Diagnosis and treatment of prostate adenoma

The most common urological pathology with which a urologist is visited by men over the age of 45 is prostate adenoma. The presence of this pathology significantly impairs the quality of life of men. One of the most frightening consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.

Surgical and medical treatments are used to combat prostate adenoma. The most effective drugs or methods of surgery are selected by hospital specialists, taking into account the stage of the disease, the general condition and age of the patient, and the presence of comorbidities. The surgical clinic has created comfortable conditions for treating patients.

Causes of the disease

The occurrence of adenoma is most often associated with age-related changes in the prostate, namely, changes in its structure and increase in size. As a result of such changes, the urethra, which is located in the thickness of the prostate gland, gradually compresses and disturbances in the urination process appear.

Prostate adenoma in men develops as a result of hormonal changes in the body that are accompanied by age-related changes. Testosterone (male hormone) levels gradually decrease with age, while female sex hormone (estrogen) levels, on the contrary, increase. This phenomenon is called male menopause.

The development of prostate adenoma can be caused by the following risk factors:

• By the age of the patient - the enlarged prostate gland is extremely rare in men under the age of forty and is diagnosed almost every second after sixty years;
• Hereditary predisposition - if a prostate adenoma has been diagnosed in a man’s close blood relatives, there is a huge risk of inheriting this disease in adulthood;
• Diabetes, cardiovascular diseases - benign prostate cancer (adenoma) can be caused not only by these diseases, but also by the harmful effects of medicines used to treat them (such as beta-blockers);
• Improper lifestyle - the risk of developing prostate adenoma increases in obese men with insufficient physical activity.

Symptoms

Prostate adenoma is suspected if a man develops the following symptoms, which are most common in this disease:

• increased urination;
• the appearance of tension in the abdominal muscles to urinate;
• painful feelings, the presence of a burning, slow flow of urine;
• discomfort and insufficient emptying of the bladder;
• increasing the duration of the urination process.

Prostate adenoma leads not only to a deterioration in the quality of life of men, but also to acute urinary retention, which requires the use of surgical treatment methods. To avoid surgery, many patients use special medications to treat prostate adenoma, relieve symptoms, and restore normal prostate function. However, for the treatment of prostatitis and prostate adenoma, only a qualified professional can recommend the best treatment. He should be contacted when the first symptoms of the disease appear.

Treatment of prostate adenoma is unique to each patient. Medicines for the treatment of prostate adenoma, their dose and duration of use are prescribed by your doctor. The use of anti-inflammatory and anti-prostate adenoma drugs alone is not only ineffective but can also be dangerous. Given the presence of certain "personal" chronic diseases in older men, drugs for the treatment of prostate adenoma in the elderly should be selected taking into account comorbidities.

Stages of disease development

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

• The first stage of the disease is associated with minimal urinary incontinence. Your frequency may increase slightly, especially at night, and slow flow of urine may occur. The first phase can last from one year to 12 years or more.
• The second stage of prostate adenoma is characterized by more marked disorders of urination: intermittent flow of urine, the appearance of the need for tension during urination, and a feeling of incomplete emptying of the bladder. Urine retained in the bladder and urinary tract causes an inflammatory process that is affected by pain, a burning sensation while urinating, pain in the lumbar region and above the pubic area.
• The third stage is characterized by periodic or permanent involuntary urination, which forces the patient to use a urine bag.

Complications

In some men, prostate adenoma does not impair quality of life and progresses without complications. However, in some cases, the disease can have the following negative consequences:

• Acute urinary retention - characterized by a sudden inability to empty the bladder and pain in the suprapubic region. In such a condition, the patient requires emergency medical care by catheterization or small operation;
• Incidence of urinary tract infections - stagnation of urine, which creates favorable conditions for the reproduction of pathogens, the development of cystitis and pyelonephritis;
• The formation of stones in the bladder is also a consequence of stagnant urine;
• Bladder damage - it stretches with irregular emptying of the bladder, protrusions (pockets) form in the walls of the organ, in which urine stagnates;
• Kidney Damage - Increased pressure in the urethra and bladder has a direct detrimental effect on the kidneys, resulting in kidney failure.

