The most common urological pathology, which is addressed to the urologist, men over the age of 45, is prostate adenoma.The presence of this pathology significantly worsens the quality of men's life.One of the most formidable possible consequences of the pathological process is the degeneration of the hyperplasia of the benign prostate in a malignant tumor.
To combat prostate adenoma, surgical and pharmacological treatment methods are used.The hospital specialists select the most effective medications or methods of surgery taking into account the stadium of the disease, general conditions and the age of the patient, as well as the presence of related pathologies.In the surgery clinic, comfortable conditions have been created for the treatment of patients.
The causes of the development of the disease
Adenoma's occurrence is often associated with age -related changes in the prostate, i.e. a change in its structure and an increase in size.As a result of these changes, the urethra is gradually compressed, which is found in the thickness of the prostate gland and the violations of the urination process appear.
Prostate adenoma in men develops due to the hormonal renovation of the body associated with age -related changes.The testosterone level (male hormone) is gradually decreasing with age, while the concentration of female sex hormone (estrogen), on the contrary, increases.This phenomenon is called menopause male.
The development of prostate adenoma may be due to the following risk factors:
- The patient's age - the increase in prostate iron is extremely rare in men under the age of forty years and after sixty years they are diagnosed in almost every second;
- Hereditary predisposition - If the prostate adenoma has been diagnosed in close relatives of a man's blood, it has a huge risk of inheriting this disease in adulthood;
- Diabetes mellitus, cardiovascular disease-a (adenoma) tumor of prostate can occur due to not only of these same diseases, but also of the harmful effects of drugs for their treatment (for example beta-blockers);
- The wrong lifestyle: the risk of developing prostate adenoma has increased in men with obesity, insufficient physical activity.
Symptoms
Prostate adenoma can be suspected when a man appears in the following symptoms that are more typical of this disease:
- duties of urination;
- the aspect of the need for tension of the abdominal muscles for urination;
- the presence of pain, burning, slow urine flow;
- insufficient discomfort and emptying of the bladder;
- Increase 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 surgery, many patients use special drugs for the treatment of prostate adenoma, eliminating symptoms and restoring the normal prostate activity.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 the duration of use are prescribed by the attending physician.The intake of products from prostatitis and prostate adenoma independently cannot be only ineffective, but also a dangerous measure.Due to the presence in the men of the oldest generation of some "personal" chronic diseases, drugs for the treatment of prostate adenoma should be selected taking into account the accompanying pathologies.
Disease development phase
Prostate adenoma is characterized by gradual development, which can be divided into three phases.
- The first phase of the disease proceeds with minimum urination disorders.Its insignificant increase can be observed, especially at night, and a slow urine flow.The first phase can last from a year to 12 years or more.
- The second stage of prostate adenoma is characterized by more pronounced urination disorders: the intermittence of the flow of urine, the aspect of the need to strive during urination and a sense of incomplete emptying of the bladder.The residual urine, which lingers into the bladder and in the urinary tract, causes an inflammatory process that is accompanied by pain, a burning feeling during urination, pain in the lower part of the back and over the pubis.
- The third stage is characterized by a periodic or constant involuntary urine release, which forces the patient to use the ureter.
Complications
In some men of 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 sharp delay of the urine - is characterized by a sudden impossibility of emptying the bladder and pain in the knotted region.With a similar condition, the patient needs emergency care with catheterization or a small operation;
- The occurrence of infections in the urinary tract is the stagnation of the urine, which creates favorable conditions for the reproduction of pathogenic agents, leads to the development of cystitis and pyelonefrite;
- The formation of stones in the bladder - is also a consequence of the stagnation of the urine;
- Damage to the bladder - With the irregular emptying of the bladder, the formation of protrusions (pockets) on the walls of the organ is elongated, in which the urine stands out;
- Reni damage to the increase in pressure in ureters and bladder has a harmful effect on the kidneys, following which renal failure develops.
Prostate adenoma and power
The adenoma and prostate power are closely interconnected.The adenoma interrupts the structure of the fabric of the glands, which, in turn, leads to the defeat of another organ, not less important - the testicles responsible for the androgen products.Therefore, 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 maintaining a urination diary with the setting of quantitative and qualitative parameters: dedicated urine volumes, characteristics of the fluid consumed, called imperative, night impulse.The main physical examination method in case of suspicion of prostate adenom is a rectal examination of the prostate to identify its increase and exclude some other pathologies.
The diagnosis of prostate adenoma in the hospital is carried out using the following laboratory and instrumental methods:
- General tests of blood and urine;
- Biochemical blood test for the markers of the condition of the kidneys, urea and the level of creatinine;
- Analysis for the dog level (in order to exclude prostate cancer);
- Transrettal ultrasound examination (ultrasound);
- Urofloometry (to determine the speed of the urine current);
- Determination of the volume of the residual urine (using ultrasound);
- Electromyography of the pelvic background;
- Urethystoscopy;
- Excretory urography.
