What is moderate prostatic hyperplasia. Treatment of benign prostatic hyperplasia depending on the stage Possible complications after surgery

For citation: Lukyanov I.V. Benign prostatic hyperplasia. Modern possibilities of treatment. // RMJ. 2004. No. 14. S. 830

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in older men. The prevalence of histologically detectable hyperplasia increases with age.

By the age of 60 , according to different authors, 13 to 50% of men suffer from this disease , and by the age of 90, approximately 90% of men have morphological changes characteristic of BPH. On average, half of these patients have a macroscopic enlargement of the gland, and 25% of patients develop clinical symptoms requiring treatment. The social significance and urgency of this problem is emphasized by WHO demographic studies, which testify to the growth of the world's population over the age of 60, and its pace is significantly ahead of the growth in the population as a whole. This pattern is also typical for our country. According to various estimates, by the age of 80, every 4th man will need treatment for prostatic hyperplasia. Numerous clinical manifestations and symptoms of BPH are extremely diverse and depend on the progression of the disease, physical and mental status, age, social status and medical awareness. The symptoms of BPH manifestation are different, non-specific and very diverse, and therefore there are disagreements about the interpretation of the results of diagnostic examinations. Assessment of symptoms (their intensity, degree, frequency, duration and significance) is often subjective and depends not only on the patient, but also on the qualifications of the treating urologist. Such subjectivism not only complicates the diagnosis and prognosis in BPH, but also does not allow an objective comparison of treatment results in different clinics and thereby evaluate the effectiveness of various methods of conservative and surgical treatment. Only in the last two decades in most countries of the world, including Russia, there has been a trend towards the formation of common principles for assessing and interpreting the symptoms of BPH. This assessment is based on the refinement of not only each symptom and their combination, but also their correlation with the data of an objective examination, the possibilities of which have increased dramatically at the present time due to the advent of new technologies. Most of the symptoms of BPH accompany two other prostate diseases - cancer and prostatitis. This should explain the need for differential diagnosis when examining patients with various types urination disorders. The problem of diagnosis and treatment of benign prostatic hyperplasia is currently one of the most dynamically developing areas of urology. The basis of the revolutionary changes that took place were fundamental research in the field of molecular biology, physiology, immunology, morphology and hormonal regulation of the prostate gland, a detailed study of the issues of epidemiology, etiology and pathogenesis of the disease, as well as the introduction of high-tech achievements of scientific and technological progress into medical practice.

Clinical manifestations of benign prostatic hyperplasia are determined by obstacles in the path of urine flow and, accordingly, by violations of the habitual act of urination - a typical symptom complex, which is leading in all varieties of growth of hyperplastic nodes (Table 1). Changes in the act of urination are determined by obstruction of the prostate part of the urethra, which is circularly or segmentally covered by adenomatous nodes, stretched in length and deformed. The characteristic clinical picture in an elderly patient at the first visit immediately allows the doctor to associate complaints with the development of BPH. IN initial stage the patient notes only minor disorders of urination, and frequency prevails, especially at night. The first sign of an incipient disease is precisely nocturia , which disturbs sleep and therefore causes concern to the patient. If the condition is not aggravated by new symptoms, he reconciles with the inconvenience that arises and does not turn to the urologist. Functionally, urination disorders are compensated by the detrusor muscles, which easily overcome the obstacle that has arisen. In practical urology, the division into symptoms of obstruction and symptoms of irritation has become quite widespread. With this division, they try to emphasize not only the nature of the symptoms, but also their differences in severity. Obstructive symptoms are more dangerous in terms of prognosis and, as it were, aim for surgical treatment. Irritative symptoms, although significantly reducing the quality of life, are less dangerous and can be eliminated with proper conservative treatment.

