Diagnosis and treatment of prostate adenoma

The most common urological pathology, directed to the urologist, men over 45, is the 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 in a malignant tumor.

To combat prostate adenoma, surgical methods and treatment drugs are used.Hospital experts select the most effective medicines or methods of surgical intervention, taking into account the stage of the disease, the general condition and the age of the patient, as well as the presence of related pathologies.At the surgery clinic, comfortable conditions were created for the treatment of patients.

The causes of disease development

Adenoma is more often associated with age -related prostate changes, namely a change in its structure and an increase in size.As a result of such changes, the urethra is gradually compressed, located in the thickness of the gland and violations 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) 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 may be due to the following risk factors:

• The age of the patient - increased prostate iron is extremely rare in men under forty and, after sixty years, is diagnosed in almost every second;
• Hereditary predisposition - If prostate adenoma has been diagnosed with blood relatives near a man, he has a huge risk of inheriting this disease in adulthood;
• Diabetes mellitus, cardiovascular disease-benign tumor (adenoma) of the prostate may occur as a result not only of these diseases, but also the harmful effects of drugs for their treatment (eg betabloquers);
• Wrong Life - The risk of developing prostate adenoma is increased in men with obesity, insufficient physical activity.

Symptoms

Prostate adenoma may 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 voltage of the abdominal muscles for urination;
• the presence of pain, burning and slow and slow urine;
• Insufficient bladder insufficient discomfort and emptying;
• Increasing the duration of the urination process.

The prostate adenoma leads not only to a decrease in a man's quality of life, but also to acute delay in urination, which requires the use of surgical treatment methods.To avoid surgical intervention, many patients use special drugs to treat prostate adenoma, eliminating symptoms and restoring normal prostate activity.However, only one qualified expert can suggest the best prostatitis and prostate adenoma remedy.It is necessary to contact when the first symptoms of the disease appear.

Treatment of prostate adenoma individually for each patient.Preparations for the treatment of prostate adenoma, its dosage and duration of use are prescribed by the assistant doctor.Taking prostatitis and prostate adenoma products independently may not only be an ineffective measure, but also a dangerous measure.Due to the presence in men of the oldest generation of some "personal" chronic diseases, drugs for the treatment of prostate adenoma should be selected taking into account the pathologies that accompany it.

Stages of disease development

Prostate adenoma is characterized by gradual development, which can be divided into three stages.

• The first stage of the disease continues with minimal disturbances of urination.Its insignificant increase, especially at night, and a slow urine flow can be observed.The first step can last from one year to 12 years or more.
• The second stage of prostate adenoma is characterized by more pronounced urination disorders: the intermittent of the urine current, the appearance of the need to strive during urination, and an incomplete emptying of the bladder.Residual urine, which remains 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 release of periodic or constant involuntary urine, which forces the patient to use the ureter.

Complications

In some prostate adenoma men, the quality of life does not get worse and continues without the development of complications.However, in some cases, the disease may cause the following negative consequences:

• The acute delay of urine - is characterized by a sudden impossibility of emptying the bladder and pain in the right 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 the 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, the formation of protrusions (pockets) in the organ walls, where the stagna urine is stretched;
• Kidney Damage - Greater pressure on urethrers and bladder has a direct harmful effect on the kidneys as a result of renal failure.

Prostate and Power Adenoma

Adenoma and prostate power are closely interconnected.The adenoma interrupts the structure of the gland tissue, which, in turn, leads to the defeat of another, no less important organ - the testicles responsible for androgens products.Thus, prostate adenoma can cause impotence that requires prolonged and complex therapy.

Diagnosis

A simple and effective way to establish a preliminary diagnosis is the patient, maintaining a urination diagnosis with the fixing of quantitative and qualitative parameters: dedicated urine volumes, characteristics of the consumed fluid called imperative, night insistence.The main physical method of examination in case of suspected prostate adenoma is a rectal prostate examination to identify its increase and exclude some other pathologies.

The diagnosis of prostate adenoma in the hospital is performed using the following laboratory and instrumental methods:

• General tests of blood and urine;
• Biochemical blood test for markers of the condition of the kidneys, urea and creatinine level;
• Analysis for dog level (to exclude prostate cancer);
• Transto ultrasound exam (ultrasound);
• Urofloometry (to determine the velocity of urine current);
• Determination of residual urine volume (using ultrasound);
• Pelvic background electromyography;
• Urethrocioscopy;
• Excretory urography.

Treatment

The treatment of prostate adenoma aims to facilitate the symptoms of the lower urinary tract, improve patient quality and prevent the development of disease complications.Patients with poorly exposed symptoms that do not worsen quality of life, usually prescribe the tactics of dynamic observation with regular examinations with a urologist, who controls the course of the disease and provides recommendations on how to interrupt prostate adenoma growth.During this period, attention is focused on non -Drug therapy.Wrong methods can be an addition to conservative treatment, which is the intake of the following medications:

• Alpha (Tamsulosin, Alfuzosin) blockers;
• 5-alpha reductase inhibitors (Finsteride);
• Type 5 phospho inhibitors (sildenafil);
• 5-alpha reductase inhibitor combinations and alpha blockers;
• Muscated or m-colinic receptors blockers.