Treatment
The treatment of prostate adenoma aims to facilitate the symptoms of the lower urinary tract, improve the quality of the patient and prevent the development of complications of the disease.Patients with poorly exposed symptoms that do not worsen the quality of life, often prescribe the tactics of dynamic observation with regular exams with a urologist, which controls the course of the disease and provides recommendations on how to stop the growth of prostate adenoma.During this period, attention is focused on non -pharmacological therapy.Hertic methods can be an addition to conservative treatment, which is the intake of the following drugs:
- Alpha blockers (tamsulosine, alfuzosin);
- 5-ALFA inhibitors Redittasi (Finsteride);
- Type 5 phosphodesterase inhibitors (sildenafil);
- Combinations of 5-Alfa inhibitors Reductase and Alfa blockers;
- Blocking of the Muscarino or Col-Cololitici receptor.
Patients with prostate adenoma in an advanced stage are recommended to conduct surgical treatment, which can be performed with different methods: transurereral excision, transureral resection and prostate removal.
There are some indications for the use of surgical treatment:
- Detected delay of the urine;
- Renal failure caused by prostate adenoma;
- Stones in the bladder;
- Infections of the recurring urinary tract;
- Repeatedly hematuria.
In addition, surgery is needed for patients in the absence of effectiveness from pharmacological treatment.
During conservative therapy or in the postoperative period, patients need constant medical supervision with standard studies (determining the urine current rate, ultrasound, analysis of the PSA level).
Drugs
There is a certain scheme on the basis of which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma.A high effectiveness of the treatment is obtained thanks to the use of drugs of the Alfa Redittasi inhibitors and the 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 by prostate adenoma?The list is led by Alpha1 adrenergic receptors blocking.In addition, this list includes 5-ALFA inhibitors of reductase, vitamins and minerals.
The drug therapy complex includes not only drugs.With prostate adenoma, conservative treatment can be integrated with biologically active additives - dietary supplements that improve the therapeutic effect of drugs and provide early recovery.Some of them include zinc.This macro element is directly involved in spermatogenesis and in the synthesis of testosterone.Vegetable phytosterols normalize urination.
Treatment with drugs of the Alfa1-Audrenoptors group group group
These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improving the urine process.Tamsulosin with the same name of the active substance, which is part of other drugs (alfuzosine, silodinos, etc.), is a highly sequential drug that has a selective effect on the alpha1-adrenergic receptors of the prostate muscles, the prostate of the ureter and bladder.Thanks to a decrease in muscle tone, the outflow 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 to patients with chronic hypertension.
Alfa-adrenergic receptors' antagonists must be constantly used, so that we can obtain a gradual reduction in irritation and obstruction with prostate adenoma.Pharmacological tamsulosine in the treatment of prostate adenoma occupies a priority well paid for the purpose of urologists.
The form of the drug tablet is considered more progressive, since due to the controlled release of tamsulosine, the active substance is in the body in constant concentration.The medicine enters uniformly in the bloodstream, thus guaranteeing a decrease in the probability of developing the main side effects of the drugs of the Escortehobocaders group - a strong decrease in blood pressure.
An equally effective drug with tamsulosine acting substance is a lesson.The intake of this drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, an increase in angina attacks in patients with coronary heart disease, therefore it can be prescribed for men with heart disease.Dosage and conformity correctly selected with all the rules on the use of the drugs of the Alpha-Bockers group allow you to obtain a good therapeutic effect in the almost complete absence of side effects.
Medicines of the group of inhibitors (blockers) Redittasi
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 obtained after six months of therapy with these drugs.
Finasteride and Dutasteride are specific inhibitors of the 5-Alfa Redittasi 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 the inhibitors of the 5-Alfa Redittasi, the products of the intraindustial 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;
- Improve the outflow of urine and eliminate the symptoms of prostate adenoma;
- Reduce the risk of developing acute urinary conservation and the need to conduct surgery.
Finasteride and Dutasteride have a pronounced antiandrogenic effect, that is, they contribute to a decrease in the level of male hormones in the blood.In addition, these drugs have a teratogenic effect, therefore they must be cautiously taken.With the help of modern drugs, you can stop prostate growth and prevent the need for surgical treatment.
Antispasmodic and analgesic tablets with exacerbation of the disease
The main prescription of the antispasmodic and analgesic effects with exacerbation of prostate adenoma is to alleviate the patient's general condition and eliminate pain syndrome.The anti -inflammatory and analgesic effect is exerted by non -pounded 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 -short anti -inflammatory drugs, the inflammatory process decreases, the swelling of the prostate gland decreases, the body temperature is normalized and the unpleasant symptoms are eliminated.
Neopioid analgesics produced in the form of tablets or candles help to stop pain syndrome with exacerbation of prostate adenoma.The most convenient of them is sodium metamizol.However, this drug is destined more to the use of the past, since it can only influence a weak pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesin and novocaine (ichtammol, benzocaine, Tribenoside + lidocaine) are effective.
