The most common urological pathology, which is addressed to the urologist, of men over 45, is the adenoma of the prostate.The presence of this pathology considerably worsens the quality of life of men.One of the most formidable consequences of the pathological process is the degeneration of benign prostate hyperplasia in a malignant tumor.
To combat prostate adenoma, surgical and drug treatment methods are used.Hospital specialists select the most effective medicines or methods of surgical intervention that take into account the stage of the disease, the general condition and the age of the patient, as well as the presence of related pathologies.In the surgery clinic, comfortable conditions for the treatment of patients have been created.
The causes of the development of the disease
The occurrence of adenoma is most often associated with age -related changes in the prostate, namely a change in its structure and an increase in size.Due to these changes, the urethra is gradually compressed, which is located in the thickness of the prostate gland and the violations of the urination process appear.
The adenoma of prostate in men is developing due to the hormonal restructuring of the body associated with age -related changes.The level of testosterone (male hormone) gradually decreases with age, while the concentration of female sexual hormone (estrogen), on the contrary, increases.This phenomenon is called male menopause.
The development of the prostate adenoma may be due to the following risk factors:
- The age of the patient - The increase in prostate iron is extremely rare in men under the age of forty and, after sixty years, is diagnosed with almost every second;
- Hereditary predisposition - If the prostate adenoma has been diagnosed in parents of blood close to a man, it has a huge risk of inheriting this disease in adulthood;
- Diabetes mellitus, cardiovascular diseases-a benign (adenoma) prostate tumor can occur not only of these diseases themselves, but also harmful effects of drugs for their treatment (for example, beta-blockers);
- The bad way of life - The risk of developing an adenoma of prostate is increased in men with obesity, insufficient physical activity.
Symptoms
Prostate adenoma can be suspected when a man appears in the following symptoms which are most typical of this disease:
- mics of urination;
- the appearance of the need for the tension of the abdominal muscles for urination;
- the presence of pain, burn and slow urine stream;
- Insufficient discomfort and emptying of the bladder;
- Increase in the duration of the urination process.
The adenoma of the prostate not only leads to a decrease in the quality of life of a man, but also of 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 the symptoms and restaurants normal prostate activity.However, only a qualified specialist can suggest the best remedy for prostatitis and prostate adenoma.It is necessary to contact him when the first symptoms of the disease appear.
Treatment of prostate adenoma individually for each patient.Preparations for the treatment of the prostate adenoma, their dosage and their duration of use are prescribed by the attending physician.Taking prostatitis and prostate adenoma products independently may not only be an ineffective, but also dangerous measure.Due to the presence in men of the older generation of certain "personal" chronic diseases, drugs for the treatment of prostate adenoma must be selected taking into account the pathologies that accompany it.
Steps of the development of the disease
The adenoma of the prostate is characterized by a progressive development, which can be divided into three stages.
- The first step in the disease proceeds to a minimum of urination disorders.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 the prostate adenoma is characterized by more pronounced urination disorders: the intermittentness of the urine flow, the appearance of the need to stretch during urination and a feeling of incomplete emptying of the bladder.The residual urine, which lingers in the bladder and the urinary tract, causes an inflammatory process which is accompanied by pain, a burning sensation during urination, pain in the lower back and above the pubis.
- The third step is characterized by a release of periodic or constant involuntary urine, which obliges the patient to use the ureter.
Complications
Among some men of the prostate adenoma, the quality of life does not worsen and does not take place without the development of complications.However, in some cases, the disease may cause the following negative consequences:
- The acute delay of urine - it is characterized by a sudden impossibility of emptying the bladder and the pain in the region due to the right.With a similar condition, the patient needs emergency medical care with catheterization or a small operation;
- The occurrence of urinary tract infections 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 the stagnation of urine;
- Too bad the bladder - with an irregular emptying of the bladder, it is stretched, the formation of protuberances (pockets) in the walls of the organ, in which urine stagnates;
- Damage to the kidneys - increased pressure in the ureters and the bladder has a direct prejudicial effect on the kidneys, following which renal insufficiency develops.
