The most common urological pathology addressed to the urologist, men over 45, is the prostate -adenoma.The presence of this pathology significantly worsens the quality of life of the people.One of the most impressive consequences of the pathological process is the degeneration of benign prostate hyperplasia in a malignant tumor.
Surgical and drug treatment methods are used to combat the prostate adenoma.Specialists from the hospital choose the most effective medication or methods of surgical interventions taking into account the stage of the disease, the general state and age of the patient as well as the presence of related pathologies.Comfortable diseases for the treatment of patients were generated in the operating clinic.
The causes of the development of the disease
The appearance of the adenoma is most commonly associated with age -related changes in the prostate, namely a change in its structure and an increase in size.As a result of such changes, the urethra is gradually compressed, which is located in the thickness of the prostate gland and violations of the urine process appear.
The prostate adenoma in men develops due to the hormonal restructuring of the body, which is associated with age -related changes.The testosterone level (male hormone) gradually decreases with the age, while the concentration of the female sex hormone (estrogen) increases.This phenomenon is called male menopause.
The development of the prostate adenoma can be due to the following risk factors:
- The age of the patient - increased prostate iron is extremely rare in men under forty years and is diagnosed in almost every second after sixty years.
- Hereditary disposition - if the prostate -ada -adenoma has been diagnosed in the narrow blood conditions of a man, he has a great risk of inheriting this disease in adulthood.
- Diabetes mellitus, cardiovascular diseases-a benign tumor (adenoma) of the prostate can not only occur these diseases itself, but also the harmful effects of medicinal products on their treatment (e.g. beta blocker);
- The wrong lifestyle - the risk of a prostateadenoma is increased in men with obesity and inadequate physical activity.
Symptoms
The adenoma of the prostate can be assumed if a man occurs in the following symptoms that are most typical for this disease:
- Duties of urination;
- the appearance of the need for the tension of the abdominal muscles for urination;
- the presence of pain, burns, sluggish urine beam;
- Complaints and insufficient emptying of the bladder;
- Increase the duration of the urine process.
The prostateada -adenom not only leads to a man's quality of life, but also to an acute delay in urination, which requires the use of surgical treatment methods.In order to avoid surgical intervention, many patients use special drugs for the treatment of the prostateadenoma, which eliminates the symptoms and restore the normal activity of the prostate.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 occur.
Treatment of the prostateadenome individually for each patient.Preparations for the treatment of the prostate adenoma, your dosage and duration of use are prescribed by the treating doctor.Taking products from prostatitis and prostate adenoma can not only be an ineffective, but also a dangerous measure.Due to the presence of men of the older generation of some “personal” chronic diseases, medication for the treatment of the prostateadenoma should be selected, taking into account the associated pathologies.
Development stages of the disease
The prostate adenoma is characterized by a gradual development, which can be divided into three stages.
- The first stage of the disease is with minimal urine disorders.Its insignificant climb, especially at night and a slow urine current, can be observed.The first phase can take from one year to 12 years or more.
- The second stage of the prostate adenoma is characterized by more pronounced urination disorders: the intermittent of the urine stream, the appearance of the need for an exertion during urination and a feeling of incomplete emptying of the bladder.The rest of the urine, which is lingered in the bladder and in the urinary tract, causes an inflammatory process that is accompanied by pain, combustion sensations while urinating, pain in the lower back and over the thrust.
- 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 the prostate adenoma, the quality of life does not worsen and takes place without the development of complications.In some cases, however, the disease can cause the following negative consequences:
- The acute delay of the urine - it is characterized by a sudden impossibility to empty the bladder and pain in the right region.In the event of a similar illness, the patient needs medical emergency care with catheterization or small operation.
- The occurrence of infections in the urinary tract is the stagnation of urine that creates favorable diseases for the reproduction of pathogens, for the development of cystitis and pyelonephritis;
- The formation of stones in the bladder is also a result of urine stagnation;
- Damage to the bladder - with irregular emptying of the bladder, it is stretched, the formation of projections (bags) in the walls of the organ in which urine stagnates;
- Damage to the kidneys - increased pressure in the ureter and bladder has a direct harmful influence on the kidneys, which is why kidney failure develops.
Prostate -Denoma and potency
Prostate -Denoma and potency are closely linked.The adenoma disturbs the structure of the glandular tissue, which in turn leads to the defeat of another, no less important organ - the testicles responsible for the products of androgens.This can cause the prostate adenoma impotence that requires longer and complex therapy.
