How to cure prostate adenoma without surgery: all about modern drugs. Dgpzh - what is it? symptoms, treatment of benign prostatic hyperplasia Treatment with autosuggestion of prostatic hyperplasia

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

Prostatic hyperplasia (N40)

Urology

general information

Short description

Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 of December 12, 2013

benign prostatic hyperplasia(BPH) is a benign tumor that develops as a result of hyperplasia of predominantly glandular (epithelial) and less stromal cells of the prostate, against the background of a violation of the prostate receptor apparatus that interacts with testosterone metabolites, which leads to an increase in organ weight, as well as a deterioration in the passage of urine from the bladder ( infravesical obstruction), due to compression of the posterior urethra (the prostate surrounds the urethra). The process has a chronic course, resulting in decompensation of the contractile function of the bladder, an increase in residual urine, the formation of ureterohydronephrosis, the occurrence and progression of inflammatory diseases of the kidneys, bladder, and renal failure. (Lopatkin N.A. 1998)

I. INTRODUCTION

Full title: benign prostatic hyperplasia
Tooneprotocol:

ICD-10 code:
N40 - Prostatic hyperplasia

Abbreviations used in the protocol:
BAC-biochemical blood test
BPH - benign prostatic hyperplasia
IVO - infravesical obstruction.
OAM-general urinalysis
PSA prostate specific antigen
Ultrasound-ultrasound examination

Protocol development date: April, 2013
Patient category: men aged 45 years and over, with complaints of difficulty urinating, who, according to ultrasound, have BPH
Protocol Users: urologists, andrologists, surgeons

Classification

Clinical classification:
Stage 1 - the occurrence of urination disorders with complete emptying of the bladder,
Stage 2 - a significant violation of the function of the bladder, the appearance of residual urine,
Stage 3 - the development of complete decompensation of bladder function, the appearance of paradoxical ischuria. (Lopatkin N.A. 1998)

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

List of basic and additional diagnostic measures

Examinations required before planned hospitalization:

Diagnostic criteria

Complaints and anamnesis: complaints of difficulty urinating, frequent nocturnal urination, feeling of residual urine for a long time, or acute urinary retention, resulting in catheterization or cystostomy.

Physical data: rectally, the prostate is enlarged in size, adenomatically changed, densely elastic consistency, also in the presence of a large volume of residual urine, when the bladder is palpated in the suprapubic region, an overflowing bladder is palpated.

Laboratory research:
- in OAM, leukocyturia, bacteriuria, hematuria are possible;
- with prolonged IVO in the LHC, an increase in blood urea and creatinine is possible.

Instrument data:
- according to the ultrasound examination: residual urine, echographic signs of BPH;
- according to uroflowmetry: violation of the urodynamics of the lower urinary tract;
- on roentgencystography: a filling defect along the lower contour of the bladder.

Pproviding expert advice: taking into account the severity of concomitant diseases:
- in coronary pathology - a cardiologist;
- in case of diabetes mellitus - endocrinologist;
- in chronic renal failure - nephrologist;
- elevated PSA and hematuria-oncologist, etc.

Differential Diagnosis

Differential Diagnosis

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Treatment

Targetandtreatment:
Elimination of BPH as a cause of infravesical obstruction, drainage to unload the lower urinary tract. During the hospitalization of the patient, the volume of the necessary additional examination is determined in order to determine the volume of BPH and comorbidity, which determines the volume and type of surgical intervention, as well as measures of preoperative preparation and features of postoperative management of patients.

Treatment tactics

Non-drug treatment: stationary mode, semi-bed, table No. 15.

Medical treatment during planned hospitalization:
1. Antibacterial therapy (3rd generation cephalosporins 1 g x 2 r / d i / m, amikacin 0.5 g x 2 r / d i / m, metronidazole 100 ml x 1-2 r / d / i / v, ciprofloxacin 100 ml x 1-2 r/d i.v., levofloxacin 500 mg x 1 r/d i.v.)
2. Hemostatic therapy (dicynone 2.0 x 2 r/d i/m, etamsylate 2.0 x 2 r/d i/m, tramin 10% 5 ml x 1-2 r/d i/v)
3. Restorative therapy (glucose 5% 250 ml x 1 r/d i.v., vit. C 10.0 x 1 r/d i.v., vit. B1 1.0 x 1 r/d i.v., vit. B6 1.0 x 1 r/d i/v)
4. Metabolic drugs with immunomodulating effect: vitaprost suppositories 1 time per day. 10 days
5. Pain relief therapy (ketoprofen 2.0 x 2 r/d i/m, promedol 2% 1.0 x 1 r/d i/m)
6. Antispasmodic therapy (drotaverine 2.0 x 2 r/d i/m)
7. Drugs that improve intestinal motility (metoclopramide 2.0 x 2 r/d i/m)

Other types of treatment: No

Surgery: Trocar cystostomy, transvesical adenomectomy, transurethral photoselective laser vaporization of BPH, transurethral plasma vaporization of BPH, transurethral microwave thermotherapy of BPH, mono- and bi-polar transurethral resection of BPH, high section of the bladder epicystostomy (Gold standard - Transurethral resection of BPH-, with prostate adenoma up to 80 grams)

Preventive actions:
- drugs inhibitors of alpha 5 reductase: dutasteride 500mcg x 1 r/d-3-6 months, finasteride 500mcg x 1 r/d-3-6 months, prostamol-uno 320mg x 1 r/d-3 months
- alpha adreno-blockers: doxazosin 1 tab x 1 r / d and its forms, tamsulosin 0.4 mg 1 capsule x 1 time per day and its forms;
- metabolic therapy: vitaprost tablets 100 mg x 2 times a day for 30 days;
- Observation by a urologist, control of KLA, OAM, ultrasound of the kidneys, bladder, prostate, residual urine volume - after 1 month, if necessary, anti-inflammatory therapy, in order to sanitize chronic foci of urinary system infection.

Further management:
- within 1 month after surgery: do not take anticoagulants, antiaggregants
- restriction of physical activity
- control of blood pressure (not higher than 140/90 mm Hg)
- do not take hot water treatments
- to prevent intestinal obstipation (during defecation, do not strain).

Indicators of treatment efficacy and safety of diagnostic and treatment methods described in the protocol:
- decrease or absence of residual urine volume, free urination, light urine
- with adenomectomy - wound healing by primary intention, consistency of sutures, dry and clean postoperative wound
- in laboratory tests, the absence of high leukocytosis, leukocyturia is allowed, a moderate decrease in hemoglobin and erythrocyte levels.

Drugs (active substances) used in the treatment

Groups of drugs according to ATC used in the treatment

Hospitalization

Indications for hospitalization (planned):
- difficult, frequent urination,
- nocturnal pollakiuria,
- residual urine,
- chronic urinary retention,
- the impossibility of independent urination, with the presence of a cystostomy or urethral catheter.

Information

Sources and literature

1. Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. 1. "2010 Update: Guidelines for the management of benign prostatic hyperplasia", Canadian Board of Prostate Health and Canadian Urological Association Guidelines Committee‡; Can Urol Assoc J 2010;4(5):310-316 2. Lopatkin N.A. Benign prostatic hyperplasia. - M., 1998. 3. Gorilovsky L.M. Prostate diseases in the elderly. - M., 1999. 4. Trapeznikova M.F. Classification of methods for the treatment of benign prostatic hyperplasia - M., 1997.

Information

III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION

List of protocol developers:
Alchinbaev M.K. - Doctor of Medical Sciences, Director of the Scientific Center of Urology. Academician B.U. Dzharbusynova

Reviewers:
MD, Professor Hairley G.Z.

Indication of no conflict of interest: missing.

Indication of the conditions for revising the protocol: Revise the protocol 5 years after its entry into force and / or when new methods of diagnosis / treatment become available with a higher level of evidence.

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: a therapist's guide" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

Methods for determining prostate adenoma and its treatment depend on the stage of the pathology. At an early stage, conservative therapy is effective; in chronic and acute cases, the patient is prescribed a surgical operation. Due to the possibility of dangerous complications, the treatment of pathology should be started immediately after the diagnosis.

What causes the disease

The exact nature of prostate adenoma and the causes of its occurrence have not been established. The tumor develops and grows gradually: first, a nodule is formed, which eventually increases in size and compresses the urinary canal.

The causes of neoplasm may be:

• hormonal disorders;
• irregular sex life;
• STDs;
• heavy physical activity;
• side effects of drugs;
• alcohol abuse;
• smoking;
• pathologies of the cardiovascular system;
• inflammatory processes.

High testosterone contributes to the development of adenoma and its degeneration into prostate cancer.

Risk factors contributing to the appearance of a tumor:

• excess weight;
• heredity;
• atherosclerosis;
• sedentary lifestyle;
• malnutrition;
• hypertension.

Pathological changes come from constant stress and emotional overstrain. A neoplasm can develop against the background of chronic renal failure and disorders of the genitourinary system.

Stages and symptoms

Symptoms of prostate adenoma in men are divided into 2 groups: irritative and obstructive. As the pathology develops, increasing signs and complications are observed.

Modern medicine distinguishes 4 stages of the development of the condition. The main signs of adenoma correspond to characteristic changes in the functioning of the urethra.

Compensated form

Prostate adenoma of the 1st degree is characterized by contraction of the urethra, as a result of which urine is excreted with difficulty.

Initial symptoms:

• frequent urge to urinate during the day;
• decrease in the amount of urine excreted;
• imperative urges become more frequent;
• periodically there is a delay in the outflow of urine;
• the need for tension of auxiliary muscles.

The kidneys and ureters do not undergo changes, so the general condition of the patient remains stable.

subcompensation

Benign prostatic hyperplasia of the 2nd degree negatively affects the functioning of the bladder. Due to the constant increase in the volume of unexpelled urine, the ureters expand, signs of CRF and other changes appear in the upper urinary system.

Grade 2 symptoms are:

• portioned release of the bladder;
• the thickness of the bubble walls increases;
• there is a delay of part of the urine;
• involuntary urination becomes more frequent;
• urine is cloudy, may contain bloody impurities.

Decompensation

At this stage, the clinic of chronic renal failure is growing. There may be complications from progressive kidney disease.

Symptoms of adenoma 3 degrees:

• constant urge to urinate;
• the ureters expand as much as possible;
• severe pain in the lower abdomen;
• excretion of urine in small portions.

Concomitant signs in men with pathology:

• weakness;
• nausea;
• loss of appetite;
• constipation;
• thirst.

There is a high chance of developing cancer in stage 3. Due to the large size of the tumor and the complete dysfunction of the bladder, toxins accumulate in the body, which leads to intoxication.

Terminal

The final stage, in which atony occurs, and urination completely stops. The volume of accumulated urine can reach up to 2 liters.

Symptoms of prostate adenoma of the 4th degree are accompanied by symptoms of chronic renal failure, incompatible with life. In the patient's blood, the nitrogen content sharply increases, the water and electrolyte balance is disturbed, and the patient dies from uremia.

How to Diagnose

There is a special algorithm for diagnosing BPH.

The diagnosis is made on the basis of a summary assessment of all symptoms and the patient's quality of life.

Questioning and urological examination

During a conversation with a patient, the doctor asks questions related to the frequency and nature of urination. The international IPSS questionnaire and its QOL application have been specially developed by WHO.

To determine BPH and its degree, scores are used:

• 0-7 - therapy is not required;
• 8-19 - prostate adenoma stage 1-2, conservative treatment is recommended;
• 20-35 - severe symptoms, surgery is needed.

The urologist conducts an external examination of the genital organs and a study of the gland through the rectum. Palpation of the prostate allows you to determine the size, texture and tenderness of the prostate.

Laboratory and instrumental methods

To clarify the diagnosis and determine the stage of the disease, the patient is prescribed a number of laboratory and instrumental studies.

First of all, the patient needs to take tests:

1. OAM. A general urine test determines the presence of urinary tract infections, bleeding and CRF.
2. Kidney tests.
3. Biopsy of the prostate. Histological examination is carried out to determine the likelihood of degeneration of benign neoplasms into malignant ones.
4. PSA blood. A study on the level of prostate-specific antigen is the main screening method.

