Benign prostatic hyperplasia (BPH) or adenoma is an increase in 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 is about 40% after 50 years, and more than 75% after 65 years.In fact, 90% of all men will encounter the disease sooner or later, 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 it does not harm the body by itself.However, as the tissues grow, they block the lumen of the urethra, preventing the passage of urine.This is accompanied by many unpleasant complications and painful sensations, especially in the later stages.The resulting congestion can lead to infections, the formation of bladder stones, its damage, and serious disruption of kidney function, including the development of kidney failure.Therefore, at the slightest manifestation of symptoms, you should immediately make an appointment with a urologist, undergo a thorough examination, and based on the results, choose the most effective method of prostate adenoma treatment.
Stages and symptoms
The course of the disease can be divided into three main stages, which are accompanied by different symptoms:
- I – characterized by more frequent urging, nocturia (increased nocturnal diuresis), first signs of incontinence and sluggish flow.The disease can remain in 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 hernias and rectal prolapse.After a visit to the toilet, the 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 form, and incontinence increases.General symptoms of poisoning may also appear - weakness, loss of appetite, nausea, constipation, constant dry mouth.
It is worth understanding that similar symptoms are accompanied by certain types of nervous system disorders and cancer.An accurate diagnosis can only be made at the clinic after appropriate research.
Treatment of the disease
Currently, prostate adenoma hyperplasia is a fairly well-studied disease.Its treatment is not particularly difficult and can be carried out in several ways depending on the severity, type, speed and degree of development of the disease, the patient's age, general health and other factors.
In general, all methods are traditionally medicinal, non-pharmacological and surgical.There are also many recipes 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 prostate adenoma treatment only complicate the course of the disease, negatively affecting the patient's condition.
Non-drug methods
In case of mild or more severe symptoms of the disease that do not affect the quality of life, watchful waiting, also known as active waiting, is used.This 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 going to bed;
- physical therapy, Kegel exercises and other activities aimed at training the pelvic muscles;
- reducing consumption of diuretic products and liquids, especially three hours before bedtime.
The technique is used independently and as a supplement 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-anticholinergic agents, muscarinic receptor blockers - with a clear predominance of symptoms caused by congestion;
- phosphodiesterase type V inhibitors - usually used to treat impotence and its causes, but have also 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 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 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, maintaining normal urination and erection.Their main advantage is that they can be used at any stage of the disease.There are several main types of surgical interventions at our clinic.The decision on how to treat the prostate adenoma is made by the attending physician after a thorough examination and examination together with the patient.
Open adenomectomy
Open adenomectomy is a classic operation in which an incision is made in the perineum or lower abdomen and the inflamed glandular tissue is removed with 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 every clinic.However, due to the open nature of the operation, it is often associated with extensive bleeding.In addition, due to the proximity of the prostate to nerve nodes, there is always a risk of damage, which leads to 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 popular and frequently performed surgeries due to its low invasiveness.All the instruments are brought to the formation through the urethral canal without an incision, as a result of which there is no blood loss, no scars remain on the skin, and the recovery period is only a few days.In addition, during the procedure, complete information is collected about the state of the urinary system and any abnormalities found are eliminated.
A novelty in the treatment of prostate adenoma
Minimally invasive methods using advanced technologies and equipment are considered the most promising.These are:
- Holmium laser enucleation of prostatic hyperplasia (HoLEP) - the operation is performed through small (up to 2 cm) incisions.Using the laparoscope, a laser fiber is inserted into the bladder and through its neck into the gland.The adenoma tissue is removed by careful incision with an ultra-precise and safe holmium crystal laser and then morcellated.This approach guarantees almost complete absence of damage to healthy tissues and minimal blood loss;
- transurethral photoselective vaporization - the method consists in completely burning out damaged tissues with focused laser radiation without damaging healthy cells.The intervention is performed through the urethral canal, which eliminates possible incisions and scars, allows for a minimal number of relapses, and reduces the recovery time to several days;
- robot-assisted laparoscopy - using the advanced Da Vinci robot complex, equipped with the necessary tools and equipment for video recording.Control is performed by an experienced surgeon on a special terminal, and the image from the camera is displayed on a large monitor in high resolution, which significantly expands the operating space.Special robot algorithms smooth out all sudden and random movements of the operator, completely eliminating the human factor, such as shaking.The use of the complex allows you to perform the operation as accurately and precisely as possible, through small incisions of a few millimeters.
All these methods have a significant drawback - the need for expensive equipment and experienced, trained personnel.Therefore, such techniques cannot be used in all hospitals.