficient drainage of the bladder;
- Narrowing of his neck;
- Urinary infiltration of near -pussy tissue;
- The formation of the “prenatal” (the residual cavity in the place where the prostate adenoma was removed);
- The formation of narrowing of the lumen of the urethra;
- Urine incontinence.
This negatively affects the quality of life of patients and lengthens the restoration of adequate urination.
The consequences of the operation are less pronounced when the intervention is performed using a laparoscope.The laparoscopic operation to remove the prostate adenoma is one of the less invasive options for surgical interventions on the prostate gland.Hospital urologists use this technique if the patient has a sufficiently large adenoma of the prostate.
If the prostate gland of the patient with an adenoma does not exceed 120 cm3, it is recommended for transurethral resection of the prostate adenoma.But 10% to patients who need surgery, this option is not suitable, since the iron reaches more than 120 cm3.The laparoscopic operation to remove the prostate adenoma during uarolitiasis, inguinal hernia, diverticulum of the bladder, and ankylose joints of the lower extremities is not performed.In this case, the decision on the possibility of conducting an operation is made collegially by a urologist, andrologist, an abdominal surgeon and other hospital specialists.