Instrumental research methods are also assigned:

1. ultrasound. Determines the degree of damage to the prostate tissue and the functionality of the kidneys.
2. X-ray methods. X-ray and excretory urography determines the presence and nature of changes in the kidneys and ureters.
3. Uroflowmetry. Investigation of the jet, urination rate, volume and duration.
4. Urethrocystoscopy. Allows you to assess the nature of the narrowing of the urethra and determine possible changes in the bladder.
5. Cystomanometry. Screening to determine the pressure inside the bladder.
6. Cystography. Examination of the circulatory system around the bladder.
7. MRI and CT. Diagnosis helps to study in detail benign tumors: their structure, size, degree of growth.

How to treat

There is no single treatment for prostatic hyperplasia. Specialists select therapy, taking into account the general condition of the patient, his age, degree of pathology and other factors.

The most effective methods of treatment depending on the stage of BPH:

1. Adenoma 1 degree. conservative methods.
2. Treatment of the 2nd degree. Surgical intervention: minimally invasive and classical techniques.
3. 3 degree neoplasm. Therapy consists of a set of activities.

Medicines

For the drug treatment of prostate adenoma, drugs of different therapeutic groups are used.

1. Alpha blockers. The medications Doxazosin, Prazosin, Terazosin, Alfuzosin, and Tamsulosin help to relax pressure on the urethra and make it easier for urine to flow.
2. 5-alpha reductase inhibitors. Dutasteride, Finasteride help reduce the volume of the prostate by blocking the conversion of testosterone to its active form.
3. Phytopreparations. Herbal medicines Speman, Tentex forte and Himkolin help to normalize the rate of urinary flow and the amount of residual urine.
4. Combined funds. Simultaneous administration of drugs from the groups Alpha-blockers and 5-alpha-reductase inhibitors.
5. Antispasmodics and drugs that have an analgesic effect. Recommended for exacerbation.
6. orthomolecular therapy. Vitamins and mineral supplements.

In parallel with the treatment with medications, a number of therapeutic measures are carried out aimed at combating comorbidities and disorders:

1. Antibiotic Levofloxacin has a high antibacterial activity, and helps in the treatment of infections of the urological tract.
2. Prostatilen works against inflammation and helps reduce swelling.
3. Timalin is used in the treatment of prostatitis and cystitis.

Contraindications to the treatment of BPH with medications: urolithiasis, renal failure, acute pyelonephritis.

If the patient is taking medication, the attending physician should be notified. With BPH, you can not use rectal suppositories Anuzol.

Physiotherapy

Treatment of adenoma in the early stages is carried out using physiotherapy. Procedures are divided into 2 types:

1. A complex aimed at stimulating blood flow and strengthening the immune system. This category includes: magnetotherapy, laser therapy and inductotherapy. With their help, you can cure prostatitis, which often accompanies a pathological condition.
2. The course is aimed at removing inflammatory processes and eliminating the symptoms of benign prostatic hyperplasia.

In case of pathology, sanatorium treatment is indicated.

The treatment course includes:

1. Urological massager.
2. Phonation is a new technology in the treatment of adenoma. It is a deep micro-massage at the cellular level.
3. magnetic therapy. The magnet is used to speed up blood flow and relieve symptoms.

Photodynamic therapy

Effective treatment helps with malignant and benign tumors, adenomas and other tissue pathologies.

In the patient's body, photosensitizers that relieve inflammation and restore damaged tissue cells.

Ozone therapy

The mechanism of action of this therapy lies in the natural properties of ozone, which contains active oxygen.

This procedure normalizes the metabolism in the body, saturates the blood with vitamins and minerals. The therapy has no side effects. Combination with other methods of treatment is possible.

Diet

Diets should be followed all the time while prostate adenoma is being treated, as well as for its prevention. The basis of the diet is foods high in selenium and zinc.

The menu should be light and balanced.

Do not drink beer or other alcoholic beverages.

Hunger, like overeating, negatively affects health.

Allowed products:

• lean meat and fish;
• soups on vegetable broth, milk and water;
• cereals;
• vegetables and fruits: tomatoes, peppers, apples, pears.

exercise therapy

Exercise therapy classes are assigned at all stages. Physical exercise helps relieve inflammation and restore the functioning of the urinary system.

After surgery, with the help of physiotherapy exercises, you can completely cure prostate adenoma and avoid the development of pathology in the future.

Hirudotherapy

Tumor enlargement reduces sexual ability. For the treatment of erectile dysfunction in men, a course of hirudotherapy is prescribed.

The procedure helps to normalize blood circulation and remove toxins from the body.

For therapy, only medical leeches are used. The treatment session lasts 7-15 minutes.

Operation

Surgical treatment is a prostate gland. The patient is operated on in case of complications, chronic renal failure and infectious infection.

Surgical methods:

1. Open prostatectomy (adenectomy). A complex abdominal operation, which is performed under general anesthesia.
2. Transurethral resection. The operation is performed without incisions, through the urethra.

Minimally invasive methods:

1. Transurethral microwave thermotherapy. The affected tissues are affected by high temperature (55…80°C). The mechanism of action is the destruction of the affected tissues of the prostate.
2. Prostatic stenting of the urethra.
3. Transurethral microwave therapy.
4. If indicated, the patient is assigned free arterial embolization.

It is impossible to remove benign hyperplasia with the help of surgery in case of pathologies of the cardiovascular system, decompensated respiratory disorders, etc. If surgical treatment is not possible, palliative methods are resorted to.

Folk ways

An alternative treatment for BPH is traditional medicine. Herbs, plants and other means are used as adjuvant and preventive therapy.

Popular folk remedies:

1. Onion peel with honey is used to prepare a decoction that is useful for normalizing the functioning of the genitourinary system.
2. For treatment are used: pumpkin seeds with watermelon, Ivan-tea and young potato juice.
3. For prevention, it is useful to drink aspen bark brewed with boiling water.
4. Hydrogen peroxide in the treatment of adenoma is taken orally in the form of a weak dilute solution. For 2 st. l. water enough 1-2% peroxide solution.
   There are no contraindications to taking hydrogen peroxide. Healing is achieved by enriching the blood with oxygen.
5. In pathology, salt pads can be applied to the affected areas.
6. The subconscious mind programming method is new in the treatment of BPH. The White Noise channel helps to tune the body to recovery on a subconscious level.

Complications

In the early stages, the treatment of a prostate tumor - adenoma has a favorable prognosis. If you start treatment in a timely manner, you can get rid of an unpleasant condition with the help of conservative methods.

BPH is a benign tumor, does not metastasize, but can degenerate into prostatic cancer.

If the pathology develops, complications may appear:

• pain when urinating;
• the formation of stones in the bladder;
• acute urinary retention;
• hematuria;
• kidney failure;
• osteodystrophy (pain in the lumbar and spine in the lower part).

The consequences of refusing treatment can be life-threatening and lead to the death of the patient. If the lower abdomen hurts, there are discomfort during urination and other symptoms of pathology, you should immediately contact a urologist.

How to prevent illness

Prostate adenoma is a benign tumor of the stroma or glandular tissue. Chronic urinary retention leads to intoxication and the development of CRF. To avoid the development of pathology, it is recommended to carry out preventive measures.

These include:

1. Complete cessation of smoking and alcohol.
2. Balanced diet.
3. HLS. Regular exercise.
4. With prostate adenoma, you can have sex. Regular sex life stimulates the work of the gland.

Regular examinations by a urologist, especially after 30 years, will help to identify violations in time and start treatment in a timely manner.

Prostate adenoma is insidious in that the tumor can grow for a long time, sometimes 10 years, imperceptibly for a person to grow, slowly worsening the quality of life, in particular, making it difficult to urinate. Shame, laziness, lack of knowledge or simply a frivolous attitude to the gradual deterioration in the process of urination lead to the fact that a man postpones the diagnosis and treatment of prostate adenoma for a long time. As a result, the likelihood be on the operating table, or become disabled, and in the absence of the possibility of obtaining emergency medical care, even die as a result of acute urinary retention.

biophysicist, full member of the Academy of Medical and Technical Sciences Fedorov V.A.

prostate adenoma is benign a tumor of the prostate gland or scientifically - benign prostatic hyperplasia (abbreviated as BPH). The disease begins to be detected in 20% of men under 40, at the age of 50-60 years - in 40%, at the age of 61-70 - in 70% of men, and after 70 years - in 80% (Berry, 1994).

It is necessary to immediately clarify that a benign tumor of the prostate gland cannot degenerate into a malignant one, that is, into cancer, as they grow from different parts of the prostate gland. Adenoma is the growth of small periurethral (submucosal) glands of the central zone surrounding the urethra, and prostate cancer develops from large glands located on the periphery, away from the center.

Symptoms of urinary incontinence

Although the disease is called "benign", it manifests itself as a significant deterioration in the quality of life:

• there is a need to urinate at night, and more than once, which leads to sleep disturbance and general overwork;
• increased daytime urination (normal frequency no more than every 2 hours during the day);
• there is no feeling of complete emptying of the bladder;
• difficulty urinating: you need to make extra efforts, urinate in several doses;
• sharp and uncontrollable urge to urinate.

Difficulties in urination are caused by the fact that the tumor, and to a greater extent severe swelling developing in the prostate (especially with 1 and 2 degrees of BPH), compress the urethra. At the same time, efforts to “push out” urine are not enough to completely empty the bladder. Due to residual urine in the bladder, there are repeated frequent urges to empty. This explains the increased frequency of urination, both day and night. Pain when urinating not typical.

The brightness of the manifestation of the above symptoms does not depend on the size of the tumor itself (it can be large, and the quality of life does not decrease significantly). This is often related to the direction of tumor growth. In this regard, it is very important for men after 40 to regularly visit a urologist, especially with changes in the process of urination, and take preventive measures (for example,). In the early stages of BPH, there is still a high probability of a positive result from conservative treatment. without surgery.

There are 3 stages of BPH:

An international classification is also used with an assessment according to the IPSS* scale:

1. Minor stage - 0-7 points.

2. Moderate stage - 8-19 points.

3. Expressed stage - 20-35 points.

*IPSS (International Prostate Symptom Score) - an international system for the total assessment of prostate diseases ().

You can send the completed application form to the address to receive advice on the possibility of using a non-surgical method for the treatment of prostate adenoma and the selection of an apparatus in your case.

An important condition for the effective treatment of prostate adenoma

Under effective and gentle treatment prostate adenoma refers to the removal of edema in the tumor area, slowing down and stopping the growth of the tumor, as a result of which urination is restored and the quality of life improves.

Reducing the frequency of urination and strengthening the jet is achieved primarily due to edema removal in this region. If the problem of urination was caused only by a tumor, then no drug therapy and physiotherapy () would ever improve urination without surgery. However treatment without surgery is possible!

Edema is usually the body's reaction to an excess of dead cells in that area. Obviously, dead cells begin to accumulate for 2 main reasons:

1. The nutrition and protection of each cell deteriorates, they begin to die faster. With age, there are often problems with the blood supply to the pelvic organs, there is a hormonal imbalance (less and less hormones are produced that are necessary to maintain health and youth).
2. The body does not have time to remove dead cells in a timely manner. Dead cells are excreted through the lymphatic vessels, however existing resources of the lymphatic system are no longer enough in order to utilize the increased number of dead cells and completely cleanse the tissues.

In addition, the remains of dead cells (especially their protein components) are the "building material" for tumor growth. One of the reasons for the development of edema is the body's attempt to prevent the growth of tumor tissue, but thereby the edema also leads to clamping of the urethra ("". Vasiliev A.E., Kovelenov A.Yu., Ryabchuk F.N., Fedorov V.A. , 2004).

Conclusion: an important condition for the successful treatment of adenoma - increased lymph flow(lymphatic drainage), which would cleanse the tissues of excess dead cells. This solves two problems at the same time: removal of edema in the prostate gland, slowing down and cessation of tumor growth.

Treatment of prostate adenoma without surgery

Currently, conservative (non-surgical) treatment of prostate adenoma is provided by medicine in 2 ways, as well as their combination.

1. Drug therapy

Medical treatment consists of taking:

The failure rate of drug therapy reaches 30%, and the effectiveness, respectively, is 70%.