Prostate adenoma and potency

Prostate adenoma and potency are closely related. Adenoma disrupts the structure of glandular tissues, which in turn leads to damage to another, no less important organ, the testes, which is responsible for the production of androgens. Thus, prostate adenoma may be the cause of impotence, which requires long-term and complex therapy.

Diagnostics

A simple and effective way to make a preliminary diagnosis is to keep a diary of the patient’s urination, recording quantitative and qualitative parameters: the amount of urine excreted, the characteristics of fluid intake, the imperative urge, the night urge. The main physical examination method for suspected prostate-suspected adenoma is digital rectal examination of the prostate to detect it and rule out some other pathologies.

The diagnosis of prostate adenoma is made in the hospital by the following laboratory and instrumental methods:

• General blood and urine tests;
• Biochemical blood tests for markers of kidney disease, urea and creatinine levels;
• PSA test (to rule out prostate cancer);
• Transrectal ultrasound (ultrasound);
• Uroflometry (to determine the flow rate of urine);
• Determination of residual urine volume (using ultrasound);
• Pelvic floor electromyography;
• Urethrocystoscopy;
• Selective urography.

Treatment

Treatment of prostate adenoma is aimed at relieving lower urinary tract symptoms, improving the patient’s quality of life, and preventing the development of disease complications. For patients with mild symptoms and no deterioration in quality of life, follow-up tactics are often prescribed with regular examinations by a urologist who monitors the course of the disease and makes recommendations to stop the growth of prostate adenoma. During this period, the focus is on non-drug therapy. The above methods may be in addition to conservative treatment, which is the administration of the following drugs:

• Alpha-blockers (tamsulosin, alfuzosin);
• 5-alpha reductase inhibitors (finasteride);
• Phosphodiesterase type 5 inhibitors (sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha-blockers;
• Muscarinic receptor blockers or M-anticholinergics.

For patients with advanced prostate adenoma, surgical treatment is recommended, which can be performed by a number of methods: transurethral excision, transurethral resection, and prostate removal.

There are some signs of using surgical treatment:

• Recurrent urinary retention;
• Renal failure caused by prostate adenoma;
• Bladder stones;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgery is required for patients in the absence of efficacy of medication.

During conservative therapy or in the postoperative period, patients require constant medical supervision with standard tests (determination of urine flow rate, ultrasound, analysis of PSA levels).

Drugs

There is a certain system according to which specific drugs are prescribed to treat prostatitis and prostate adenoma. High efficacy of treatment is achieved with the use of drugs belonging to the group of 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 restore enough urine.

What are the most effective and widely used pills for the treatment of prostate adenoma? At the top of the list are blockers of alpha1-adrenergic receptors. This list also includes 5-alpha reductase inhibitors, vitamins and minerals.

The drug therapy complex is not just about drugs. In the case of prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements that enhance the therapeutic effect of drugs and ensure rapid healing. Some of them contain zinc. This macronutrient is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urine.

Treatment of drugs of the alpha1-adrenoceptor antagonist group

These drugs for the treatment of prostatitis and prostate adenoma relax the smooth muscles of the urinary system and improve urine flow. Tamsulosin, with the same active ingredient of the same name as other drugs (Alfuzosin, Silodosin, etc. ), is a highly selective drug that has a selective effect on alpha1-adrenergic receptors in the prostate gland, prostate muscle. urethra and bladder. It facilitates the outflow and excretion of urine due to the decrease in muscle tone. Tamsulosin, like all selective drugs, has a minimal number of side effects, does not affect vascular tone, and can be prescribed to patients with chronic hypertension.

Alpha-adrenergic receptor antagonists should be used continuously to achieve a gradual reduction in irritation and obstruction in the prostate adenoma. The drug tamsulosin is a well-deserved priority in the treatment of prostate adenoma in the prescriptions of urologists.

The tablet form of the drug is considered to be more progressive because the active substance is present in a constant concentration in the body due to the controlled release of tamsulosin. The drug enters the bloodstream evenly, reducing the likelihood of a major side effect of drugs in the adrenergic blocking group, a sharp drop in blood pressure.

