The most common urological pathology, which is addressed to the urologist, men over 45, is prostate adenoma.The presence of this pathology significantly impairs the quality of life of men.One of the most feared possible consequences of the pathological process is the degeneration of benign prostate hyperplasia in a malignant tumor.
Surgical and medicinal methods of treatment are used to combat prostate adenoma.Hospital specialists choose the most effective drugs or surgery methods, taking into account the stage of the disease, general condition and age of the patient, as well as the presence of related pathologies.The clinic of surgery has created convenient conditions for the treatment of patients.
The causes of the development of the disease
The appearance of an adenoma is most often associated with changes related to age in the prostate, namely a change in its structure and increasing size.As a result of such changes, the urethra is gradually compressed, which is located in the thickness of the prostate gland and there are disorders of the urination process.
Prostate adenoma in men develops due to hormonal restructuring of the body associated with age -related changes.The level of testosterone (male hormone) gradually decreases with age, while the concentration of the female sex hormone (estrogen), on the contrary, increases.This phenomenon is called male menopause.
The development of prostate adenoma may be due to the following risk factors:
- The patient's age - increased prostate iron is extremely rare in men under forty years and after sixty years is diagnosed almost every second;
- Hereditary predisposition - if the prostate adenoma is diagnosed with close blood relatives of a man, he or she has a huge risk of inheriting this disease in adulthood;
- Diabetes of sugar, cardiovascular disease-good quality tumor (adenoma) of the prostate can occur as a result of not only these diseases but also the harmful effects of medicines for their treatment (eg beta-blockers);
- Wrong Lifestyle - The risk of developing prostate adenoma is increased in men with obesity, insufficient physical activity.
Symptoms
Prostate adenoma can be suspected when a person appears in the following symptoms that are most characteristic of this disease:
- urination obligations;
- the emergence of the need for tension of the abdominal muscles for urination;
- The presence of pain, burning, sluggish flow of urine;
- discomfort and insufficient emptying of the bladder;
- Increasing the duration of the urination process.
Prostate adenoma leads not only to reduce the quality of life of the person, but also to an acute slowdown in urination, which requires the use of surgical treatment methods.To avoid surgery, many patients use special medicines to treat prostate adenoma, eliminate symptoms and restore normal prostate activity.However, only a qualified specialist can offer the best medicine for prostate prostatitis and adenoma.It is necessary to contact it when the first symptoms of the disease appear.
Treatment of prostate adenoma individually for each patient.Prostate adenoma, their dose and duration are prescribed by the attending physician.Taking prostatitis products and prostate adenoma can independently be not only an ineffective but also dangerous measure.Due to the presence of men of the older generation of some "personal" chronic diseases, medicines should be chosen to treat prostate adenoma, taking into account the accompanying pathologies.
Stages of disease development
Prostate adenoma is characterized by a gradual development, which can be divided into three stages.
- The first stage of the disease occurs with minimal disorders of urination.Its slight increase, especially at night and a slow flow 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 urinary disorders: the periodicity of the urine flow, the appearance of the need for tension during urination and a feeling of incomplete emptying of the bladder.The residual urine, which lingers in the bladder and urinary tract, causes an inflammatory process that is accompanied by pain, burning sensation during urination, lower back pain and above the pubis.
- The third stage is characterized by periodic or constant release of urine, which forces the patient to use the ureter.
Complications
In some prostate adenoma men, the quality of life does not deteriorate and continues without the development of complications.In some cases, however, the disease can have the following negative effects:
- Acute slowdown in urine - is characterized by a sudden inability to empty the bladder and pain in the right area.In this condition, the patient needs emergency medical care with catheterization or small surgery;
- The onset of urinary tract infections 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 improper emptying of the bladder, it is stretched, the formation of protrusions (pockets) in the walls of the organ in which the urine stagnates;
- Kidney damage - increased pressure in the urethra and bladder has a direct harmful effect on the kidneys, resulting in renal failure.