The mechanism of action of drugs from each group is different: alpha-1-blockers help facilitate the process of urination, and 5-alpha reductase inhibitors help to inhibit the tumor growth process. The course of treatment lasts at least 6 months, usually a year or more, to get a pronounced effect. After some time, the symptoms of the disease may reappear, and then there is the need for a second course of treatment: this situation may persist until the end of the patient's life.

Possible individual intolerance to the components that make up the drugs. When accepting these funds, it is possible side effects, which is also associated both with the specifics of the mechanism of action of drugs, and with the characteristics of a particular organism. Medications, by their very nature, forcibly change the body's priorities, leading to additional stress on the liver, kidneys, circulatory system, digestive system, and so on.

As indicated in the Russian clinical guidelines for moderate and severe symptoms of BPH (impaired urination), drugs are prescribed simultaneously from both groups. In this case, the minimum treatment budget for a year can be about 15,600 rubles.

2. Vibroacoustic therapy (phonation)

This physiotherapy treatment has no side effects can allow avoid surgery and improve the patient's condition without drugs.

Phonation can also be used in combination with drug therapy. Sound microvibration improves the transport and metabolic processes in tissues, and thereby facilitates the delivery of the drug to the right place, that is, increases the effectiveness of drug therapy.

However, in accordance with long-term observations, the use of only The Vitafon device is usually enough to significantly improve the quality of life and relieve swelling.

When conservative treatment (or drug therapy) does not help, surgery remains if the general health of the patient allows surgery. Sometimes in elderly people, surgical treatment is not possible due to the presence of severe comorbidities, repeated myocardial infarctions, heart failure, strokes, etc. In this case, as indicated in, it is indicated. This type of physiotherapy, in any case, will create conditions so that the process of urination does not worsen further.

The operation is indicated in the following cases:

• Prostate adenoma in stage 3, when the patient is unable to urinate on his own due to atony (weakened and stretched bladder muscles).
• Patients with a pronounced decrease in the quality of life (regardless of the size of the tumor), assessed on the IPSS scale - 20–35 points.
• Patients in whom the first manifestation of the disease was acute urinary retention in 60% of cases are forced to operate within a year after the detection of BPH.

At the moment, preference is given to this type of operation as transurethral resection(TUR) when a special device is inserted through the urethra resectoscope and the tumor is removed without incision of the bladder. Another type of surgery without an incision in the bladder is laser vaporization when a special device is inserted into the urethra and the laser “evaporates” the tumor in layers. Both with TUR and with laser vaporization, there is a risk that some part of the tumor will not be removed: in this case, a recurrence is possible and then a second operation may be prescribed.

For large tumors, adenectomy(cavitary operation), when an incision is made on the anterior abdominal wall (or access is through the perineum), the bladder is opened and the tumor is removed.

Despite the fact that during the operation the tumor itself is removed, the quality of life of the patient may remain unsatisfactory. Often retained frequent urination, incontinence, presence of residual urine(according to statistics in 10% of patients), and complications and consequences may also occur:

• bleeding;
• joining the infection;
• impossibility of independent urination and lifelong use of a catheter;
• retrograde ejaculation (sperm is thrown into the bladder during intercourse)
• impotence;
• sclerosis of the neck of the bladder;
• narrowing of the lumen of the urethra (stricture).

In order to speed up the healing process and reduce the risk of postoperative complications, it is recommended to perform phonation both at the stage of preparation for the operation and at the stage of rehabilitation. As shown, the use of phonation with the Vitafon device after TUR allows reduce the frequency of urination, completely get rid of residual urine, reduce the size of the prostate gland by removing postoperative edema. Phonation was originally used in traumatology and the treatment of postoperative sutures and showed its high efficiency in accelerating healing.

Phoning in this case is carried out according to. The catheter is not an obstacle for phonation.

Thus, the operation must be carried out strictly according to the doctor's indications. If there are no clear indications for surgery, microvibration makes sense, similar to biological microvibrations. For more than 25 years of use, more than 2 million people have not had a single case of a negative side effect.

On the contrary, the expansion of the list of diseases that can be successfully treated with the help of Vitafon devices occurred precisely due to the identification of side effects. positive effects:

The effectiveness of the treatment of these diseases is confirmed, which For more than 25 years, there are already over 100.

In addition to research, there is also medical practice, which also confirms the high efficiency of the new method of physiotherapy, as evidenced by

Reading time: 54 min

Prostate adenoma is a common pathology in men over the age of 40 years. The disease is characterized by a benign course and, if treated on time, does not lead to complications.

What does the term prostate adenoma mean?

This disease is characterized by the growth of prostate tissue, leading to the gradual formation of one or more nodules. The resulting nodules increase the size of the organ and can squeeze the nearby urethra, which leads to impaired urination.

Alternative name, emergence dynamics

In modern medicine, prostate adenoma is often referred to as BPH - benign prostatic hyperplasia.

According to statistics, in men aged 40 to 50 years, BPH is found in 12% of cases. In 80-year-old patients, the disease occurs in 82%, after this age, adenoma is diagnosed in 96% of men.

WHO cites data according to which the frequency of development of pathology is determined by belonging to a particular race and the nutritional habits of the population of different states.

More often, prostate adenoma is detected in men of the Negroid race. In Japan and China, representatives of a strong half of the population suffer from the disease less often, and they attribute this to the fact that their main food is rich in phytosterols.

Epidemiology

BPH is a pathology characterized by a high prevalence, the likelihood of which increases significantly with age. The average indicators of its development depending on age are shown below:

• Over the age of 40 and under 50, 50% of men suffer from the disease;
• After 50 and up to 60 years, the probability of BPH increases to 60%;
• After 70 and up to 80 years, approximately 70% of men are exposed to an unfavorable diagnosis;
• At the age of 70 years, pathology occurs in 80-85% of cases.

Problems with urination worry about 40% of sick men, but only a fifth of this group seek medical help from a urologist in time.

Pathogenesis

Benign growth of the prostate often begins with its central part, gradually the lateral lobes of the organ are included in the process. The growth process begins with a small node, with the increase of which problems with urination begin.

The growth of an adenoma is not accompanied by metastases to other organs, although the neglected process of growth does not exclude its degeneration into a malignant tumor.

Tissue growth occurs due to adenomatous enlargement of the paraurethral glands located in the submucosal layer of the urethra. Growth leads to a displacement of the structures of the prostate to its outer part - a process of formation of a kind of capsule occurs on the growing adenoma.

Hyperplastic tissue simultaneously grows towards the rectum and towards the bladder. This leads to a pathological displacement of the internal opening of the bladder upwards and to an elongation of the urethra in its rear part.

Prostate adenoma is classified according to the type of growth:

There are cases of BPH, in which the tumor has several foci. The initial stage of the development of the disease is shown in the photo.

Normal physiology of the prostate

The prostate is located in the pelvic area, under the bladder and above the pelvic floor in front of the rectum.

The gland surrounds the urethra and vas deferens on all sides, its shape resembles a chestnut. The tissues of the organ are represented by glandular epithelium, which is several times less in comparison with fibrous connective and muscle tissues.

In benign hyperplasia, it is not the secreting epithelium that increases, but the fibromuscular tissue.

The glandular epithelium contains three types of cells:

1. Secretory, secretion-producing glands and make up the majority of epithelial tissue. Represented by prismatic epithelium.
2. Basal, forming the basis of secretory and capable of further differentiation into secretory cells.
3. Neuroendocrine, capable of accumulating a small amount of hormones produced in other glands (somatotropic hormone, serotonin, thyroid hormones).

Fibromuscular tissue includes cells (smooth muscle, endothelial, fibroblastic) and non-cellular elements (protein molecules of the intercellular environment - elastin and collagen, basement membrane, etc.).

The organ is placed in a capsule of fibrous tissue, from which connective tissue strands go deep into it, dividing the glandular epithelium into separate compartments, connecting into lobules.

The functionality of the gland is determined by the secretion of fluid entering the urethra in its anterior part, called the prostatic. In this place, the prostate fluid is subject to mixing with the secrets of the testicles, seminal vesicles and the formation of ejaculate. All structures form viscosity, acid-base balance and ejaculate volume.

In the diagnosis of hyperplasia, an important role is played by the secret of the prostate glycoprotein nature - a prostate-specific antigen that contributes to the liquefaction of sperm after ejaculation before fertilization.

To maintain a certain acid-base balance, the secretory cells of the prostate produce a number of chemicals: citric acid, fibrinolysin, phosphates and dihydrophosphates. The innervation of the organ is carried out autonomously and by the somatic nervous system.

The latter, in turn, controls the process of urination, provides muscle contractions of the pelvic diaphragm. The sympathetic division of the autonomic nervous system has branches in the muscles of the prostate, body of the bladder, bladder neck, and urethral sphincters.

The parasympathetic division of the ANS excites the cholinergic receptors of the body of the bladder under the influence of the parasympathetic branch of acetylcholine released in the synaptic cleft.

Causes of BPH

The exact mechanism for the development of prostate adenoma has not yet been fully established. Most researchers believe that the main cause of the pathology lies in the violation of the neuroendocrine regulation of organ functions.

The historical approach to explaining prostatic hyperplasia was based on two points of view that are in constant conflict.

One half of the medical luminaries argued that the only cause of adenoma lies in the age of a man: the older, the more likely it is to display a common pathology of the genitourinary system.

Proponents of a different point of view were of the opinion about the negative impact of abiotic environmental factors.

In support of the opinion about age-related changes in the prostate is a change in the hormonal balance between androgens and estrogens in old age towards female sex hormones.

Testosterone deficiency cannot be ignored by the functionality of the cellular structures of the testicles, seminal vesicles and prostate. As a result, a decrease in the secretion of the contents of the ejaculate by the gonads.

Violation of the functionality of the prostate gives rise to subsequent anatomical pathologies, including adenoma.

A direct relationship between environmental factors and the occurrence of BPH has not been identified. It is not worth rejecting the negative impact of alcohol abuse, smoking, drug use, sexually transmitted diseases and the consequences of infectious attacks, non-traditional sexual orientation on the state of the genitourinary system in general and on the prostate gland in particular.

To draw a conclusion regarding the true cause of the pathology on the basis of the described phenomena allows you to tip the scales in the direction of age-related changes, without neglecting external provoking factors.

The disease can develop for a long time without revealing itself symptomatically. Separate dim signs are not taken into account while there is a sluggish acute process. Obvious signs begin to disturb when the pathology becomes chronic.

An annual routine examination of the prostate allows you to detect its enlargement at an early stage, during the period of a small symptomatic manifestation.

Another factor conducive to early prostate enlargement is heredity. If a man had cases of this disease on the paternal side, an examination by a urologist should begin at the age of 30 with a mandatory annual diagnosis.

Timely noticed deviations can completely prevent the development of hyperplasia or delay the onset of the pathology as much as possible.

This leads to a decrease in the formation of male hormones, in particular testosterone, and to an increase in the production of female ones.

Changes in the hormonal background contribute to the rapid development and reproduction of gland cells.

Does not affect the likelihood of developing adenomas and the sexual orientation of men.

Despite the absence of reliable reasons for the development of adenoma, there are several provoking factors, under the influence of which the risk of the formation of a benign tumor increases, these are:

• Reduced physical activity;
• Obesity - adipose tissue is able to produce female hormones;
• Hypertonic disease;
• genetic predisposition;
• Eating predominantly fried, too fatty foods and dishes with spicy spices.

The exclusion of the influence of provoking factors on the body reduces the likelihood of prostate adenoma.

Other factors provoking the disease:

• irrational nutrition with a predominance of fast foods in the daily diet;
• hypertonic disease;
• hyperglycemia;
• obesity of all degrees;
• exceeding the maximum permissible concentrations of harmful chemical compounds in the environment;
• decrease in testosterone levels;
• an increase in receptors that perceive testosterone due to its deficiency.

The testicles produce 2 androgens: testosterone and dihydrotestosterone.

The sensitivity of prostate follicles to androgens is not the same: dihydrotestosterone deficiency is perceived by cells more acutely.

Normally, testosterone is converted into the homologous hormone dihydrotestosterone under the influence of an enzyme from the group of oxidoreductases - 5-alpha reductase.