BPH has a significant impact on the patient's quality of life . The more severe the symptoms, the worse quality the patient's life and the greater their impact on his daily activities (Table 2). However, it is obvious that the isolation of obstructive symptoms and the determination of the amount of residual urine can only serve as a basis for a preliminary idea of ​​the disease and its prognosis. Often, when choosing a method of therapy for BPH, it is necessary to focus on the predominance of a group of certain complaints in the picture of the disease. As a rule, obstructive and irritative symptoms are observed to varying degrees in the same patient and there is no direct relationship between the severity of these manifestations and the severity of the condition according to an objective examination. This provision somewhat reduces their significance and makes the division into obstructive and irritative symptoms largely artificial. It becomes clear that a more objective approach to assessing the symptoms of BPH is needed. This circumstance probably explains the appearance various systems calculation and derivation of the index of symptoms. To quantify the patient's complaints and observed symptoms, it is recommended to use the questionnaire ("Symptom Index", developed by the American Urological Association), filled out by the patient himself (Table 3). The symptom rating scale classifies symptoms according to severity, dividing them into mild (0-7 points), moderate (8-19 points) and severe (20-35 points). The questionnaire should be used when planning treatment and during subsequent scheduled examinations of the patient. This method is not an independent tool for the diagnosis of BPH, since the symptoms to which the questions relate are not specific to this disease. According to the recommendations of the International Conciliation Committee on BPH, S-L-Q-R-V-PQ parameters can be used to describe the clinical status of a patient (Table 4). When making a diagnosis, a urologist takes into account a fairly large number of symptoms and initial data (results of instrumental tests, medical history, etc.). However, it has been shown that the number of signs effectively considered by a doctor when making a diagnosis, as a rule, does not exceed 15, and about 50,000 different combinations occur during diagnosis. Each urologist considers his own set of signs. However, when using computer methods diagnostics, it is possible to increase the number of considered criteria, since there are practically no restrictions on the complexity and number of options to be sorted out. Computer information systems are currently being successfully used to automate many aspects of human activity, for example, to support workflow and information processes. However, the use of computers in medicine is not limited to auxiliary accounting functions - it is associated with an attempt to automate diagnostics and involve computers directly in the process of treating a patient. International conciliation committees and groups of urological experts have defined the concept "standard" patient . Criteria for exclusion from the concept of "standard patient": - age less than 50 years; - the presence of prostate cancer; - previous therapy for prostate hyperplasia, which did not bring positive results; - treatment-resistant diabetes mellitus, diabetic neuropathy; - presence in history or on physical examination of signs of a neurological disease; - the presence of a history of surgical interventions or injuries in the pelvic region; - taking medications that can affect the bladder.

Minimum list diagnostic measures when treating a patient with urination disorders should include: - history taking; - measurement of the total score according to the international system for the total assessment of symptoms in diseases of the prostate gland on a 35-point scale (IPSS); - assessment of the quality of life on a 6-point scale (QOL); - digital rectal examination (DRE); - general analysis urine; - determination of urea and creatinine in blood serum; - assessment of the morphofunctional state of the kidneys and upper urinary tract using x-ray or radioisotope methods of examination; - ultrasound examination of the prostate gland, abdominal and transrectal; - urodynamic study (uroflowmetry); - determination of the presence and amount of residual urine (RV); - determination of the level of prostate-specific antigen (PSA) and, if necessary, determination of PSA fractions - "free" prostate-specific blood antigen. Dihydrotestosterone is the most potent enzymatic product of testosterone and the predominant prostate androgen. Testosterone is converted to DHT by the enzyme 5? -reductases. There are 2 isoforms 5? -reductases (type 1 and type 2), which are encoded by different genes - SRD5A1 and SRD5A2, respectively. The role of enzyme 5? -reductase became clear after it was discovered that male pseudohermaphrodites with a deficiency of 5? -reductases (mutation of the SRD5A2 gene) are characterized by a pronounced decrease in DHT, normal level testosterone levels, small prostate (lifelong) and no BPH development. The basis for the development of inhibitor 5? -reductase type 2 was the fact that the genetic deficiency of this enzyme leads to the involvement of DHT in the growth and development of the prostate gland. At the same time 5? -reductase is localized directly in the prostate. These facts suggested that targeted inhibition of 5 ? α-reductase type 2 and thus inhibition of DHT production could potentially influence an important causal factor in BPH. Imbalance of intracellular enzymes contributes to the rapid growth of BPH, which is manifested by: - ​​proliferation of hyperplastic prostate tissue; - increased activity and tone? 1-adrenergic receptors; - a violation of metabolic processes in the prostate tissue, which leads to circulatory disorders and the addition of an inflammatory process. The role of DHT in the regulation of prostate function is great, because without it, the prostate cannot develop, differentiate, maintain and maintain its functions. In a normal prostate gland, the processes of cell proliferation and cell death are in dynamic equilibrium. This state is maintained by the required level of androgenic steroids.