Adenoma and prostate potency
Prostate and potency adenoma are closely related.The adenoma disrupts the structure of the tissue of the gland, which in turn leads to the defeat of another, no less important organ - the testes responsible for the products of androgens.In this way, prostate adenoma can cause impotence, which requires prolonged and complex therapy.
Diagnostics
A simple and effective way to establish a preliminary diagnosis is the patient, keeping a log for urinating with the fixation of quantitative and qualitative parameters: volumes of specialized urine, characteristics of the consumed fluid, necessary calls, night impulse.The main physical method of examination in the case of suspicion of prostate adenoma is a rectal examination of the prostate finger to identify its increase and exclusion of some other pathologies.
The diagnosis of prostate adenoma in the hospital is performed using the following laboratory and instrumental methods:
- General tests for blood and urine;
- Biochemical blood test for kidney condition markers, urea and creatinine levels;
- Analysis of the dog level (to exclude prostate cancer);
- Transrectal ultrasound (ultrasound);
- Uroflometry (to determine the speed of urine current);
- Determination of residual urine volume (using ultrasound);
- Pelvic floor electromyography;
- Urethrocystoscopy;
- Exclusive urography.
Treatment
Treatment for prostate adenoma is aimed at facilitating the symptoms of a more urinary tract, improving the quality of the patient and preventing the development of complications of the disease.Patients with poorly exposed symptoms who do not impair quality of life, often prescribe dynamic tactics with regular urologist examinations, which controls the course of the disease and makes recommendations on how to stop the growth of prostate adenoma.During this period, attention is focused on therapy that is not disturbed.Techortic methods can be supplemented to conservative treatment, which is the use of the following medicines:
- Alpha blockers (tamsulosin, alfusosin);
- 5-alpha reductase inhibitors (finsteride);
- Phosphodesteris inhibitors type 5 (sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha blockers;
- Muscarinic receptors blockers or M-cholinolytics.
Patients with advanced prostate adenoma are recommended to undergo surgical treatment, which can be performed by several methods: transurethral excision, transurethral resection and prostate removal.
There are certain indications for the use of surgical treatment:
- Repeatedly delayed urine;
- Renal failure provoked by prostate adenoma;
- Bladder stones;
- Recurrent urinary tract infections;
- Repeated hematuria.
In addition, surgery is required for patients in the absence of effectiveness of drug treatment.
In the course of conservative therapy or in the postoperative period, patients need constant medical control with standard studies (determination of urine current, ultrasound, PSA level analysis).
Medication
There is a certain scheme that prescribes specific drugs for the treatment of prostatitis and prostate adenoma.The high effectiveness of treatment is achieved due to the use of medicines of alpha reductase and alpha-blockers inhibitors.These medicines 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 prostate adenoma tablets?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 medicines.With prostate adenoma, conservative treatment can be supplemented with biologically active supplements - nutritional supplements that enhance the therapeutic effect of medicines and provide early recovery.Some of them include zinc.This macro element is directly involved in spermatogenesis and testosterone synthesis.Vegetable phytosterols normalize urination.
Treatment with Antagonists Drugs Alpha1-Adrenoceptors
These medicines for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve the urine process.Tamsulosin, with the same name of the active substance that is part of other medicines (alfusosin, silodino, etc.), is a high sequential drug that has a selective effect on alpha1-adrenergic prostate muscle receptors, urethral prostatics and bladder.Due to the decrease in muscle tone, the release of leakage and urine is facilitated.Tamsulosin, like all selective drugs, has a minimum number of side effects, does not affect the tone of blood vessels and can be prescribed to patients with chronic hypertension.
Alpha-adrenergic receptors antagonists should be used constantly so that you can gradually reduce irritation and obstruction with prostate adenoma.Medicinal Tamsulosin in the treatment of prostate adenoma occupies a good priority for the purposes of urologists.