It is recommended that patients with prostate adenoma at an advanced stage perform surgical treatment, which can be performed by various methods: transureral excision, transureral resection and prostate removal.

There are certain indications for the use of surgical treatment:

• Delay in repeated urine;
• Renal failure caused by prostate adenoma;
• Bladder stones;
• Recurring urinary tract infections;
• Repeating 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 (determining the urine current rate, ultrasound, PSA level analysis).

Drug

There is a certain scheme according to which specific medicines are prescribed for the treatment of prostatitis and prostate adenoma.The high efficacy of treatment is achieved thanks to the use of alpha reductase inhibitors and alpha blockers.These drugs for the treatment of prostate adenoma in men help eliminate the main symptoms of the disease as well as restore sufficient urination.

What are the most effective and widely used pills of prostate adenoma?The list is headed by alpha-adrenergic receptors blockers.In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.

The drug therapy complex includes not just medications.With prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements that increase the therapeutic effect of drugs and provide early recovery.Some of them include zinc.This macro element is directly involved in spermatogenesis and testosterone synthesis.Vegetable phytosterols normalize urination.

Alpha1-Adrenoceptors antagonist drug treatment

These drugs for the treatment of prostate prostatitis and adenoma provide relaxation of the smooth muscles of the urinary system and improving the urine process.Tamsulosin with the same name as the active substance, which is part of other medicines (alfuzosin, forests, etc.), is a highly sequential medicine that has a selective effect on the alpha-adrenergic receptors of prostate muscles, the prostatic urethra and Bladder.Thanks to a decrease in muscle tone, the output and release of urine are 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 in patients with chronic hypertension.

Alpha-adrenergic receptor antagonists should be used constantly so that you can get a gradual reduction in irritation and obstruction with prostate adenoma.Drug Tamsulosin in the treatment of prostate adenoma occupies a well -distributed priority on the purpose of urologists.

The form of the drug tablet is considered more progressive, because due to the controlled release of tamsulosin, the active substance is in the body in constant concentration.The drug enters the bloodstream uniformly, thus ensuring a decrease in the likelihood of developing the main side effects of adrenaehobocator group medications - a marked decrease in blood pressure.

An equally effective medicine with the substance of acting of Tamsulosin is a lesson.Taking this medicine is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, an increase in angina attacks on patients with coronary heart disease so that it can be prescribed for men with heart pathologies.Properly selected dosage and compliance with all rules on the use of alpha-blocked group drugs allow a good therapeutic effect on the almost complete absence of side effects.

Drugs of the inhibitors group (blockers) reductase

The drugs of this pharmacological group (Finsteride, Dutasteride) contribute to relieving urine output and, therefore, the elimination of the main symptoms of the disease.A stable therapeutic effect already occurs two to three weeks after the beginning of the course.All symptoms are completely interrupted after three months.According to the results of clinical studies, the maximum efficiency is achieved after six months of therapy with these medicines.

Thin and ductasterid are specific inhibitors of the 2nd type 5-alpha (cell enzyme responsible for transforming testosterone into dihydrotestosterone).Prostate growth with prostate adenoma is directly related to a similar transformation of testosterone.Thanks to 5-alpha reductase inhibitors, intra -industrial dihydrotestosterone products are blocked and their blood concentration is significantly reduced.

Finsteride and ductasteride are used for the following purposes:

• Treatment and control of prostate hyperplasia;
• Improve urine output and eliminate prostate adenoma symptoms;
• Reducing the risk of developing acute urinary retention and the need for surgical intervention.

Finasteride and ductasteride have a pronounced antiandrogenic effect, that is, they contribute to a decrease in the level of male blood hormones.In addition, these medications have a teratogenic effect, so they need to be taken with caution.With the help of modern medications, you can stop prostate growth and prevent the need for surgical treatment.

Anticasmodic and compressed analgesic with an exacerbation of the disease

The main prescription of antispasmodic and analgesic effects with prostate adenoma exacerbation is to relieve the patient's general condition and eliminate pain syndrome.The anti -inflammatory and analgesic effect is exerted by non -esteroid anti -inflammatory drugs (diclofenac, ibuprofen).They help fight not only with painful sensations that occur in the urination process, but also with constant pain in the groin and perineum.Due to the action of non -steroid anti -inflammatory drugs, the inflammatory process decreases, the swelling of the prostate gland decreases, body temperature is normalized and unpleasant symptoms are eliminated.

The neopioid painkillers produced in the form of tablets or candles help to interrupt pain syndrome with prostate adenoma.The most affordable of these is sodium metamizole.However, this medicine is more intended for the use of a time, as it can only affect a weak pain syndrome.In addition, painkillers with lidocaine, benzocaine, anesthesine and novocaine (ichtammol, benzocaine, tribenooside + lidocaine) are effective.

Vitamin E 400

Tocopherol or vitamin E acetate is part of the complex treatment of prostate adenoma such as antioxidant, radioprotective agent and an indispensable connection in reproductive processes.Vitamin E at a dose of 400 mg of urologists is prescribed in patients with erectile function disorders and spermatogenesis associated with prostate gland adenoma.