Men turned into eunuchs in childhood or suffering from a congenital deficiency of 5-alpha reductase do not find benign changes in the prostate gland.

Men undergoing prostate surgery notice that their pedigree has already included cases of prostate surgery or deaths due to untreated prostate problems.

Especially often, hereditary predisposition is realized in the pre-retirement age of a man. Prostate adenoma is rarely detected in residents of eastern countries. For example, in Japan, this disease almost does not exist.

The probable reasons for the low incidence are the lack of information in the genes about premature disruption of the prostate gland and a deterrent in the form of eating seafood and food enriched with phytoestrogens.

Pathogenesis

Benign prostate enlargement (BPH) begins with the central lobe, after which the pathological process covers the lateral lobes.

Further growth is due to hyperplasia of the paraurethral glands, which increase in size towards the outer part of the prostate.

As a result, nearby organs are displaced: the internal sphincter of the bladder is displaced upward, the terminal part of the urethra is lengthened.

The gland also increases towards the ampulla of the rectum.

According to the type of prostate hyperplasia, 3 types are distinguished, the basis of which is the direction of growth in relation to the bladder:

1. Subvesical form, in which the adenoma is displaced towards the rectum.
2. intravesical form. Growth is observed towards the bladder.
3. The retrotrigonal form is symptomatically the most dangerous, since urinary retention occurs for two reasons at once. The first block occurs on the way to the bladder sphincter. The second obstruction is found in the mouths of the ureters. Over time, the connection between the two types of blockage creates a triangle between the orifices of the ureters and the internal circular muscle of the bladder. The triangle was named Lieto.

A single type of prostate hyperplasia in the practice of monitoring adenomas is not uncommon, but a mixed type of disease is more often found.

When is a visit to the doctor indicated?

The reasons for the immediate appeal to the urologist are:

• urinary retention;
• a sluggish stream or problems with urination;
• cloudy urine or detectable blood;
• symptoms of kidney failure or benign prostatic hyperplasia.

The sudden delay in the excretion of the stream of urine causes severe pain. If this happens, you should postpone all business and hurry to.

Gradually accumulating, not excreted urine from the bladder overflows it, subsequently standing out in a weak stream or frequent drops.

If a visit to the doctor is postponed, the urine becomes more concentrated, prone to the formation of urinary stones, the reproduction of infectious pathogens.

The appearance of blood in urine does not mean the development of prostatic hyperplasia, it can be assumed that urolithiasis, bladder cancer, and renal disorders.

To prevent a malignant neoplasm in the prostate, all men need to be examined annually by a urologist, and representatives of the Negroid race and people who have problems with the prostate gland in their family should have a urological examination after the age of 40.

Oncology of the prostate gland passes to the last stage without obvious signs.

Second stage

Got a name subcompensatory, since the bladder is not completely emptied. The patient feels the remains of urine, but cannot remove them. The urge to urinate becomes very frequent, although urine is excreted in small portions.

Urine ceases to be transparent, except for turbidity, blood may appear in it. Congestion in the bladder causes kidney dysfunction. Sometimes the patient is not able to urinate on his own, for which they resort to urethral catheters. The thickness of the walls of the bladder becomes thicker, sometimes the overflowing bladder releases urine voluntarily.

Third stage

In the last stage of decompensation, the thickening of the walls of the bladder reaches its maximum. There is always so much residual urine in the bladder that it leads to a strong stretching of the organ. Urine is turbid, with blood. Independent jet urination is difficult, urine drips randomly through the urethra.

Symptoms of urination disorders are accompanied by severe kidney disorders, leading to kidney failure. Patients lose weight, have an unhealthy skin color, experience frequent malaise, and suffer from constipation.

From the mouth of patients with prostate hyperplasia of 2 and 3 degrees, an unpleasant smell of urine spreads, the mucous membranes of the oral cavity are dry. The skin of patients has unhealthy shades, devoid of blush. A blood test reveals anemia.

At the last stage, in addition to the specific symptoms of prostate adenoma, it is manifested by general weakness, lack of appetite, visible weight loss, the smell of acetone when exhaling air, constipation, and manifestations of anemia.

Fourth stage

Is the continuation of the third only in terms of the complexity of treatment is an order of magnitude higher. In advanced cases of adenoma, patients die from chronic renal failure.

Symptoms of the disease

Manifestations of prostate adenoma are usually divided into obstructive and irritative symptoms.

Irritative ones indicate irritation of the walls of the bladder, which occurs as a result of a long stay in the organ of urine that has not been excreted to the end.

This group of signs of the disease include:

• Poolakiuria during the daytime. The rate of urination per day for an adult is up to 6-8 times a day. With adenoma, the multiplicity increases up to 20 times;
• Nocturia - frequent urination at night. Normally, a person should sleep peacefully at night, without interrupting his rest to go to the toilet. Men with an enlarged prostate indicate that they urinate at night up to 3-4 times;
• False urge to urinate. The centers of the brain receive signals about the filling of the bladder, but as a result, urine does not pass.

Obstructive manifestations of the pathology are associated with impaired urination resulting from compression of the ureters by the tumor, these are:

• Feeling of an incompletely emptied bladder;
• Sluggish urination;
• intermittent urination;
• The need for straining to carry out the act of urination;

An obstructive symptom includes urinary retention, that is, a sick man has to wait for urine to appear from the urethra for some time while visiting the toilet. With BPH, after urination, droplets of urine may be released for several minutes.

Significantly reduce the quality of habitual life irritative manifestations of pathology, but they are less dangerous for the patient and their severity quickly decreases under the influence of treatment.

As a rule, irritative and obstructive symptoms of varying severity are detected in one patient.

Other symptoms of BPH:

• weakening of the jet during urination up to drip excretion;
• the beginning of urination is accompanied by problems of a physiological, and then a psychological nature;
• small breaks between the urge to urinate;
• lack of a continuous stream during urination;
• during urination, you have to strongly strain the abdominal and pelvic muscles in an involuntary manner;
• inability to completely empty the bladder;
• upon arrival from the toilet, there is a repeated desire to urinate;
• chronic stagnation of urine leads to the growth of colonies of infectious agents, affecting many organs of the urinary system;
• stagnation of urine leads to urolithiasis in the kidneys and urinary tract;
• pathologies of a chronic nature in the kidneys;
• squeezing of the urethra by the enlarged prostate, as a result, urine is excreted either in a thin, sluggish stream, or the removal occurs in separate portions.

Just as one should not disregard the symptoms with their individual, rather than complex manifestation, it would be unreasonable to establish a diagnosis on their own without a comprehensive examination.

The main differences between adenoma and prostatitis

Some people without medical education believe that prostate adenoma and are synonymous with one pathology.

In fact, these are two different ailments. Prostatitis is an inflammatory disease, and adenoma is a benign tumor.

Other differences in diseases include features of the symptoms of pathologies, age of onset, changes in the prostate gland. Methods for eliminating adenoma and prostatitis also differ.

Urologists refer to the characteristic symptoms indicating prostate adenoma:

• Intermittency of the urine stream during its outflow;
• Urine leakage after urination.

Benign prostate enlargement, impaired quality of life, sexual dysfunction are the main causes of depressed mood, irritability and self-doubt. As a result, depression and nervous exhaustion occur.

Prolonged course of prostate adenoma is a good reason to make an appointment with a psychotherapist and a sex therapist.

Diagnostics

The examination of the patient begins with a thorough history taking. In 1997, international committees on the problem of prostate adenoma adopted a single standard for taking anamnesis.

The symptoms of pathology in each patient are determined using a special test questionnaire (IPSS) and a scale that assesses the quality of life (QQL).

The results are evaluated in points:

1. 0-7 points - minor manifestations of the disease;
2. From 8 to 19 - moderate manifestations;
3. From 20 to 35 points - a severe disease.

The patient is invited to keep a diary, which indicates the number of urination per day and night, the amount of urine excreted.

Instrumental research methods are also required:

• Rectal digital examination of the prostate. Examination is necessary to determine the size of the prostate, its structure, the degree of pain;
• . Scanning the organ is required to identify the degree of its growth, to establish the localization and size of adenomatous nodes. At the same time, an ultrasound of the kidneys is performed, which makes it possible to establish the development of pathological processes in them.
  
• TRUS. Research stands for . Conducting TRUS helps to differentiate an adenoma from an inflammatory reaction and a malignant formation. Establishes even before the appearance of the first pronounced symptoms.
  
• UROFLOWMETRY. It is carried out in order to measure the characteristics of the stream of excreted urine. For the study, the bladder must be completely filled, when urine is released, the time of urination and its maximum speed are recorded. Normally, an adult person should excrete 100 ml of urine in 10 seconds, if the volume is less, then more time is required. The flow rate also depends on the age of the patient, every 10 years it decreases by 2 ml / s.
  
• Determining the presence of residual urine in the bladder. It is customary to combine the study with uroflowmetry, after urination, an ultrasound is immediately done. This examination allows you to establish the stage of pathology.
• CYSTOMANOMETRY. It is used to determine the pressure in the cavity of the bladder at different degrees of fullness of the organ. The accumulation of urine in a volume of 100-150 ml brings the intravesical pressure to 7-10 mm Hg. Art., with a volume of 250-300 ml, the pressure can reach up to 25-30 mm Hg. Art. The deviation of intravesical pressure in the direction of its increase indicates an increase in the contractility of the detrusor - the muscle that expels urine. A decrease in pressure indicates detrusor hyporeflexia.
• CYSTOGRAPHY. The study is carried out using a contrast agent. determines pathological changes in the neck of the bladder, preventing its normal filling. Ascending cystography is prescribed to determine the condition of the prostate gland.
• CT. Tomography examines the organ in layers, determining the location of the adenomatous tumor, its size, stage. CT also shows the complications that develop with prostatitis.
  
• MRI. The research technique is based on obtaining three-dimensional layered images of the prostate using a nuclear magnetic resonator. There are three options, it all depends on the hardware that is being used. In the first option, a rectal coil is inserted into the rectum, which creates an additional magnetic field. In the second, the contrast is injected drip, it is quickly distributed throughout the body and concentrated in the prostate gland.
  In the second and third versions (without contrast), during the examination, the patient is placed in a cylindrical tube equipped with magnets around the circumference. After preparation, a series of images is taken, on the basis of which the doctor can determine the inflammation in the prostate, the size of the tumors, their goodness or cancerous degeneration. MRI is a safe study that allows you to get the most reliable data in a few minutes.
  

An accurate diagnosis is made to the patient after evaluating all the examinations performed.

In order to select an effective therapy, the doctor needs to establish whether there is an inflammatory process in the gland and the stage of development of the adenoma.

Anamnesis

Careful study of the anamnesis of the disease allows to differentiate between obstructive and irritating symptoms.

From this point of view, a urination diary, if available, is better at diagnosing a disease than questioning the patient.

When mentioning individual symptoms, prostatic hyperplasia may be similar to:

• bladder carcinoma;
• infectious diseases of the bladder and urethra;
• urethral stricture resulting from trauma, prolonged use of a catheter, sexually transmitted diseases (gonorrhea);
• hyperglycemia, which has the consequences of frequent urge to urinate and insufficient emptying of the bladder;
• infectious pathologies of the prostate gland;
• bladder dysfunction associated with insufficiency or lack of nerve impulses (spinal injuries, strokes, multiple sclerosis, Parkinson's disease, etc.).

Physical examination

Physical examination of the patient begins with an examination of the skin, general health, external palpation of the bladder for the degree of its fullness.

After this, the doctor conducts a rectal examination of the prostate gland, for which the surface of the prostate is examined with the index finger of the hand on which a medical glove is worn.

The gland is located above the rectum. If the surface of the gland enlargement is uniform and smooth, it is concluded that the hyperplasia is benign.

Prostate cancer changes the surface of the prostate from smooth to bumpy, in which nodules are palpable. It is wrong to judge the degree and nature of hyperplasia in accordance with the size. Not all men have the same size prostate.

Men with a large gland on palpation detect an increase, but this is not detected symptomatically or histologically.

The small prostate of men with hyperplasia does not reveal abnormalities on palpation, although the symptoms of benign hyperplasia of the gland are present or obstructive phenomena are found in it.