The tablet form of the drug is considered more progressive, because due to the controlled release of tamsulosin, the active substance is in the body at constant concentration.The drug enters the blood evenly, thus guaranteeing a decrease in the likelihood of developing the main side effects of Adrenaehobocators' drugs - a sharp decrease in blood pressure.
An equally effective drug with the acting substance tamsulosin is a lesson.The administration of this medicine is not accompanied by the following side effects: orthostatic hypotension, tachycardia, increased angina attacks in patients with coronary heart disease, so it can be prescribed for men with cardiac pathologies.Properly chosen dose and adherence to all rules for the use of medicines of the Alpha-Blockers group allow you to achieve a good therapeutic effect in the almost complete absence of side effects.
Medicines of the Inhibitors Group (Blockers) Reductase
The drugs of this pharmacological group (Finsteride, Dutasteride) contribute to relieving the leakage of urine and therefore eliminating the main symptoms of the disease.A stable therapeutic effect occurs two to three weeks after the start of the course.All symptoms are completely stopped after three months.According to the results of clinical trials, maximum effectiveness is achieved after six months of therapy with these drugs.
Finasteride and detasteride are specific inhibitors of 5-alpha reductase of type 2 (cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone).Prostate growth with prostate adenoma is directly associated with a similar transformation of testosterone.Due to the 5-alpha reductase inhibitors, intra-industrial dihydrotestosterone products 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 urine leakage and eliminating the symptoms of prostate adenoma;
- Reducing the risk of developing acute urinary retention and the need for surgery.
Finasteride and dutasteride have a pronounced anti -androgen effect, ie.They contribute to a decrease in the level of male hormones in the blood.In addition, these drugs have a teratogenic effect, so they should be taken with caution.With the help of modern medicines, you can stop prostate growth and prevent the need for surgical treatment.
Antispasmodics and analgesic tablets with exacerbation of the disease
The main prescription of antispasmodic and analgesic effects with exacerbation of prostate adenoma is to relieve the patient's general condition and eliminate 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 the 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, the swelling of the prostate gland decreases, the body temperature normalizes and the 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 these is sodium metamizole.However, this medicine is more intended for use at one time, as it can only affect mild pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesine 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, a radio protective agent and an indispensable connection in reproductive processes.Vitamin E at a dose of 400 mg urologists are prescribed to patients with erectile function disorders and spermatogenesis associated with the prostate adenoma.
The treatment of such a serious chronic disease as prostate adenoma should be prescribed and controlled by a urologist.It is strictly forbidden to take certain medicines independently without prior consultation with the attending physician, since the self in this case can be not only ineffective but also dangerous to the health of men.Only a qualified specialist can suggest which prostate adenoma tablets are most effective in any case and which ones can have negative effects.
Operations
Hospital urologists, who masterfully perform classic and minimally invasive surgical interventions, use innovative methods for surgical treatment for prostate adenoma.Each patient is chosen that the surgery that suits him more.
Overall, the 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 infraviisal obstruction (narrowing of the urethra) and related symptoms.The rehabilitation period is short.During or after surgery, bleeding, water intoxication syndrome, may develop.
Alternative methods of treating prostate adenoma include the following surgical interventions:
- Stenting;
- Balloon dilation;
- Hyperthermia;
- Thermotherapy;
- Ultrasound, laser and ablation needle;
- Interstitial coagulation.
After that, the complications arise more rarely, but these methods are more than transurethral resection in terms of effectiveness, both clinical and economic.
Laparoscopic removal of the prostate adenoma is used when the tumor has grown significantly and it is problematic to remove it with the help of transurethral resection.This operation is more complex, under anesthesia.Through small cuts, the surgeon introduces special tools into the body cavity, which performs the removal of prostate adenoma.The operation is performed according to the image of camcorders, which is displayed on the screen.The main advantages of intervention are the minimum volume of blood loss, the unlikely of complications.After the surgery, the patient does not need long -term rehabilitation.