Diagnosis
A simple and effective way to determine a preliminary diagnosis is the patient by maintaining a diary of urination with the fixation of quantitative and qualitative parameters: volumes dedicated urine, properties of the used liquid, imperative calls.The most important physical examination method in the event of suspicion of the adenoma of the prostate is a rectal finger examination of the prostate to identify its increase and to exclude some other pathologies.
The diagnosis of a prostateada in the hospital is carried out with the following laboratory and instrumental methods:
- General blood and urine tests;
- Biochemical blood testing for markers of the condition of the kidneys, urea and creatine indicators;
- Analysis for the dog level (to rule out prostate cancer);
- Transrectal ultrasound examination (ultrasound);
- Urofloometry (to determine the speed of the urine current);
- Determination of the volume of the remaining urine (using ultrasound);
- Pelvic electromyography;
- Urethrocystoscopy;
- Excretionurography.
Treatment
Treatment of the prostate adenoma aims to facilitate the symptoms of a lower urinary tract, improve the quality of the patient and prevent the development of disease complications.Patients with poorly exposed symptoms who 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 the growth of the prostateadenoma can be stopped.During this time, attention focuses on the non -drug therapy.Thehertic methods can be a supplement to conservative treatment, which represents the inclusion of the following medication:
- Alpha blocker (tamsulosin, alfuzosin);
- 5-alpha reductase inhibitors (finsterid);
- Type 5 Phosphodesterase inhibitors (sildenafil);
- Combinations of 5-alpha reductase inhibitors and alpha blockers;
- Muscarine receptor blocker or M cholinolytic.
Patients with prostate adenoma in an advanced stage are recommended to carry out surgical treatment that can be carried out using various methods: transurethral excision, transurethral resection and removal of the prostate.
There are certain indications of the use of surgical treatment:
- Repeated urine delay;
- Kidney failure by prostate -adenoma;
- Stones in the bladder;
- Recurring urinary tract infections;
- Repeat hematuria.
In addition, surgery is required for patients if there is no effectiveness through medication.
In the course of conservative therapy or in the postoperative period, patients need constant medical control with standard studies (the rate of urine flow, ultrasound, analysis of the PSA level).
Drugs
There is a certain scheme according to which specific drugs for the treatment of prostatitis and prostate adenoma are prescribed.A high effectiveness of the treatment is achieved by the use of medicines of the alpha reductase inhibitors and alpha blockers.These drugs for the treatment of the prostateada adenoma in men help to eliminate the main symptoms of the disease and to restore sufficient urination.
What are the most effective and most widespread tablets of the prostate adenoma?The list is directed by Alpha1 adrenergic receptor blockers.This list also contains inhibitors of 5-alpha reductase, vitamins and minerals.
The complex of drug therapy does not only include medication.With the prostateadenoma, conservative treatment can be supplemented by biologically active additives - dietary supplements that improve the therapeutic effect of medicinal products and provide early recovery.Some of them are zinc.This macro element is directly involved in spermatogenesis and testosterone synthesis.Plant phytosterols normalize urination.
Treatment with medication from the antagonist group Alpha1 adrenoceptors
These drugs for the treatment of prostatitis and prostateadenoma ensure the relaxation of the smooth muscles of the urea system and the improvement of the urine process.Tamsulosin with the same name of the active substance, which is part of other medicines (alfuzosin, silodinos, etc.), is a high-sequential drug that has selective effect on alpha1 adrenergic receptors of the prostate muscle, the prostate of the urethra and blader.Thanks to a decrease in muscle tone, the drain and the urine release are made easier.Tamsulosin, like all selective medication, has a minimal number of side effects, does not affect the tone of blood vessels and can be prescribed patients with chronic hypertension.
Antagonists of alpha-adrenergic receptors must be used constantly so that they can achieve a gradual reduction in irritation and obstruction with prostate adenoma.The drug tamsulosine in the treatment of the prostateada adenoma has a well -processed priority for urologists.
The tablet form of the drug is more progressive, since the active substance is in the body due to the constant concentration in the body.The medicine occurs evenly into the bloodstream and thus ensures that the main name effects of the medicines of the adrenaehobocators group - a strong decrease in blood pressure.