Vitamin E 400
The acetate of tocopherol or vitamin and is often part of the complex treatment of prostate adenoma such as antioxidant, radioprotective agent and an indispensable connection in reproductive processes.Vitamin E in a dosage of 400 mg of urologists is prescribed to patients with erectile and spermatogenesis disorders associated with the adenoma of the prostate gland.
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 drugs independently, without a preliminary consultation with the attending physician, since in this case the car -medion can be not only ineffective, but also dangerous for male health.Only a qualified specialist can suggest which prostate adenoma tablets 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 adapts most.
The standard generally recognized in the surgical treatment of prostate adenoma is the transureal resection of the prostate.The operation is highly effective.After intervention, patients get rid of infravizing obstruction (narrowing of the urethra) and associated symptoms.The rehabilitation period is short.During or after surgery, bleeding can develop, "water poisoning syndrome".
Alternative methods for the treatment of prostate adenoma include the following surgery:
- Stenting;
- Balloon dilation;
- Hyperthermia;
- Thermotherapy;
- Ultrasound, laser and needle ablation;
- Interstitial coagulation.
After them, the complications arise less often, but these methods are lower than the transureal resection in terms of effectiveness, both in the clinic and economically.
The laparoscopic removal of prostate adenoma is used when the tumor has grown significantly and it is problematic to remove it using the transureal resection.This operation is more complicated, carried out under anesthesia.Through small engravings, the surgeon introduces special tools into the body's cavity, which performs the removal of prostate adenoma.The operation is performed based on the image of the 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 the treatment of laser adenoma laser.The intervention is carried out with large size of the neoplasm.Excess fabrics are removed using a laser.The operation is performed through the urethra.The tumor is separated, divided into small parts and therefore displayed.The method is considered minimally invasive.It has a series of significant advantages: it does not violate the integrity of the cavities, it 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 affects it highly with a strong green laser.The depth of laser penetration and the accuracy of its blow can avoid damage to nearby areas.The method is minimal, without blood, quick and effective.Its only disadvantage is the inability to take a tumor tissue for the histological examination.
In some situations, the inevitable method of treatment of prostate adenoma is abdominal surgery - adenomectomy.It is performed if other methods cannot help the patient.During the surgery, the surgeon with a scalpel brings access to the prostate gland and manually, using surgical tools, removes the adenoma.As a result of the operation, significant blood losses may occur, complications develop.After surgery, the patient needs prolonged rehabilitation.
The removal of the prostate adenoma through the (transluccal) adenomectomy custody method consists in the radical excision of the hyperplash tissues of the prostate through the longitudinal engraving of the wall and the front abdominal bladder.The operation is performed in the advanced phases of the disease, when the tumor reaches large dimensions, the bladder is canceled due to its accumulated urine overflow and renal failure develops.
The bladder is pre -gaterized and filled with a sterile solution of furatsiline or other substance.Therefore it is assigned and taken in two places to special participations, for which they raise the body's wall.The surgeon analyzes the format formed and performs the opening of the bladder.
From the internal end of the established urinary catheter, it determines the area of the neck of the bladder and around the holes of the urethra that appeared in the visual field, withdrawing from 0.5-1 cm from it, makes the mucous membrane of the mucosa.After that, the operational urologist penetrates the finger in the thickness of the prostate, it enters the capsule of the tumor and the adenomatous nodes and is the latter.At the same time, the doctor gives the gland to the front of the patient in the patient's rectum in the rectum in the front abdominal wall.It becomes more convenient for manipulation.Thanks to this technique, the operational time is reduced and the blood loss is reduced.
Then the surgeon performs the hemostasis (bleeding stop) of the remote adenoma bed and sutures the bladder, leaving a thin drainage in the wound.It is designed to wash its cavity with 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 seized during the prostate part of the urethra.
Cuspolare adenomectomy refers to the most traumatic of all the methods used for the adenoma of the prostate gland.Is accompanied by the risk of developing the following complications:
- Bleeding from the loggia of the neoplasm;
- Stagnant pneumonia;
- Compromised 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 the operations can occur to remove prostate adenoma:
- Insufficient drainage of the bladder;
- Shrink the neck;
- Urinary infiltration of near -Pussure fabric;
- The formation of the "prenatal" (the residual cavity in the place where the prostate adenoma was removed);
- The formation of the narrowing of the urethra lumen;
- 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 least invasive options for surgical interventions on the prostate gland.The urologists of the hospital use this technique if the patient has a sufficiently large adenoma of the prostate.
If the patient's prostate gland with 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 suitable, since iron reaches more than 120 cm3.The laparoscopic operation to remove prostate adenoma during the urolytians, the inguinal hernia, the diverticulum of the bladder and the articulations of ankylose of the lower ends are not performed.In this case, the decision on the possibility of conducting an operation is made collectively by a urologist, andrologist, an abdominal surgeon and other hospital specialists.