Prostate adenoma and power
The adenoma and the power of the prostate are closely interconnected.Adenoma disturbs the structure of the gland fabric, which, in turn, leads to the defeat of another no less important organ - the testicles responsible for the products of androgens.Thus, the adenoma of prostate can cause helplessness that requires prolonged and complex therapy.
Diagnosis
A simple and effective way to establish a preliminary diagnosis is the patient by organizing a micational journal with the fixing of quantitative and qualitative parameters: volumes of dedicated urine, characteristics of the imperative calls consumed by the liquid, nocturnal desire.The main physical method of examination in the event of suspicion of the prostate adenomname is a rectal examination of the prostate fingers to identify its increase and exclude certain other pathologies.
The diagnosis of prostate adenoma in the hospital is carried out using the following laboratory and instrumental methods:
- General blood and urine tests;
- Biochemical blood test for the markers of the state of the kidneys, urea and creatinine;
- Dog level analysis (in order to exclude prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Urofloometry (to determine the speed of the urine current);
- Determination of the volume of residual urine (using ultrasound);
- Electromyography at the pelvic background;
- Urethrocystoscopy;
- Excretory urography.
Treatment
The treatment of prostate adenoma aims to facilitate the symptoms of lower urinary tract, to improve the quality of the patient and to 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 examinations with a urologist, who controls the course of the disease and gives recommendations on how to stop the growth of prostate adenoma.During this period, attention is focused on non -drug therapy.Necrères methods can be added to conservative treatment, which is the contribution of the following drugs:
- Alpha blockers (tamsulosin, alfuzosin);
- Inhibitors of 5-alpha reductase (Finterid);
- Type 5 phosphodesterase inhibitors (sildenafil);
- 5-alpha reductase inhibitors and alpha blockers;
- Muscarian receptor or m-cholinolytic receptor.
Patients with prostate adenoma at an advanced stage are recommended to carry out surgical treatment, which can be carried out by several methods: transureral excision, transureral resection and prostate elimination.
There are certain indications for using surgical treatment:
- Repeated urine delay;
- Kidney failure caused by prostate adenoma;
- Stones in the bladder;
- Recurrent urinary tract infections;
- Repeat hematuria.
In addition, surgery is necessary for patients in the absence of drug treatment effectiveness.
During conservative therapy or during the postoperative period, patients need constant medical control with standard studies (determining urine current, ultrasound, PSA level analysis).
Drug
There is a certain scheme that specific drugs are prescribed for the treatment of prostatitis and prostate adenoma.A great efficiency of treatment is obtained thanks to the use of drug inhibitors of alpha reductase and alpha-blockers.These drugs for the treatment of prostate adenoma in men help eliminate the main symptoms of the disease, as well as to restore sufficient urination.
What are the most effective and most used tablets of the prostate adenoma?The list is directed by alpha-adrenergic alpha receptor blockers.In addition, this list includes inhibitors from 5-alpha reductase, vitamins and minerals.
The pharmacotherapy complex not only includes drugs.With prostate adenoma, conservative treatment can be supplemented by biologically active additives - food 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 synthesis of testosterone.Plant phytosterols normalize urination.
Treatment with drugs from the Alpha-Adrenergateurs antagonist group drugs
These drugs for the treatment of prostatitis and the adenoma of prostate provide relaxation of the smooth muscles of the urinary system and the improvement of the urine process.Tamsulosin with the same name of the active substance, which is part of other drugs (alfuzosin, silodinos, etc.), is a highly sequential medication which has a selective effect on alpha-adrenergic receptors of the muscles of the prostate, the prostatic of the Urrethra and the bladder.Thanks to a decrease in muscle tone, release of outing 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.
The antagonists of alpha-adrenergic receptors should be used constantly, so that you can obtain a gradual reduction in irritation and obstruction with the adenoma of the prostate.Drug tamsulosin in the treatment of prostate adenoma occupies a well -deserved priority with the aim of urologists.
The form of drug tablet is considered to be more progressive, because due to the controlled liberation of tamsulosin, the active substance is in the body in constant concentration.The drug also falls into the bloodstream, thus guaranteeing a decrease in the probability of developing the main side effects of the drugs of the adrenahobocatrian group - a sharp decrease in blood pressure.