An equally effective medication with the drama substance tamsulosin is a lesson.Taking this drug is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, an increase in angina attacks in patients with coronary heart disease, so that it can be prescribed for men with heart pathologies.Properly selected dosage and compliance with all rules for the use of pharmaceuticals from the Alpha-Blockers group enable you to achieve a good therapeutic effect with almost complete absence of side effects.
Medicines of the group of inhibitors (blockers) reductase
The medication in this pharmacological group (Finsterid, Dutastasteride) contribute to the relief of urine outflow and thus to eliminate the main symptoms of the disease.A stable therapeutic effect takes place 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 achieved after six months of therapy with these medication.
Finasteride and dutastone are specific inhibitors of the 5-alpha reductase of the 2nd type (cell enzyme for the conversion of testosterone into dihydrotestosterone).The growth of the prostate with prostate adenoma is directly related to a similar transformation of testosterone.Thanks to 5-alpha reductase inhibitors, the products of the intra-industrial dihydrotestosterone are blocked and its concentration in the blood significantly reduced.
Finsterid and dutastoneide are used for the following purposes:
- Treatment and control of prostate hyperplasia;
- Improvement of urine outflow and elimination of the symptoms of the prostate adenoma;
- Reduction of the risk of developing acute urinary retention and the need to carry out surgical interventions.
Finasteride and Dutastasteride have a pronounced antiandrogenic effect, i.e.H. contribute to a decrease in the level of male hormones in the blood.In addition, these drugs have a teratogenic effect, so they have to be taken with caution.With the help of modern drugs, you can set the growth of the prostate and prevent the need for surgical treatment.
Anti -spas modos and analgesic tablets with an aggravation of the disease
The main bond of anti -spasmodic and analgesic effects with worsening of the prostateadenoma is to relieve the general condition of the patient and to eliminate pain syndrome.The anti -inflammatory and analgesic effect is exerted by non -steroidal anti -inflammatory medication (Diclofenac, ibuprofen).They contribute not only to fight with painful sensations that occur when urinating, but also with constant pain in the groin and perineum.Due to the effect of non -steroidal anti -inflammatory drugs, the inflammatory process decreases, the swelling of the prostate gland decreases, the body temperature is normalized and unpleasant symptoms are eliminated.
Neopioid analgesics, which are generated in the form of tablets or candles, help to stop pain syndrome with a deterioration of the prostate adom.The most affordable is sodium metamizole.However, this drug is more intended for a time use, since it can only affect weak pain syndrome.In addition, analgesics with lidocaine, benzocaine, anesthesia and novocaine (ichtamol, benzocaine, tribeasid + lidocaine) are effective.
Vitamin E 400
Tocopherolaceta or vitamin E is often part of the complex treatment of the prostate adenoma as an antioxidant, radio protection agent and an indispensable connection in reproduction processes.Vitamin E in a dosage of 400 mg urologists are prescribed patients with diseases of erectile function and spermatogenesis in connection with the adenoma of the prostate gland.
The treatment of such a serious chronic disease as a prostate adenoma should be prescribed and controlled by a urologist.It is strictly forbidden to take certain medication independently without a preliminary consultation with the treating doctor, since in this case the self -mediation can be not only ineffective, but also for male health.Only a qualified specialist can suggest which tablets of the prostate adenoma are most effective and which of them can have negative consequences.
Operations
Hospital urologists carry out masterful classic and minimally invasive surgical interventions and use innovative methods for the surgical treatment of the prostateada.Each patient is selected this operation that corresponds more.
The generally recognized standard in the surgical treatment of the prostate adenoma is the transurethral resection of the prostate.The operation is very effective.After intervention, patients remove the infravyzic obstruction (narrowing of the urethra) and the associated symptoms.The rehabilitation phase is short.During or after the operation, the syndrome can develop "water casting".
The alternative methods for the treatment of prostateadenoma include the following surgical interventions:
- Stenting;
- Balloon dilation;
- Hyperthermia;
- Thermotherapy;
- Ultrasound, laser and needleblation;
- Interstitial coagulation.
Complications occur less frequently after them, but these methods are the transurethral resection in terms of effectiveness in both clinically and economically.