Silox is an equally effective drug with the active substance tamsulosin. The drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, an increased incidence of angina attacks in patients with coronary heart disease, and therefore can be prescribed to men with heart disease. Well-chosen dosing and adherence to all the rules for the use of drugs belonging to the group of alpha-blockers make it possible to achieve a good therapeutic effect without almost complete absence of side effects.

Drugs belonging to the group of reductase inhibitors

The drugs of this pharmacological group (Finasteride, Dutasteride) help to alleviate the outflow of urine and, consequently, to eliminate the main symptoms of the disease. A stable therapeutic effect occurs within two to three weeks after the start of the course. All symptoms disappear completely after three months. Clinical trials have shown that maximum efficacy is achieved after six months of therapy with these drugs.

Finasteride and dutasteride are specific inhibitors of type 2 5-alpha reductase (a cellular enzyme responsible for the conversion of testosterone to dihydrotestosterone). Prostate gland growth in BPH is directly related to testosterone conversion. Due to 5-alpha-reductase inhibitors, the production of intraprostatic dihydrotestosterone is blocked and blood levels are significantly reduced.

Finasteride and dutasteride are used for the following purposes:

• Treatment and control of prostate hyperplasia;
• Improving urine output and eliminating symptoms of prostate adenoma;
• It reduces the risk of developing acute urinary retention and the need for surgery.

Finasteride and dutasteride have a pronounced antiandrogenic effect, helping to reduce the levels of male hormones in the blood. In addition, these drugs are teratogenic and should be used with caution. Modern medicines can be used to stop prostate growth and prevent the need for surgical treatment.

Anticonvulsants and analgesics to aggravate the disease

The main purpose of antispasmodics and analgesics is to alleviate the patient's general condition and relieve pain when the prostate adenoma worsens. Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have anti-inflammatory and analgesic effects. Not only do the painful feelings that occur when urinating, but they also help fight the constant pain in the groin and perineum. The effect of non-steroidal anti-inflammatory drugs reduces the inflammatory process, reduces prostate swelling, normalizes body temperature and eliminates unpleasant symptoms.

Non-opioid analgesics in the form of tablets or suppositories help relieve pain syndrome during the progression of prostate adenoma. The most readily available of these is metamizole sodium. However, this drug is intended for single use only, as it can only affect mild pain syndrome. In addition, they are effective with lidocaine, benzocaine, anesthesia and novocaine (painkillers).

Vitamin E 400

Tocopherol acetate or vitamin E is often used in the treatment of prostate adenoma complex as an irreplaceable link between antioxidants, radiation protection agents, and reproductive processes. Vitamin E at a dose of 400 mg is prescribed by urologists to patients with erectile dysfunction and spermatogenesis associated with prostate adenoma.

Treatment of such a severe chronic disease, such as prostate adenoma, should be prescribed and monitored by a urologist. It is strictly forbidden to take certain medications on their own without prior consultation, as self-medication in this case may not only be ineffective but may also be dangerous to men’s health. Only a qualified professional can tell you which pills are most effective in all cases of prostate adenoma and which ones can cause negative consequences.

Activities

The hospital's urologists masterfully perform classic and minimally invasive surgical interventions, using innovative methods in the surgical treatment of prostate adenoma. Each patient is selected for the surgery that suits them best.

Transurethral resection of the prostate is a generally accepted standard in the surgical treatment of prostate adenoma. The operation is extremely efficient. After the procedure, patients get rid of the blockage of the bladder outlet (narrowing of the urethra) and the associated symptoms. The rehabilitation period is short. Bleeding may occur during or after surgery, a syndrome of "water poisoning" in the body.

Alternative methods of treating prostate adenoma include the following surgical interventions:

• Stenting;
• Balloon dilatation;
• Hyperthermia;
• Heat therapy;
• Ultrasound, laser and needle ablation;
• Interstitial coagulation.

Complications are less frequent thereafter, but these techniques are lower in transurethral resection, both clinically and economically.