A detectable enlargement of the prostate is not a reason for the use of conservative treatment, but the history of the disease, symptoms and diagnostic ultrasound examination, together with the size of the prostate, provide a basis for the development of a treatment regimen.

Before starting treatment, the neurological nature of the occurrence of prostatic hyperplasia should be excluded.

Normal PSA levels

PSA (PSA) is the term for prostate-specific antigen. This is an enzyme produced by the cells of the prostate gland, its main purpose is to thin the seminal fluid.

Some PSA enters the bloodstream. With BPH, the concentration of the enzyme in the blood steadily increases, with malignant degeneration of the tumor, PSA increases several times. To determine the amount of enzyme in the blood is carried out.

The norm of prostate-specific antigen by age:

• Before the age of 50, PSA in men should be less than 2.5 ng / ml;
• After 50 and up to 60 years - the norm is less than 3.5 ng / ml;
• At 60-70 years old - normal values ​​​​up to 4.5 ng / ml;
• In patients over 70 years of age - PSA should be less than 6.5 ng / ml.

If the amount of the enzyme reaches more than 10 ng / ml, then this indicates a possible malignant formation in the prostate.

The level of PSA also increases depending on the weight of the tumor - each increase in 1 gram of a benign formation increases the enzyme by 0.3 ng / ml.

In a malignant process, each gram of the tumor leads to an increase in PSA by 3.5 ng / ml.

In the normal course of BPH, the PSA level increases by no more than 0.75 ng / ml per year. If this figure is significantly higher, then malignant growth of neoplasms should be excluded.

Prostate-specific antigen is divided into two subspecies:

• Free PSA, it circulates unchanged in the blood;
• Bound PSA - found in combination with other proteins.

Adenoma malignancy is suspected if the free enzyme is less than 15% of the total PSA, or vice versa is too high.

Xatral is used as a drug to reduce the symptoms of BPH. The drug can be prescribed to elderly patients who have a steady growth of adenoma.

For patients taking antihypertensive drugs and the elderly, it is better to start treatment with 5 mg Uroxatral per day. The dose is increased to the usual gradually over several days.

Xatral is contraindicated for use:

• With liver failure;
• With orthostatic hypotension;
• With individual intolerance to alfuzosin.

Uroxatral reduces tension in the walls of the urethra, facilitates the excretion of urine, increases the amount of urine and prevents the appearance of sedimentary urine.

Kardura

The drug is available in tablet form, tablets can be in a dosage of 1, 2 or 4 mg. The medicine is made in Germany.

The main active ingredient is doxazosin, which is an adrenergic blocker.

In the treatment of BPH, it improves urodynamics and significantly reduces the manifestations of the disease. Under the influence of the drug, the flow of urine normalizes, nighttime urges disappear, the amount of residual urine decreases.

Cardura does not violate metabolic reactions, so the drug is not prohibited for patients with asthma, diabetes, cardiovascular diseases.

In the treatment of prostate adenoma, the initial dosage should be 1 mg per day, this minimizes the risk of developing postural hypotension.

Gradually, in one to two weeks, the dose is first increased to 2 mg per day, then up to 4. But the daily amount of the drug should not be more than 8 mg.

The drug is taken for a long time, in a maintenance dosage, the drug can be taken up to 48 months. Elderly patients do not require dose adjustment.

Cardura is not prescribed to patients:

• With hypotension;
• With anuria;
• With hypersensitivity to the components of the drug;
• With infectious processes in the urinary tract;
• With identified stones in the bladder;
• Under 18 years old.

Rapaflo

The active ingredient in Rapaflo is the adrenergic blocker silodosin. A medication is prescribed to reduce discomfort and improve urodynamic parameters in BPH. Available in capsules of 8 mg.

In the treatment of prostate adenoma, the daily dosage is 8 mg, taken at a time, preferably at regular intervals.

The capsule is swallowed whole with plenty of water. Rapaflo should be taken with meals.

Silodosin is contraindicated for use if the patient has a severe form of hepatic or renal insufficiency, hypersensitivity to the components of the drug.

Hytrin

The main active ingredient in Hytrin is terazosin. Dosage form - tablets with different dosages.

The appointment of Haytrin for prostate adenoma allows you to normalize urination, the drug does not cause tachycardia.

Hytrin is contraindicated in patients:

• With hypertension;
• With hypersensitivity to the components of the drug;
• With type 1 diabetes;
• With ischemic heart disease and angina pectoris;
• with liver failure.

Of the adverse reactions, orthostatic hypotension, which usually occurs in the first days of therapy, is most likely.

Medications with Alfuzosin

Alfuzosin is an adrenergic blocker with a selective action.

Alfuzosin acts mainly on the area of ​​the urethra, triangle of the bladder and prostate.

Under the influence of drugs with alfuzosin, the pressure in the urethra normalizes, thereby facilitating the release of urine, and reducing dysuric manifestations.

Alfuzosin contains the drug Dalfaz as the main active ingredient.

The medicine is produced by the French company SANOFI WINTHROP INDUSTRIE. Form of production - tablets.

For the treatment of prostate adenoma, Dalfaz Retard is used - tablets with a dosage of 5 mg.

The standard regimen is 5 mg in the morning and evening. In the elderly, as well as in patients taking antihypertensive drugs and with a history of renal failure, treatment should begin with taking 5 mg of the drug in the evening.

Gradually, the dosage is brought to the standard. Tablets are drunk whole, without chewing.

Dalfaz is contraindicated in persons with orthostatic hypotension, with hypersensitivity to the components of the drug, with severe liver pathologies.

Dalfaz's analogs:

• Dalfuzin;
• Alfuzosin;
• Alfuprost;
• Alfuzosin.

Medicines based on Tamsulosin

Tamsulosin (Tamsulosin) refers to alpha1A / D-adrenergic blockers.

The drug selectively blocks adrenergic receptors localized in the prostatic part of the urethra, in the smooth muscles of the body and bladder neck, and in the prostate gland.

Taking Tamsulosin has practically no effect on adrenoceptors located in the smooth muscles of the vessels, and therefore there is no significant decrease in blood pressure.

Taking drugs containing Tamsulosin allows you to achieve:

• Improved emptying of the bladder;
• A pronounced decrease in discomfort during urination;
• Reducing the manifestations of obstruction that occurs under the influence of a growing tumor.

A noticeable therapeutic effect when taking the drug begins to appear after 2-3 weeks from the start of therapy. Tamsulosin can be used for a long time. One of the representatives of drugs containing Tamsulosin, Omnik Okas.

The drug is produced in the Netherlands in the form of tablets, one tablet contains 400 micrograms of tamsulosin, which, after ingestion, is slowly released throughout the day.

Omnic Okas is prescribed to patients with prostate adenoma to eliminate urination disorders that occur under the influence of a growing tumor.

The standard dosage is 1 tablet per day, it is drunk whole, without chewing. The drug can be taken continuously.

Absolute contraindications to the appointment of Omnic:

• orthostatic hypotension;
• Severe forms of insufficiency of the kidneys and liver;
• Individual sensitivity to tamsulosin or other components of the drug.

For patients with persistent arterial hypotension, the drug is prescribed carefully.

Medicines containing Terazosin

Terazosin (Terazosin) is an α1-blocker that selectively blocks adrenergic receptors of smooth muscles in the celiac vessels, in the vessels of the prostate gland and located in the bladder neck.

Relaxation of the muscles of the neck of the bladder and the prostate gland reduces dysuric phenomena.

At the same time, the level of total cholesterol and triglycerides is normalized, which improves the plasma lipid profile. Long-term use of Terazosin reduces the effects of left ventricular hypertrophy.

The drug Terazosin, when administered to patients with adenoma, leads to an improvement in urination approximately two weeks after the start of treatment, a persistent therapeutic effect begins to be observed after one to one and a half months.

Terazosin is available in 2 and 5 mg tablets. The initial dosage is 1 mg, depending on the manifestation of the disease, it can be increased to 10-20 mg per day. It is recommended to take the medicine once a day in the evening.

Terazosin is contraindicated in case of arterial hypotension and hypersensitivity to the components of the drug.

Analogues for the active substance:

• Setegis;
• Cornam;
• Terazosin-Teva;
• Haytrin;
• Terazosin hydrochloride dihydrate.

Terazosin is produced in Canada, Macedonia, Israel.

Hyperprost and its analogues are effective in blockade of receptors located only in the prostate gland and bladder walls (alpha1A receptors). Alpha-blockers are prescribed in cases of non-absolute indications for surgical intervention, when the patient's life is not in danger.

Medicines can be used when the volume of urine in the bladder does not exceed 0.3 liters after emptying. The stream of urine under the influence of alpha-blockers becomes more intense.

About half of patients with benign hyperplasia noted that after taking medication, the symptoms weakened or disappeared.

The use of alpha-blockers produces a gradual therapeutic effect, reaching a maximum peak after 14 days. From this point on, the situation of the absence of symptoms of the disease becomes stable.

The urologist's choice of a particular remedy is based on the individual's perception of the remedy.

In chronic hypotension of the patient, the drugs described, with the exception of Hyperprost, further reduce blood pressure.

Approximately one in twenty men who take Hyperprost or its analogues suffer from the effects of reverse ejaculation.

Doxazosin

The drug is produced by several companies in Russia and the Canadian company Nu-Pharm Inc. Release form of tablets containing doxazosin mesylate as the main substance.

Doxazosin selectively blocks adrenergic receptors, including those located in the cells of the prostate and bladder neck.

The use of the drug allows you to reduce resistance and pressure in the urethra and in the internal sphincter.

The therapeutic effect on average begins to develop two weeks after the first dose and persists for a long period.

Patients with prostate adenoma are prescribed to take the drug from one milligram per day. For 2-4 weeks, the amount is adjusted to 4, less often up to 8 mg.

After achieving improvement in urodynamic parameters, the drug is recommended to be taken for a long time at a maintenance dosage of 2 mg.

Doxazosin is contraindicated for men only if hypersensitivity to its components is detected.

Analogues of the drug: Cardura, Zoxon, Artezin, Kamiren, Urocard, Doxazosin Sandoz, Doxazosin Zentiva, Doxazosin Belupo, Tonocardin, Doxazosin-Teva, Doxazosin mesylate, Cardura Neo, Artesin retard, Doxazosin-ratiopharm.

Prazosin

Prazosin blocks postsynaptic α1-adrenergic receptors and interferes with the vasoconstrictive effect of sympathetic innervation. As a result, the volume of arteries and veins expands. The drug is produced in the UK, available in tablet form.

In the treatment of prostate adenoma, therapy begins with taking 0.5-1 mg of the drug per day, the dose is divided into 2-3 doses. Within three days, the dosage gradually increases and is selected based on the symptoms of the pathologist.

The maintenance dose of Prazosin after achieving the desired effect is from 3 to 20 mg.

Prazosin is contraindicated in patients with:

• Hypersensitivity to the components of the drug;
• Hypotension;
• Heart defects and tamponade;
• Hyponatremia.

An analogue of Prazosin is Polpressin.

Urorek (Urorec)

The medicine is made in Ireland. The main active ingredient is silodosin. Release form - gelatin capsules.

Silodosin reduces the severity of obstruction and irritation phenomena that occur in patients with benign prostatic hyperplasia.

A decrease in the tone of the smooth muscle fibers of the prostate and the tone of the prostatic part of the urethra leads to a significant improvement in the evacuation of urine.

Urorek has no effect on blood pressure. Its use is contraindicated only with increased individual sensitivity to the components of the drug and with a severe form of kidney and liver diseases, leading to insufficient functioning of organs.

The drug is prescribed 8 mg per day once, the capsule should be drunk at the same time, without chewing.

A reduced dose of 4 mg is given to patients with renal insufficiency. The dosage is increased to the standard if the drug does not cause adverse reactions.

Duodart

The two-component drug contains dutasteride and tamsulosin hydrochloride as active ingredients.

The drug is an α1-adrenergic antagonist. The manufacturer of the drug is a German company. Duodart is produced in the form of capsules.

The drug reduces the symptoms that develop with an enlarged prostate with moderate to severe manifestations.

Long-term use increases the speed of urination, reduces the size of the growing tumor of the prostate, reduces the risk of acute urinary retention.