Treatment of a chronic disease as severe as a prostate adenoma should be prescribed and controlled by a urologist.It is strictly forbidden to take certain medications independently, without a preliminary consultation with the assistant doctor, as self -medication in this case can be not only ineffective but also dangerous for male health.Only a qualified expert can suggest which prostate adenoma tablets are the most effective in each case and which 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 this operation that suits it more.

The pattern generally recognized in the surgical treatment of prostate adenoma is the transureral resection of the prostate.The operation is highly effective.After intervention, patients get rid of infravicle obstruction (narrowing of urethra) and associated symptoms.The rehab period is short.During or after surgery, bleeding can develop, "water poisoning" syndrome.

Alternative prostate adenoma treatment methods include the following surgical interventions:

• STENT;
• Balloon dilation;
• Hyperthermia;
• Thermotherapy;
• Ultrasonic ablation, laser and needle;
• Interstitial coagulation.

After them, complications arise less often, but these methods are lower than transureral resection in terms of efficacy in both clinical and economically.

Laparoscopic removal of prostate adenoma is used when the tumor grows significantly, and it is problematic removes it using transureral resection.This operation is more complicated, performed under anesthesia.Through small incisions, 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 the video cameras displayed on the screen.The main advantages of 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 to treat adenoma - laser enucleation.The intervention is performed with large sizes of neoplasia.Excess tissue is removed using a laser.The operation is performed through the urethra.The tumor is separated, divided into small parts and then displayed.The method is considered minimally invasive.It has several significant advantages: it does not violate the integrity of the cavities, it does not cause unnecessary damage.

Laser vaporization consists of destroying the laser evaporation adenoma.Through the urethra, the urologist has a special device, is brought to neoplasia and affects it insightfully with a strong green laser.The depth of laser penetration and the accuracy of its hit can prevent damage to neighboring areas.The method is minimal, without blood, fast and effective.Its only disadvantage is the inability to do a 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 when other methods cannot help the patient.During surgery, the scalpel surgeon carries access to the gland and manually using surgical instruments, removes the adenoma.As a result of the operation, a significant blood loss may occur, complications develop.After surgery, the patient needs prolonged rehabilitation.

The removal of prostate adenoma by the Custody Method of Method (Transluccal) consists of the radical excision of prostate hyperplase tissues through the longitudinal incision of the wall and anterior abdominal bladder.The operation is performed in advanced stages of the disease, when the tumor reaches large sizes, the bladder is overthrown due to the overflow of accumulated urine and renal failure develops.

The bladder is pre -catheterized and full of a sterile solution of Furatatsiline or other substance.It is then allocated and taken in two places for special properties, to which they raise the organ wall.The surgeon dissects the formed fold and executes the bladder opening.

At the inner end of the established urinary catheter, it determines the bladder neck area and around the urethra holes that appeared in the field, retreating 0.5-1 cm, makes the mucous membrane membrane.After that, the operational urologist penetrates the finger in the prostate thickness, enters between the tumor capsule and we adenomatous and hesitates the latter.At the same time, the doctor delivers the gland in front of the patient in the patient's rectum in the rectal on the abdominal wall of the front.It becomes more accessible for manipulation.Thanks to this technique, the operating time is reduced and blood loss is reduced.

Then the surgeon performs hemostasis (stopping bleeding) from the remote adenoma and bladder sutures, leaving a thin drainage in the wound.It is designed to wash your resulting blood clots cavity.The urinary catheter, introduced before the operation, is not removed for 7 to 10 days.Around it, a new section of the urethra is formed instead of the undone throughout the prostate part of the urethra.

Pumping adnectomy refers to the most traumatic of all methods used for prostate gland adenoma.It is accompanied by the risk of developing the following complications:

• Bleeding of neoplasia accommodation;
• Stagnant pneumonia;
• Impaired motor evacuation function of the intestine, manifested by constipation.

To avoid complications, after hospital surgery, the patient is performed in early activation.The following undesirable consequences of operations to remove prostate adenoma may occur:

• Insufficient bladder drainage;
• Narrowing his neck;
• Urinary infiltration of nearby tissue -pussy;
• The formation of the “prenatal” (the residual cavity where the prostate adenoma was removed);
• The formation of narrowing of the urethra lumen;
• Urine incontinence.

This negatively affects patients' quality of life and increases the restoration of proper urination.

The consequences of the operation are less pronounced when the intervention is performed using a laparoscope.Laparoscopic operation to remove prostate adenoma is one of the least invasive options for surgical interventions in the prostate gland.Hospital urologists use this technique if the patient has a sufficiently large prostate adenoma.

If the prostate gland of the patient with an adenoma does not exceed 120 cm3, it is recommended for the transureral resection of prostate adenoma.But 10% for patients who need surgery, this option is not adequate as iron reaches more than 120 cm3.Laparoscopic operation to remove prostate adenoma during uarolithiasis, inguinal hernia, bladder diverticultura, and unqualified ankylosis joints are not performed.In this case, the decision on the possibility of conducting an operation is made collegally made by a urologist, andrologist, abdominal surgeon and other hospital specialists.