The laparoscopic removal of the prostate adenoma is used when the tumor has grown significantly, and it is problematic to remove it using a transurethral resection.This operation is more complicated and carried out under anesthesia.Through small cuts, the surgeon introduces special tools into the body cavity that carry out the removal of the prostateadenoma.The operation is carried out in accordance with the image of video cameras that are displayed on the screen.The main advantages of the intervention are minimal blood loss volume, a low probability of complications.After the operation, the patient does not need long -term rehabilitation.
If there are signs of a prostate adenoma in men, doctors use a high tech method to treat adenoma -laser -enuclation.The intervention takes place with large sizes of the neoplasm.Excess fabrics are removed with a laser.The operation is carried out by the urethra.The tumor is separated, divided into small parts and then displayed.The method is considered minimally invasive.There are a number of significant advantages: it does not violate the integrity of the cavities, does not cause unnecessary damage.
The laser evaporation is to destroy the adenoma by laser evaporation.The urologist sets a special device through the urethra, is brought to neoplasm and affects it with a strong green laser.The depth of the laser penetration and the accuracy of his hit can damage the neighboring areas.The method is minimal, bloodless, fast and effective.The only disadvantage is the inability to take a tumor fabric for histological examination.
In some situations, the inevitable method for the treatment of prostate -adenoma is abdominal surgery - adenomectomy.It is carried out in this case if other methods cannot help the patient.During the operation, the surgeon has access to the prostate with a scalpel and manually using surgical instruments.Significant blood loss can occur as a result of operation, complications develop.After the operation, the patient must need longer rehabilitation.
The removal of the prostate adenoma using the method of detention (translucent) adenomectomy consists in the radical excision of the hyperplashed tissue of the prostate through the longitudinal section of the front abdominal wall and the bladder.The operation is carried out in the advanced stages of the disease when the tumor reaches great sizes, the bladder is canceled due to its overflow of accumulated urine, and kidney failure develops.
The bladder is filled in front of the catheterized and with a sterile solution of Furnilin or another substance.Then it is assigned to special stocks in two places, for which you can raise the wall of the organ.The surgeon dissects the formed fold and carries out the opening of the bladder.
At the inner end of the established urinary catheter, it determines the area of the neck of the bladder and around the urethra holes that appeared in the field of vision and makes the mucous membrane of the mucosa membrane.Then the operative urologist penetrates into the thickness of the prostate, occurs between the tumor capsule and the adenomatous nodes and hesitates the latter.At the same time, the doctor gives the gland on 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 technology, the operating time is reduced and blood loss is reduced.
Then the surgeon carries out a hemostasis (stop bleeding) of the bed of the remote adenoma and sews the bladder, causing a thin drainage in the wound.It is designed in such a way that it is supposed to wash its cavity from the resulting blood clots.The urinary catheter introduced before the operation begins is not removed for 7-10 days.A new section of the urethra is formed around it in the course of the prostatic part of the urethra.
A cozy adenomectomy refers to the most traumatic of all methods used for the prostate glands.It goes hand in hand with the risk of developing the following complications:
- Bleeding from the lodge of the neoplasm;
- Stagnant pneumonia;
- Impaired engine vacuation function of the intestine, which is manifested by constipation.
To avoid complications, the patient is activated early after the operation in the hospital.The following undesirable consequences of operations to remove prostateadenoma can occur:
- Inadequate drainage of the bladder;
- Narrowing of his neck;
- Urine filtration of almost pussy tissue;
- The formation of the "prenatal" (the remaining cave at the point where the prostateadenoma was removed);
- The formation of the narrowing of the lumen of the urethra;
- Urine incontinence.
This has a negative effect on the quality of life of patients and extends the restoration of appropriate urination.
The consequences of the operation are less pronounced if the intervention is carried out using a laparoscope.Laparoscopic operation to remove the prostate adenoma is one of the less invasive options for surgical interventions in the prostate.Hospital urologists use this technology if the patient has a sufficiently large adenoma of the prostate.
If the patient's prostate does not exceed 120 cm3 with an adenoma, it is recommended for the transurethral resection of the prostateada.This option is not suitable for 10% for patients who need to be operated on because the iron reaches more than 120 cm3.The laparoscopic surgery to remove the prostate adenoma during the uarolitiasis, inguinal hernia, the diverticulum of the bladder and the ankylosegen joints of the lower extremities is not carried out.In this case, the decision on the possibility of an operation is made collegically by a urologist, andrologist, an abdominal surgeon and other hospital specialists.