The drug is not prescribed to patients with orthostatic hypotension, with severe hepatic insufficiency and in case of hypersensitivity to the components of Duodart.

Vezomni

Combination preparation consisting of solifenacin succinate and tamsulosin hydrochloride. Refers to alpha-blockers. The manufacturer of the drug - Astellas Pharma Europe B.V. Vesomni is available in tablet form.

The drug is used to treat prostate adenoma in order to alleviate the obstructive and irritative manifestations of the disease. The active substance, when taken orally, is released for a long time. Vesomni should be taken as a tablet once a day.

Vesomni is contraindicated if the patient has a history of:

• Liver failure in severe form;
• Gastrointestinal pathologies of severe course;
• myasthenia;
• orthostatic hypotension;
• Angle-closure glaucoma.

Cancel the drug with the development of hypersensitivity to its components.

5-alpha reductase inhibitors

Drugs related to 5-alpha reductase inhibitors reduce the effect of androgens on the prostate.

At the initial stage, this leads to a decrease in the size of the prostate, which facilitates the course of the disease.

The effectiveness of inhibitors is noted only if the gland begins to increase significantly, the withdrawal of the drug leads to the return of all uncomfortable sensations.

Inhibitor drugs reduce the risk of complications of the disease, such as the inability to urinate. Their long-term use also reduces the need for surgical intervention.

In modern urology, two inhibitors are used - dutasteride and finasteride.

Avodart

The medicine is produced in Poland. Available in the form of gelatin capsules. Avodart is prescribed both for monotherapy and for complex treatment of patients with BPH.

Its use is contraindicated only in case of allergy to the components of the capsules and in severe liver failure.

The capsule is drunk once a day, without opening or chewing. It is necessary to take Avodart for at least 6 months.

Alfinal

The medicine is produced by a Russian company - OJSC Valenta Pharmaceuticals. Dosage form - tablets.

Taking the drug for three months allows you to achieve significant relief of urination. Alfinal should be taken for at least 6 months.

The standard dosage is 1 tablet, take it regardless of the meal once a day. It is recommended to combine Alfinal with Doxazosin.

Invalid assignment:

• With hypersensitivity to the components of the drug;
• Patients with obstructive uropathy;
• With lactose intolerance, lactase deficiency and patients with glucose-galactose malabsorption.

Trade names of Alfinal:

• Finasteride;
• Prostan;
• Proscar;
• Penester;
• Finast;
• Finasteride-OBL;
• Prosterid;
• Finasteride-Teva;
• Urofin;
• Zerlon.

Other medicines used to treat patients with BPH

Trianol

The active component of the drug is a lipidosterol complex from plum bark, which has anti-inflammatory properties and contributes to the normalization of the secretory function of the prostate gland.

Trianol, when used to treat adenoma, has an antiproliferative effect, that is, it inhibits the growth of residual prostate tissue. As a result, the process of urination is facilitated - the discharge of urine is normalized, its discontinuity disappears and the sensation of incomplete emptying of the organ disappears.

Trianol is available in capsules. Patients with adenoma are recommended to take 2 capsules orally twice a day, the course of therapy is from one to two months. If necessary, the urologist may prescribe a second dose of Trianol.

The drug is well tolerated. Do not prescribe it only with individual hypersensitivity to the components of the drug.

Prostamol Uno

The drug as the main active ingredient contains an extract of the fruits of the palm tree creeping.

Prostamol Uno has anti-edematous and anti-inflammatory effects. In addition, the drug is endowed with antiandrogenic activity, that is, it reduces the production of hormones, under the influence of which the prostate increases in size.

Creeping palm fruit extract is prescribed for the treatment of prostate adenoma and chronic prostatitis.

Medicines reduces discomfort, normalizes urination, and helps to eliminate nighttime urges.

Prostamol Uno is available in capsules containing 320 mg of the main active ingredient. Take the medicine once a day, 320 mg. It is recommended to swallow the capsules after meals, without chewing and drinking plenty of liquid.

A pronounced therapeutic effect begins to appear two months after the start of therapy and reaches its peak after 3 months. Duration of reception is established by the doctor.

Analogues of Prostamol:

1. Garbeol;
2. Palprostes;
3. Permixon;
4. Prostaker;
5. Prostaland;
6. Prostaline;
7. Prostamed;
8. Prostaplant;
9. Tadenat;
10. Prostatophyte;
11. Tadimax.

Hypertrophan 40

The active substance of the drug is mepartricin. Once inside, the drug reduces the accumulation of cholesterol in the ducts of the prostate, thus eliminating one of the factors of hyperplasia of the gland.

Due to this, the symptoms of benign prostatic hyperplasia - nocturia, false urges, pollakiurria are also reduced. The drug leads to a decrease in the amount of residual urine.

Ipertrofan 40 is prescribed when it is necessary to eliminate the functional disorders of the urination process in BPH. The medicine is produced in tablets, it should be taken at 40 mg during the evening meal. The course of therapy cannot be less than 30 days.

Contraindications to taking Ipertrofan 40 - hypersensitivity to the components.

Pumpkin seed oil

Natural herbal remedy is rich in polyunsaturated fatty acids, vitamins of different groups, flavonoids, carotenoids. When taken orally, it has a complex effect on the body.

Preparations containing pumpkin seed oil as the main active ingredient have a choleretic, reparative, anti-inflammatory effect. Medicines help restore liver cells and reduce the tendency for prostate cells to grow.

When taking pumpkin seed oil in the treatment of prostate adenoma, it is possible to achieve the elimination of dysuria, pain, and activation of the immune system. Course treatment with pumpkin seed oil leads to improved sexual function.

In the treatment of prostate adenoma, pumpkin seed oil in capsules is prescribed orally and in suppositories for injection into the rectum. Usually the drug in capsules is taken 1-2 times a day.

Pumpkin seed oil is sold under the trade names:

• Peponen;
• Cholenol;
• Vitanorm Nizhpharm.

Afala

The drug is available in tablets containing antibodies to PSA - a prostate-specific antigen. The use of the drug helps to eliminate swelling and inflammation, reduces the symptoms of urination disorders.

Afalaza

The drug is produced by a Russian company. As an active substance, it contains two components:

• Affinity purified antibodies to endothelial NO synthase. Their main action is to increase the speed of blood flow in the vessels located in the prostate and penis. At the same time, antibodies reduce the reactivity of blood vessels, reduce their spasm and normalize microcirculation in peripheral vessels.
• Antibodies to PSA reduce the inflammatory response, eliminate puffiness.

The drug Afalase is prescribed to men for the treatment of prostate adenoma and prostatitis in acute and chronic form. The drug reduces dysuric disorders and helps restore sexual function. Afalase is produced in tablets.

Take the drug two tablets twice a day. It is recommended to do this on an empty stomach. The standard duration of treatment is at least 4 months.

With severe pain, the frequency of taking tablets can be increased up to 4 times a day in the first weeks of therapy.

Afalase is not used only in cases of individual hypersensitivity to the components of the drug.

Prostagut® forte

The German-made medicine contains natural substances as the main components - an extract from nettle roots and extracts or Sabal palm trees.

The drug is endowed with anti-inflammatory, decongestant, antiandrogenic, immunomodulatory and antiproliferative effects on the body.

The use of Prostagut eliminates the uncomfortable symptoms caused by the growth of prostate tissue.

Under the influence of the drug, pain during urination, nighttime urges disappear, the bladder is completely emptied. It is shown to use the medicine as a prophylactic against complications in the postoperative period.

Prostagut is available in capsules. Therapy regimen - 1 capsule twice a day for at least one month.

Most patients do not notice the negative effects of Prostagut on the body. In rare cases, allergic reactions are recorded.

Prostopin

The drug is available in the form of rectal suppositories. Its main composition is beekeeping products, it is royal jelly, propolis, honey and pollen. There are others.

The complex composition of the drug has a general strengthening effect, normalizes metabolic reactions, increases the functioning of the immune system, and improves regeneration processes.

The effectiveness of use in the treatment of patients with BPH is explained by the normalization of blood circulation in the prostate, the restoration of hormonal levels, and the improvement of spermatogenesis.

Prostapine is prescribed one rectal suppository, the time of administration is the evening hours. The course should last from 15 to 30 days. Usually, with prostate adenoma, Prostapin is included in complex therapy.

Do not use the drug for allergies to bee products.

Cernilton

The herbal preparation Cernilton is produced in the USA. The main components are extracts of wheat, rye, meadow timothy. It has a decongestant effect on the human body, accelerates metabolism and helps to relieve inflammation.

The use of the drug for the treatment of patients with BPH can reduce pain.

The muscle relaxant properties of the drug lead to relaxation of the posterior muscles of the urethra, which facilitates the exit of urine and reduces the accumulation of residual urine in the bladder.

For patients with benign prostatic hyperplasia, Cernilton is recommended to take 2 tablets three times a day for at least 6 weeks. Sometimes doctors advise using the medicine for at least 6 months. Cernilton is contraindicated only in a single case - with an allergy to its components.

The drug Cernilton Forte is available in capsules, there are twice as many active ingredients in them. Therefore, with BPH, capsules are taken one three times a day.

Longidaza

Pravenor Forte

Biologically active vitamin supplement. is prescribed in the treatment of chronic prostatitis, prostate adenoma, increases potency and improves libido in men.

Treatment with herbal remedies

With prostate adenoma, phytopreparations can also be used in conjunction with medical drugs.

Their use helps to restore the functions of the prostate, improves blood circulation and nutrition of the organ, normalizes metabolic processes and enhances the effect of the main therapy.

The most popular herbal remedies for BPH include:

Treatment with any herbal remedies should be agreed with the doctor. It should be borne in mind that plant complexes for certain diseases and disorders may be contraindicated.

Surgical intervention

Every year, several thousand patients agree to the operation, not regretting it later. Surgical intervention for prostate adenoma is divided into planned and emergency.

A planned operation is carried out after a thorough diagnosis of the patient. Emergency surgery is prescribed for the development of life-threatening complications.

Indications for elective and emergency surgery

Emergency surgery for a patient with prostate adenoma is prescribed if he has:

• Acute urinary retention;
• Massive bleeding.

An emergency operation should be performed in the first hours (maximum - 24 hours) after the onset of symptoms of a complication. As a result of immediate intervention, the prostate gland is completely removed.

Planned operations are assigned:

• With urinary retention, which cannot be eliminated with the help of catheterization;
• Patients with renal insufficiency developing as a result of adenoma;
• With frequent recurrences of infectious inflammation of the prostate gland;
• Patients with calculi in the bladder, resulting from adenoma;
• With a significant and increasing increase in the middle lobule of the prostate;
• With massive hematuria;
• Patients with a large residual volume of urine in the bladder.

Before an emergency and a planned operation, examinations are carried out, they have their own differences. In the event of a life-threatening condition, the patient is prescribed those examinations that will help to carry out the operation without negative consequences.

When planning a surgical intervention, the patient is prescribed a general and biochemical blood test, a coagulation test, ultrasound, ECG and a number of examinations of the urinary system, which allow you to determine the amount of prostate growth and the condition of the vessels.

Operation types

Open prostatectomy

It is performed under general anesthesia, during the operation the prostate gland is completely removed and, if necessary, part of the surrounding tissues.

During the operation, a fistula is formed up to the abdominal wall, through which urine is excreted into the urinal. At the same time, the normal path for the outflow of urine is restored.

Traditional prostatectomy is prescribed in advanced cases of the disease, when the volume of residual urine reaches 150 ml or more, and the mass of the prostate reaches 60 grams.

Transurethral endourological surgery

It is performed using an endoscope. The device is inserted into the urethra, the data is displayed on the monitor and the surgeon is able to remove the foci of overgrown tissue.

The advantages of the technique include:

• Slight trauma to surrounding tissues, which speeds up the recovery process;
• Constant monitoring of hemostasis, eliminating the risk of massive bleeding after surgery;
• The possibility of effective treatment for concomitant adenoma pathologies.

With transurethral endourological intervention, the risk of urethral stenosis, sclerosis of the bladder walls and retrograde ejaculation is not excluded. Long-term effects include urinary incontinence.

Transurethral electrovaporization

During the operation, a resectoscope equipped with an electrode is used.