An equally effective medication with the active tamsulosin substance is a lesson.Taking this drug is not accompanied by the following side effects: orthostatic hypotension, tachycardia, increase in angina attacks in patients with coronary disease, it can therefore be prescribed for men with cardiac pathologies.Dosage and compliance correctly selected with all the rules on the use of drugs from the Alpha-Blocker Group allow you to obtain a good therapeutic effect in the almost complete absence of side effects.
Inhibitory group drugs (blockers) reductase
The drugs in this pharmacological group (fine, dutasteride) help to alleviate the flow of urine and, therefore, to the elimination of the main symptoms of the disease.A stable therapeutic effect already 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 studies, maximum efficiency is obtained after six months of treatment with these drugs.
The finasteride and the dutasteride are specific inhibitors of the 2nd type reductase of the 2nd type (cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone).Prostate growth with prostate adenoma is directly linked to a similar transformation of testosterone.Thanks to inhibitors of 5-alpha reductase, the products of the intra-industrial dihydotestosterone are blocked and its concentration in the blood is considerably reduced.
Finesteride and dutasteride are used for the following purposes:
- Treatment and control of prostate hyperplasia;
- Improve the flow of urine and eliminate symptoms of prostate adenoma;
- Reduce the risk of developing acute urinary retention and the need to conduct surgery.
The finasteride and the dutasteride have a pronounced antiandrogen effect, that is to say contributing to a decrease in the level of male hormones in the blood.In addition, these drugs have a teratogenic effect, so they must be taken with caution.With the help of modern drugs, you can stop prostate growth and prevent the need for surgical treatment.
Antispasmodic and analgesic tablets with an exacerbation of the disease
The main prescription of antispasmodic and analgesic effects with the exacerbation of the 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 fight not only with painful sensations that occur in the process of urination, but also with constant pain in groin and perineum.Due to the action of non-steroidal anti-inflammatory drugs, the inflammatory process decreases, swelling of the prostate gland decreases, body temperature is normalized and unpleasant symptoms are eliminated.
Neopioid pain relievers produced in the form of tablets or candles help stop pain syndrome with the exacerbation of prostate adenoma.The most affordable of them is sodium metamizole.However, this medication is more intended for use at a time, as it can only affect a low pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesi 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 radioprotective agent and an essential link in reproductive processes.Vitamin E in a dose of 400 mg of urologists is prescribed to patients with erectile function and spermatogenesis disorders associated with the adenoma of the prostatic gland.
The treatment of a chronic disease as serious as an adenoma of the prostate must be prescribed and controlled by a urologist.It is strictly forbidden to take certain drugs independently, without preliminary consultation with the attending physician, because self-medication in this case may not only be ineffective, but also dangerous for male health.Only a qualified specialist can suggest which tablets of the prostate adenoma are the most effective in each case and which can cause negative consequences.
Operations
Hospital urologists masterfully carry out conventional and mini-invasive surgical interventions, use innovative methods of surgical treatment for prostate adenoma.Each patient is selected this operation which suits him more.
The generally recognized standard in surgical treatment of prostate adenoma is the transurer prostate resection.The operation is very effective.After the intervention, patients get rid of the infravyzic obstruction (narrowing of the urethra) and associated symptoms.The rehabilitation period is short.During or after surgery, bleeding can develop, "poisoning in water" syndrome.
Alternative methods of processing the prostate adenoma include the following surgical interventions:
- Stenting;
- Balloon dilation;
- Hyperthermia;
- Thermotherapy;
- Ultrasonic, laser and needle ablation;
- Interstitial coagulation.
After them, complications occur less often, but these methods are lower than transurer resection in terms of efficiency, both in clinic and economically.