When there are signs of prostate adenoma in men, doctors use a high -tech techno method to treat adenoma - laser enucleation.The intervention is performed with large neoplasm sizes.Excess fabrics are removed with the help of a laser.The operation is performed through the urethra.The tumor is divided, divided into small parts and then displayed.The method is considered minimally invasive.It has a number of significant advantages: it does not disturb the integrity of the cavities, does not cause unnecessary damage.
Laser evaporation is to destroy the adenoma by laser evaporation.Through the urethra, the urologist introduces a special device, leals into the neoplasm and emphasizes it with a strong green laser.The depth of laser penetration and the accuracy of his impact can avoid damage to adjacent areas.The method is minimal, bloodless, fast and effective.Its only disadvantage is the inability to take tumor tissue for histological examination.
In some situations, the inevitable method of treating prostate adenoma is abdominal surgery - adenomectomy.It is performed in the case where other methods cannot help the patient.During the operation, the scalpel surgeon carries access to the prostate gland and manually, using surgical instruments, eliminates the adenoma.As a result of the surgery, significant blood loss can occur, complications may develop.After the surgery, the patient needs prolonged rehabilitation.
The removal of the prostate adenoma by the method of custody (translucent) adenomectomy consists in a radical excision of the hyper -frightened tissues of the prostate by a longitudinal incision of the anterior abdominal wall and bladder.The surgery is performed at the advanced stages of the disease, when the tumor reaches a large size, the bladder overturns due to its overflow from accumulated urine and develops renal failure.
The bladder is pre -educated and filled with a sterile solution of futssetillin or other substance.It is then distributed and occupied in two special farms, for which they lift the wall of the organ.The surgeon dismembers the folded fold and performs the opening of the bladder.
Up to the inner end of the established urinary catheter, it determines the area of the bladder neck and around the openings of the urethra that appear in the visual field, withdrawing 0.5-1 cm from it makes the mucosa of the mucous membrane.The working urologist then penetrates the finger into the thickness of the prostate, enters it between the tumor capsule and the adenomatous nodes and is the last.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 anterior abdominal wall.It becomes more accessible to manipulation.Thanks to this technique, the time of operation is reduced and blood loss is reduced.
Then the surgeon performs hemostasis (stopping bleeding) on the bed of the distant adenoma and sews the bladder, leaving thin drainage in the wound.It is designed to wash its cavity from the blood clots obtained.The urine catheter introduced before the start of the surgery is not removed for 7-10 days.A new section of the urethra is formed around it, instead of sideways, during the prostatic part of the urethra.
Cuspular adenomectomy refers to the most traumatic of all methods used for prostate adenoma.It is accompanied by the risk of developing the following complications:
- Bleeding from the neoplasm lodge;
- Stagnant pneumonia;
- Disturbed function of intestinal motor and evacuation manifested by constipation.
In order to avoid complications, after the surgery at the hospital, the patient is performed early activation.The following undesirable consequences of the prostate adenoma removal operations may occur:
- Insufficient bladder drainage;
- Narrowing of his neck;
- Urinary infiltration of almost tissue tissue;
- The formation of the "prenatal" (residual cavity at the place where the prostate adenoma is removed);
- The formation of narrowing of the lumen of the urethra;
- Urine incontinence.
This has a negative effect on the quality of life of patients and prolongs the recovery of adequate urination.
The consequences of the operation are more pronounced when the intervention is performed with the help of a laparoscope.Laparoscopic surgery to eliminate the prostate adenoma is one of the less invasive possibilities for surgical interventions of the prostate gland.Hospital urologists use this technique if the patient has a large enough prostate adenoma.
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% in patients in need of surgery, this option is not appropriate as iron reaches more than 120 cm3.Laparoscopic surgery to eliminate the prostate adenoma during Warolysis, inguinal hernia, bladder diverticulum and ankylose joints of the lower limbs are not performed.In this case, the decision on the possibility of surgery is made collegially by a urologist, andrologist, abdominal surgeon and other specialists in the hospital.