The device is inserted into the urethral canal, where it is used to burn out the overgrown prostate tissue.

The electrode during the operation coagulates the blood vessels, which minimizes the risk of bleeding.

The greatest effect during electrovaporization is achieved with prostate adenoma of small size. Therefore, this method is used to treat patients with the first and second stages of BPH.

Electroincision of prostate adenoma

This method of treating adenoma is used when the size of the growth is small. Its main difference is the preservation of prostate tissue.

During the intervention, the prostate gland and bladder neck are dissected in the longitudinal direction, after which the tumor is evaporated.

Electroinization is prescribed in most cases for young patients with small adenomas and with its intravesical growth.

Be sure to exclude the malignancy of the process before the operation.

Laser surgery

Laser treatment of prostate adenoma is based on the impact of laser beam energy on hypertrophied areas of the prostate. This leads to tissue dissection at the site of impact, to evaporation of the adenoma and to coagulation of the affected vessels.

Laser vaporization is divided into contact and non-contact methods.

Laser coagulation happens:

• contact;
• contactless;
• Interstitial.

Laser vaporization of prostate tissue

This method is understood as a type of endoscopic removal of the prostate, in which overgrown tissues are evaporated with a laser.

Laser vaporization is carried out using a resectoscope, inside which there is a device that emits a laser beam.

Usually, laser vaporization is carried out together with a transurethral adenoma removal technique.

In this case, first, with the help of a loop on the resectoscope, the altered tissues are cut off, and the laser leads to the evaporation of the remaining areas of hyperplasia.

Laser vaporization is performed either under general anesthesia or with the use of spinal anesthesia. The technique reduces the risk of complications and reduces the recovery time of prostate functions.

Laser coagulation

The method of treating adenoma differs from vaporization in that the thermal effect does not lead to the evaporation of pathological tissues, but to their necrosis.

The necrosis of hypertrophied areas of the gland ends with the formation of a crust, which gradually resolves and healthy cells remain in its place.

Laser coagulation heats tissues to a lesser extent, only up to 70 degrees Celsius, but this also allows you to effectively coagulate the vessels in the intervention area.

Interstitial laser coagulation

The purpose of this technique is to expand the lumen of the urethra by reducing the volume of the overgrown gland.

This is achieved by creating incisions in the prostate using a laser, which leads to the partial destruction of the adenoma and the gradual formation of scar tissue.

Interstitial laser coagulation is performed less often than all other laser treatment methods. This is due to the fact that the healing process of deep wounds takes a long time and the entire recovery period may require additional drainage of the bladder.

Cryodestruction

Cryodestruction is the freezing of tissues with liquid nitrogen. As a result, necrosis develops at the site of exposure and pathologically altered areas are rejected over time.

With prostate adenoma, it provides free outflow of urine through the urethra. The procedure is prescribed for those patients in whom concomitant diseases do not allow radical surgery.

Cryodestruction is carried out in several ways:

• "Blind technique" is carried out without accompanying visual control of the course of manipulation;
• On an open bladder;
• With the help of an endoscope.

Endoscopic cryodestruction is considered the most effective and safe method. After the procedure, swelling of the scrotum and penis, moderate hematuria is possible. Typically, these complications resolve within a few days.

Transurethral microwave thermotherapy (TUMT)

The method of treatment is based on heating the prostate tissues with microwaves, followed by their destruction.

A device is used that emits electromagnetic waves, which accelerate the movement of water molecules in the prostate tenfold, as a result of which it “boils” and pathologically altered areas evaporate at the same time.

TUMV is not a treatment for BPH, but only a way to alleviate the symptoms of the disease. Usually, such therapy is prescribed if the operation is contraindicated due to concomitant pathologies in a man.

TUMV is characterized by a temporary elimination of symptoms, in almost 40% of patients, discomfort returns, and minimally invasive intervention is required again.

After microwave thermotherapy, in rare cases, impotence and urinary incontinence develop.

Transurethral radiofrequency thermal destruction

This method of treatment is based on the use of electromagnetic oscillations belonging to the long-wave range.

Radiofrequency thermal destruction differs from other methods of thermal exposure in that radio emission penetrates into the tissues of the prostate gland many times better.

This will allow you to successfully treat BPH that occurs with sclerotic changes and with the formation of calcifications.

Carrying out radiofrequency thermal destruction is based on the conversion of electromagnetic energy into thermal energy.

As a result, the tissue temperature locally rises to 80 degrees, which causes their destruction and the formation of an area of ​​necrosis.

After the procedure, necrotic masses are rejected for one and a half to two months, a cavity is formed and, accordingly, the obstruction caused by the adenoma is eliminated.

Stenting technique

Similar to balloon dilatation, but the expansion of the urethra with a stand is carried out for a longer time.

Artificial embolization of small arteries of the prostate. It is carried out in order to stop the nutrition of cells located in the area of ​​​​adenoma. The procedure is performed by introducing small pieces of medical plastic 100-400 microns in size through the femoral artery.

A probe inserted into the femoral artery is advanced into the prostate artery and spherical pieces of plastic are released. Moving further into small arterioles, the plastic material clogs them and disrupts the nutrition of prostate cells, which causes their death.

The described method has recently gained popularity and quickly gained popularity among endovascular surgeons.

Balloon dilatation

Balloon dilatation is one of the methods of non-surgical treatment of the prostate gland. During the procedure, an endoscopic tube is inserted into the urethra, having a “balloon” at the end.

The endoscope under the control of an x-ray machine or ultrasound is brought to the prostate gland, where the balloon is already inflated.

This allows you to expand the narrowed lumen of the part of the urethra that is in the prostate.

Balloon dilatation is a virtually painless procedure that lasts an average of half an hour. After expanding the lumen with a balloon, stenting is performed - a tight ring is installed that prevents the canal from narrowing back.

Balloon dilatation is a symptomatic method of treating BPH, that is, the technique eliminates difficulties in the outflow of urine, but has no effect on adenoma.

The procedure is not performed if there is an acute inflammatory process, a malignant neoplasm or complete sclerosis of the prostate.

Urethral stents

An invasive therapy option is used to improve the quality of life of patients with prostate adenoma with narrowing of the urethra.

The urethral stent is implanted through the urethra, which contributes to the expansion of the organ to the required physiological level. Stents are divided into temporary and permanent.

Temporary products are made of polyurethane, titanium-nickel alloys and materials that absorb after a certain period.

Temporary stents are used when it is necessary to provide continuous drainage of the bladder cavity.

Permanent stents are implants made of elastic metal mesh. After their installation, the mucous layer of the urethra gradually grows through a fine-mesh surface. The process of epithelialization lasts up to 6 months.

Urethral stents are not installed in all patients with BPH.

Their implantation is contraindicated:

• With frequently exacerbated genitourinary infections;
• If the patient has stones in the bladder cavity;
• With partial or complete urinary incontinence;
• With dementia.

Possible complications after surgery

After any surgical operation, complications may develop, and the treatment of adenoma is no exception.

After and during open removal of the prostate and transurethral resection, it most often happens:

• Bleeding. Bleeding that develops during surgery is one of the most dangerous complication of surgery; it occurs in about 3% of patients. Blood loss can sometimes be so massive that it requires a blood transfusion. Bleeding during the recovery period may require a second conventional operation or endoscopic intervention;
• Congestion due to retention of urine in the bladder. The complication occurs as a result of dysfunction of the smooth muscles of the bladder;
• Infection of the urinary organs. In 5-22% of cases, operated patients develop inflammation of the prostate gland, testicles, and kidney tissues. Prevention of this complication is to conduct antibiotic therapy after surgery;
• Non-compliance with the technique of surgical intervention causes incomplete resection of the adenoma. The remaining pathologically altered tissues continue to disrupt the process of urination, and uncomfortable symptoms intensify even more. This complication is eliminated by repeated resection;
• Retrograde ejaculation - reflux of semen into the bladder;
• Narrowing of the lumen of the urethra. Occurs in three percent of cases, eliminated endoscopically;
• TUR syndrome or otherwise "water" intoxication. It develops as a result of the ingress of the fluid used for irrigation during tissue surgery into the bloodstream;
• Erectile dysfunction. About 10% of operated patients complain about the deterioration of the quality of sexual life;
• Urinary incontinence. It may be a consequence of a dysfunction of the bladder muscle, in which case normal urination is gradually restored.

Embolization (EAP)

PEA is a minimally invasive intervention, during which embolization, or otherwise blockage, of the vessels supplying blood to the prostate gland is performed.

Embolization contributes to the gradual reduction of the body in size.

EAP for the treatment of adenoma has been successfully used since 2009. Embolization is considered the most promising method of treatment, with success it replaces the surgical removal of the organ and the TUR (endoscopic transurethral resection) method.

Consequences of treatment and rehabilitation programs

Adenoma can be completely defeated only through a surgical operation. Medicines, phytopreparations and physiotherapy are prescribed to patients only to stop the growth of the tumor and to alleviate the symptoms of the pathology.

In a number of uncomplicated cases, the constant use of conservative methods of therapy allows a man to lead a full life until the end of his life. But most often the development of adenoma requires surgical intervention.

After an open resection of the prostate and after minimally invasive treatment methods, the patient should strictly adhere to several recommendations:

• Within two weeks, you can not make sudden movements, and physical activity is excluded. Compliance with rest will allow to achieve rapid healing of postoperative sutures without complications;
• Stick to a certain diet. Diet therapy provides for the absence of highly spicy, salty and fatty foods in the daily menu. Overeating and eating foods that cause constipation are not allowed;
• It is necessary to refrain from sexual activity for at least a month and a half.

It is necessary to constantly visit a doctor to monitor the healing process. After the formation of scar tissue, constant and moderate physical activity is needed.

The risk of relapse is reduced if the patient eats a healthy diet and eliminates bad habits.

Features of the treatment of BPH with folk methods

Folk methods for the treatment of prostate adenoma in men should not replace the main treatment.

If a sick person begins to be treated according to "grandmother's" recipes, then this leads to the fact that the tumor continues to grow and the pathology progresses, which ultimately makes traditional conservative treatment with medicines ineffective.

The effectiveness of folk remedies against tumor growth has not been proven. Yes, they can reduce inflammation and partially normalize metabolic processes, but in order for the disease to recede, homemade herbal remedies must be combined with treatment prescribed by an experienced urologist.

There is no reliable evidence that courses of prostate massage lead to a decrease in the size of the prostate.

Folk remedies that facilitate the flow of BPH

It is possible to alleviate well-being and reduce the likelihood of disease progression by using simultaneously with drug therapy:

Traditional healers suggest using some herbs or their preparations for the treatment of adenoma. But you need to understand that herbal remedies need to be drunk for a long time, which is not always possible to comply with.

With prostate adenoma, treatment with natural natural substances is also useful, these are:

• CHAG. The tool is endowed with antitumor properties. With adenoma, a decoction of chaga or its oil emulsion is used;
• LYCOPINE. This substance is endowed with antioxidant properties, under its influence the functioning of the immune system improves, the walls of blood vessels are strengthened, and the risk of developing a malignant lesion of the prostate is reduced. Lycopene is found in large quantities in red tomatoes and its derivatives, red pepper, watermelon. The use of one spoonful of high-quality tomato paste per day completely covers the body's need for lycopene for a day. From the paste you can prepare a tomato drink;
• SELENIUM is a trace element with antioxidant properties. Daily intake of selenium in the body reduces the risk of any malignant neoplasm by almost 40%. Selenium is found in dried mushrooms, sunflower seeds, dates, coconut, pistachios, pork kidneys, tuna, and salmon.

medicinal plants

For the treatment of adenoma, patients can use:

IMPORTANT TO KNOW: What else exist for the treatment of prostatitis and adenoma.

What can not be done and what can be done in case of illness

The effectiveness of eliminating the symptoms of prostate adenoma and the slow progression of the disease depend on how correctly the patient follows the doctor's instructions.

It must be remembered that massage does not affect the elimination of the tumor, moreover, massage in this case is contraindicated.

Absolutely contraindicated in case of a disease and some physiotherapeutic methods of influence are:

• Ultrasound;
• Vibration procedures;
• Techniques using high temperatures;
• Electromagnetic waves.