The laparoscopic elimination of the prostate adenoma is used when the tumor has developed considerably, and it is problematic to eliminate it using transurer resection.This operation is more complicated, carried out under anesthesia.Thanks to small incisions, the surgeon introduces special tools into the body cavity, which eliminates the prostate adenoma.The operation is carried out according to the image of video cameras, which appears 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 to treat the enucleation of the adenoma-laser laser.The intervention is carried out with large sizes of the neoplasm.Excess tissues are deleted using a laser.The operation is carried out by the urethra.The tumor is separated, divided into small parts, then displayed.The method is considered to be not very invasive.It has a number of important advantages: it does not violate the integrity of the cavities, does not cause unnecessary damage.
Laser vaporization consists in destroying the adenoma by laser evaporation.Thanks to the urethra, the urologist introduces a special device, is brought to the neoplasm and affects it completely with a strong green laser.The depth of the laser penetration and the precision of its blow can avoid damaging the neighboring areas.The method is minimal, bloody, fast and efficient.His only drawback is the inability to take a tumor tissue for a histological examination.
In certain situations, the inevitable method of processing the prostate adenoma is abdominal surgery - adenomectomy.It is carried out in case other methods cannot help the patient.During surgery, the surgeon with a scalpel has access to the prostate gland and manually, using surgical instruments, eliminates adenoma.Following the operation, significant blood loss can occur, complications develop.After surgery, the patient needs prolonged rehabilitation.
The elimination of the prostate adenoma by the (transluccal) adenomectomy method consists of a radical excision of the hyperplastic tissues of the prostate by the longitudinal incision of the anterior abdominal wall and the bladder.The operation is carried out at the advanced stages of the disease, when the tumor reaches large sizes, the bladder is overthrown due to its accumulated urine overflow and renal failure develops.
The bladder is pre-cathized and filled with a sterile solution of furatiline or other substance.Then, it is allocated and taken in two places to special assets, for which they raise the wall of the organ.The surgeon dissects the form formed and opened the bladder.
At the inner end of the established urinary catheter, it determines the zone of the bladder of the bladder and around the urethra holes which appeared in the field of vision, withdrawing 0.5 to 1 cm, made the mucosa of the mucosa of the mucosa.After that, the operational urologist penetrates a finger into the thickness of the prostate, between the tumor capsule and the adenomatous nodes, and the latter.At the same time, the doctor gives the gland to the patient's front in the patient's rectum in the rectum in the front abdominal wall.It becomes more affordable for manipulation.Thanks to this technique, the operating time is reduced and the blood loss is reduced.
Then the surgeon performs the hemostasis (stopping bleeding) of the bed of the distant adenoma and sutures the bladder, leaving a thin drainage in the wound.It is designed to wash your cavity from resulting blood clots.The urinary catheter, introduced before the start of the operation, is not withdrawn for 7 to 10 days.Around, a new section of the urethra is formed instead during the prostatic part of the urethra.
Cuspular adenomectomy refers to the most traumatic of all the methods used for the adenoma of the prostate gland.It is accompanied by the risk of developing the following complications:
- Bleeding from the neoplasm lodge;
- Stagnant pneumonia;
- Evacuation function of the altered engine of the intestine, manifested by constipation.
To avoid complications, after hospital surgery, the patient is made early activation.The following undesirable consequences to eliminate the adenoma of the prostate may occur:
- Insufficient bladder drainage;
- Shrinking from his neck;
- Urinary infiltration of the fabric close to psychote;
- The formation of the "prenatal" (the residual cavity at the place where the adenoma of the prostate has been removed);
- The formation of narrowing of the light of the urethra;
- 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 carried out using a laparoscope.The laparoscopic operation to eliminate the adenoma of the prostate is one of the least invasive options for surgical interventions on the prostate gland.Hospital urologists use this technique if the patient has a sufficiently significant adenoma of the prostate.
If the patient's prostatic gland with an adenoma does not exceed 120 cm3, it is recommended for the transureral resection of the prostate adenoma.But 10% for patients who need surgery, this option is not suitable because iron reaches more than 120 cc.The laparoscopic operation to eliminate the adenoma of the prostate during uarolitase, inguinal hernia, the diverticulum of the bladder and the ankylose joints of the lower limbs are not carried out.In this case, the decision on the possibility of carrying out an operation is taken collegial by an urologist, an Andrologist, an abdominal surgeon and other hospital specialists.