Laparoscopic removal of prostate adenoma is used when the tumor has grown significantly and is difficult to remove by transurethral resection. This operation is more difficult and occurs under general anesthesia. The surgeon inserts special instruments into the body cavity through small incisions to remove the prostate adenoma. The operation is performed according to the image of the camcorders that appears on the screen. The main benefits of the intervention are minimal blood loss and low likelihood of complications. The patient does not need long-term rehabilitation after surgery.

When there are signs of prostate adenoma in men, doctors use a high-tech method of treating adenoma - laser enucleation. The procedure is performed on large tumors. Excess tissue is removed with a laser. The operation is performed through the urethra. The tumor is separated, divided into small parts, and then selected. 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 evaporation is the destruction of an adenoma by laser evaporation. The urologist inserts a special device through the urethra, delivers it to the neoplasm, and acts sharply on it with a powerful green laser. The depth of penetration of the laser and the accuracy of its impact make it possible to avoid damage to adjacent areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is its inability to bring tumor tissue for histological examination.

In some situations, the inevitable way to treat prostate adenoma is abdominal surgery - adenomectomy. It is performed when other methods cannot help the patient. During surgery, the surgeon accesses the prostate with a scalpel and removes the adenoma manually using surgical tools. As a result of the surgery, significant blood loss may occur and complications may develop. After surgery, the patient needs long-term rehabilitation.

Removal of prostate adenoma by transverse (transverse) adenomectomy consists of a radical excision of the hyperplastic prostate tissue through a longitudinal incision of the anterior abdominal wall and bladder. The operation is performed in the advanced stage of the disease, when the tumor reaches large size, the bladder is overstretched due to overflow with accumulated urine, and kidney failure develops.

The bladder is precatheterized and filled with a sterile solution of furacillin or other material. It is then isolated and taken in two places on special supports to which the wall of the organ rises. The surgeon dissects the formed fold and opens the bladder.

Along the inner end of the installed urinary catheter, determine the area of the neck of the bladder and make an incision on the mucosa around the opening of the urethra that appears in the field of view at a distance of 0. 5 to 1 cm. membrane. The operating urologist then penetrates the thickness of the prostate with his finger, entering between the tumor capsule and the adenomatous nodes, selecting the latter. However, with the finger of the other hand, which was previously inserted into the patient’s rectum, the doctor feeds the gland towards the anterior abdominal wall. It becomes more accessible to manipulation. Thanks to this technique, the time of surgery is shortened and blood loss is reduced.

The surgeon then performs hemostasis (stopping the bleeding) on the removed adenoma bed and sutures the bladder, leaving a thin drainage in the wound. It is designed to empty its cavity from the formed blood clots. A urinary catheter inserted before surgery is not removed for 7-10 days. A new section of the urethra is formed around it instead of the prostate part of the urethra excised during surgery.

Transverse adenomectomy is one of the most traumatic techniques used in prostate adenoma. This carries the risk of the following complications:

• Bleeding from the bed of the neoplasm;
• Congestive pneumonia;
• Violation of the motor function of bowel emptying is manifested by constipation.

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

• Insufficient drainage of the bladder;
• Narrowing of the neck;
• Urinary infiltration of peri-vesicular tissue;
• Formation of a "bladder" (residual cavity at the site of prostate adenoma removal);
• Development of urethral lumen narrowing;
• Difficulty urinating.

This negatively affects the quality of life of patients and prolongs the healing time required for proper urination.

The consequences of surgery are less pronounced if the procedure is performed using a laparoscope. Laparoscopic prostate adenoma surgery is one of the less invasive options for surgical procedures on the prostate gland. This technique is used by hospital urologists if the patient has a prostate adenoma large enough.

If the size of the prostate gland in a patient with adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients in need of surgery, this option is not appropriate because the gland size exceeds 120 cm3. Laparoscopic surgery to remove prostate adenoma is not performed by urolithiasis, inguinal hernia, bladder diverticula, ankylosis of the lower limb joint. In this case, the possibility of surgery is decided jointly by the urologist, andrologist, abdominal surgeon, and other hospital professionals.