It is allowed to use electrophoresis, which improves the penetration of drugs to the prostate.

• Follow the rules of a healthy diet. It is useful to include pumpkin seeds, seafood, vegetables, fresh fruits and berries in the menu, to minimize the consumption of fatty and fried foods;
• Do physical exercises daily. The condition of the prostate gland improves when performing several gymnastic exercises with a complex:
  • From a supine position on a horizontal surface, you need to raise your buttocks. On inspiration, the muscles of the anal area are drawn in, on exhalation they relax.
  • Get on all fours. At the same time, the left leg is extended to the side, the left arm forward. You need to alternate limbs 7-10 times.
  • Lie on your back on a flat surface, bend your knees. Pull the legs to the abdominal wall and deflect in different directions;
  • Here is another one.
• Quit smoking and minimize the consumption of alcoholic beverages.

Prostate adenoma is considered a benign tumor, its growth occurs only within the prostate gland. However, the degeneration of formation cells into malignant ones is not excluded.

You can establish the malignancy of the process by the level of PSA - in cancer, the enzyme increases several times.

Constant monitoring by a urologist and drug treatment reduce the likelihood of developing a malignant tumor to a minimum.

Fight against obstruction

Men who have contraindications to surgery are forced to use catheters on their own or with the help of caregivers for bedridden patients.

Under local anesthesia, the patient can also be implanted with stands that expand the urethra and keep it open.

Despite the only possible method of urination in bedridden patients, standing is used for a certain period, after which it is necessary to take a break.

Any violation in the genitourinary system needs to be diagnosed and examined by a doctor who will develop a treatment regimen in a timely and correct manner.

Disease prevention and prognosis

It is quite possible to prevent the development of benign prostatic hyperplasia; for this, men, starting from a very young age, should:

• Lead an active lifestyle, constantly play sports. Physical activity eliminates stagnation in the pelvic organs;
• Maintain weight within normal limits. Obesity negatively affects metabolic processes;
• Do not wear clothes that compress the pelvic area;
• Avoid promiscuity. Venereal diseases predispose to the occurrence of pathological processes in the prostate;
• Annually examined by a urologist, starting from the age of 40. If you experience discomfort, you should visit the doctor immediately.

Early detection of BPH and timely treatment by a qualified doctor is a guarantee of a favorable outcome of the disease.

If therapy is not started on time, then there is a high probability of urolithiasis, acute urinary retention, inflammatory and infectious pathologies of the urinary organs, and renal failure.

Late initiation of treatment increases the risk of adenoma malignancy.

5 / 5 ( 1 voice )

In modern medicine, abbreviations are often used that are not entirely clear to an ordinary person without honey. education. One of these obscure abbreviations is BPH. What it is? Speaking in the language of doctors, this is benign. But the people call it easier - prostate adenoma (a variant of "prostate adenoma" is possible). Often, prostate adenoma is confused with a disease such as prostatitis. BPH is a benign formation, and it grows not without the participation of the stromal component of the prostate (in other words, the glandular epithelium), and prostatitis is nothing more than inflammation of the prostate gland. Do not confuse them.

BPH. What it is? Statistics

As mentioned above, BPH is a benign neoplasm. With it, small nodules form in the prostate (the abbreviated name of the same one), which, as they grow, more and more compress the urethra.

Because of this, a man develops urination disorders. This disease has a benign growth, and this is what distinguishes BPH from cancer.

BPH is one of the most common diseases in urology today. According to statistics, it appears in almost 80 percent of men in old age. In 20 percent of cases, instead of BPH, there is atrophy of the gland or its enlargement.

BPH disease most often develops in men over 45 years of age.

More than half of men from 40 to 50 years old turn to a specialist with this ailment, and only in rare cases can the disease overtake the young.

Reasons for the development of BPH

To date, the exact causes of the development of BPH of the prostate gland cannot be specified, since they simply have not been fully elucidated. It is believed that the disease is one of the signs of menopause in men.

The only risk factors are the level of androgens in the blood and the person's age.

Usually, with age, the balance between estrogens and androgens is gradually disturbed in a man, which causes a violation of control over the growth and function of gland cells.

It is known that there is no connection between BPH of the prostate and sexual activity of a person, orientation, bad habits, sexually transmitted and inflammatory diseases, and none of the above does not affect the appearance of the disease.

Pathogenesis

BPH of the prostate most often appears in its central part, but sometimes it can also capture the lateral lobes. The growth of benign hyperplasia depends on the adenomatous growth (tumor) of the paraurethral glands. As a result, the gland's own tissue is displaced outward, and a capsule is formed around the growing adenoma.

Hyperplastic (that is, affected by a tumor) cells of the prostate tissue also tend to grow both towards the rectum and the bladder, and this is the reason for the upward displacement of the internal opening of the bladder and the elongation of the back of the urethra.

There are several forms of hyperplasia according to the type of its growth:

Quite often, several forms of BPH can be seen in one person at the same time. This happens when the tumor grows in several directions at once.

BPH: symptoms

The signs of this disease directly depend on the location of the tumor, on its growth rate and size, as well as the degree of dysfunction of the bladder.

BPH of the prostate can be divided into three stages:

Diagnosis of the disease

The basis for diagnosis is the characteristic complaints of men, for whom a special scale for assessing the symptoms of prostate adenoma (in English I-PSS) has been created. Basically, the diagnosis of BPH is made after a clinical examination of the patient, as well as such research methods:

1. Palpation (finger) rectal method for examining the prostate gland. Thanks to him, doctors have an idea about the consistency and size of the gland, the presence of a beard between its lobes, as well as the degree of pain on palpation.
2. Laboratory studies of BPH. What it is? First of all, this is a familiar general urine test. They also conduct a biochemical blood test, which determines the level of PSA (stands for prostate specific antigen).
3. Instrumental methods. The most common are cystoscopy and ureteroscopy. With their help, you can check the patency of the urethra, the condition of the lobes of the gland and Using these procedures, you can determine the volume of residual urine.
4. Ultrasound procedure. This is also one of the types of instrumental methods that allows you to see the size of each lobe of the gland, its condition (the presence of stones, nodular formations). In addition to conventional ultrasound, it is also used
5. X-ray methods of research. Excretory urography (with contrast) and plain radiography (without contrast) can help determine the presence of complications of BPH that has been treated. With the help of x-rays, stones in the bladder and kidneys are found.

Treatment of BPH

At the moment, there are many ways to treat the disease, each of which is highly effective at different stages of BPH. Treatment of this disease can be divided into three parts:

• Medical method of treatment
• Operative method of treatment
• Other non-surgical treatments

Usually used at the first sign of BPH.

In the first stages of BPH of the prostate, treatment is aimed at reducing the growth rate of hyperplastic prostate tissue, improving blood circulation in nearby organs, reducing inflammation of the prostate and bladder, eliminating urinary stasis, eliminating constipation, and facilitating urination.

It is also worth reducing fluid intake in the afternoon, especially before bedtime.

In the presence of clinical and laboratory signs of androgen deficiency, androgen replacement therapy is also prescribed.

Often, in parallel with the treatment of hyperplasia, its complications are treated - cystitis, prostatitis or pyelonephritis.

Sometimes (against the background of hypothermia or alcohol consumption), the patient may develop In this case, the patient needs to be urgently hospitalized and catheterize the bladder.

Let's take a closer look at each type of treatment.

Medical treatment

Two types of drugs are most commonly used to treat BPH:

• Alpha-1 blockers (eg, tamsulosin, doxazosin, or terazosin). Their action is aimed at relaxing the smooth muscles of the prostate and bladder neck, which leads to easier passage of urine. The action of these drugs can be prolonged or short.
• Inhibitors (permixon, dutasteride or finasteride). These drugs prevent dihydrotestosterone (the biologically active form of testosterone) from being formed in the body of a sick person, due to which the prostate gland shrinks.

Operative method of treatment

In especially severe cases, one drug treatment is not enough, and, as a rule, one has to resort to surgical intervention. This may be excision of hyperplastic tissue (adenomectomy) or total resection of the prostate gland (prostatectomy).

There are two types of surgery:

• Open surgeries (transvesical adenomectomy). With this intervention, access to the tissue of the gland is obtained through the wall of the bladder. This type is the most traumatic, and is used only in advanced cases. Open surgery provides a complete cure for BPH.
• Minimally invasive operations(in which there is practically no surgical intervention). They are performed using modern video endoscopic technology, without incision. Access to the prostate through the urethra.

There is another type of surgical intervention that cannot be compared with the above. Prostate artery embolization is an operation that is performed by endovascular surgeons (the above are performed by urologists) and consists in blocking the arteries of the prostate with small particles of a special medical polymer (through the femoral artery). Hospitalization is not required, the operation is performed under local anesthesia and is not traumatic.

After any type of surgery, there is a small risk of complications, such as impotence or urethral stricture, for example.

Non-surgical treatments

Non-surgical treatments include the following:

cryodestruction;

Transurethral needle ablation;

Treatment with high intensity focused ultrasound;

Method of microwave coagulation of the prostate or thermotherapy;

The introduction of prostatic stents in the area of ​​narrowing;

Prostate.

Postoperative period

Alas, at some stages of the disease, surgery is simply necessary. BPH is a serious disease, and even after surgery, you need to follow some rules in order to finally get rid of the disease and not provoke a reappearance. The three main points that you must follow after the operation are the correct diet, a healthy lifestyle and regular visits to the doctor.

The diet in the postoperative period is extremely important for the patient, since it can significantly contribute to a speedy recovery. The diet after the operation completely excludes fatty foods, spices, salty and spicy foods and, of course, alcohol. It is recommended to eat low-fat foods rich in fiber.

As for work, if your profession does not involve frequent physical activity, then you can return to the workplace a couple of weeks after the operation. When sedentary work, it is recommended to do a warm-up every half an hour. A sedentary lifestyle can contribute to stagnation of blood in the organs, from which the disease only worsens. For the first few days after surgery, do not even think about lifting weights!

Give up smoking at least in the postoperative period (two weeks after surgery), if you can not quit the addiction completely. Nicotine damages the walls of blood vessels, and this affects the blood circulation of the prostate, as a result of which an inflammatory process may occur.

Many people think that after removing BPH, you should forget about sexual activity forever. This opinion is erroneous, and the sexual function of a man is completely restored after a while. However, it is worth resuming sexual relations no earlier than 4 weeks after the operation.

Another tip worth paying attention to: you can drive a car no earlier than a month after the removal of BPH.

In general, the postoperative period lasts about a month, after which the patient can already return to his usual life. However, experts strongly recommend leading a healthy lifestyle to prevent the recurrence of the disease.

Urination after surgery

Almost immediately after the operation, the urine stream becomes stronger, and the emptying of the bladder is easier. After removal of the catheter, pain may occur during urination for some time, the reason for this is the passage of urine through the surgical wound.

Experts do not exclude the occurrence of urinary incontinence or urgent urge to urinate in the postoperative period, these phenomena are completely normal. The more your symptoms bothered you during your illness, the longer your recovery period will be. Over time, all problems will disappear and you will return to the normal rhythm of life.

Some time after the intervention, there may be blood clots in the urine. This phenomenon is associated with wound healing. It is recommended to drink as much liquid as possible to properly flush the bladder. But with severe bleeding, you should immediately contact a specialist.

Forecasts

Prolonged urinary retention (in the event that the treatment of prostate adenoma is not performed), in the end, can lead to urolithiasis, in which stones form in the bladder, and later infection. In this case, the most serious complication that a patient can expect without proper treatment is pyelonephritis. This ailment further exacerbates kidney failure.

In addition, prostate adenoma can give rise to malignant growth - prostate cancer.

The prognosis for adequate and timely treatment of the disease is very favorable.

Disease prevention

The best prevention of BPH is regular monitoring by specialists and timely treatment of prostatitis.

It is also worth eating right (reduce the amount of fried, salty foods, as well as spicy, spicy and smoked), quit smoking and alcoholic beverages. In general, a healthy lifestyle significantly reduces the risk of BPH.

So now you know what BPH is. The signs of this disease, treatment, postoperative period and even prevention are described in detail above.

In any case, this knowledge will be useful to you. Be healthy!