Modern methods treatment of BPH

The development and introduction into medical practice of fundamentally new scientific ideas makes it possible to change the attitude towards the diagnostic and therapeutic process and radically improve the results of the treatment of a particular pathological condition. The totality of BPH treatment methods that are currently used in clinical practice is an impressive list and can be represented by the following classification.

I. Drug therapy.

II. Minimally invasive non-surgical (alternative) methods of treatment. 1. Non-endoscopic thermal methods: - extracorporeal pyrotherapy; - transrectal focused ultrasonic thermal ablation; - transurethral radiofrequency thermal destruction; transurethral microwave (or radio wave) thermotherapy; - transrectal microwave hyperthermia. 2. Balloon dilatation. 3. Stenting of the prostatic urethra. 4. Endoscopic thermal methods: - interstitial laser coagulation (ILC); - transurethral needle ablation (TUNA).

III. Surgical methods of treatment: 1. Open prostatectomy. 2. Transurethral resection of the prostate. 3. Transurethral electroincision of the prostate. 4. Transurethral electrovaporization of the prostate. 5. Transurethral endoscopic laser surgery of the prostate gland (vaporization, ablation, coagulation, incision and combinations of these techniques, including with ILC). 6. Transurethral cryodestruction of the prostate. According to the recommendations of the 4th meeting of the International Conciliation Committee on the Problem of BPH (1997) absolute readings To surgical treatment are: - urinary retention (inability to urinate after at least one catheterization, or if catheterization is impossible); - repeated massive hematuria associated with BPH; - renal failure due to BPH; - bladder stones; - repeated urinary tract infection due to BPH; - a large diverticulum of the bladder. Despite the great achievements of modern high technology, the operation performed does not always give brilliant results: - Satisfied with the results of treatment - 63%; - completely dissatisfied with the results of treatment - 21%; - occurrence of new urination disorders in postoperative period- 24%; - feeling of complete recovery - 59%.

Medical treatment for BPH

Current drug therapy for BPH, specifically designed to target the prostate gland, includes therapy? - adrenoblockers and other medicines. The immediate goal of treating BPH is to relieve symptoms, while the long-term goal is to slow the progression of the disease, minimize the adverse effects of treatment, and maintain quality of life.

indications for conservative (medicated) treatment BPH: - Total IPSS score greater than 8 and less than 19; - QOL not less than 3 points; - maximum urine flow rate (Q max) not more than 15 and not less than 5 ml/s; - the volume of urination is not less than 100 ml; - the volume of residual urine is not more than 150 ml; - the presence of contraindications to surgical treatment due to concomitant diseases; - social reasons, in particular, the categorical refusal of the patient from an invasive method of treatment.

Contraindications to the appointment of conservative treatment BPH: - suspected prostate cancer; - inflammatory diseases of the lower urinary tract in the acute stage; - neurogenic disorders; - cicatricial process in the small pelvis; - bladder stones; - significant size "average share"; - frequent bouts of gross hematuria and severe renal and hepatic insufficiency; - individual intolerance to drugs. The principles of the use of drugs for the treatment of BPH are based on modern ideas about the pathogenesis of the disease. The main directions of medical treatment of BPH are first-line drugs: inhibitors 5? -reductases, - adrenoblockers. Phytotherapeutic preparations, polyene antibiotics, amino acid complexes, extracts of animal organs and combinations of these groups of preparations are also widely used.

5a-reductase inhibitors

The most common methods of drug therapy for BPH include the use of inhibitors 5? -reductases (finasteride, episteride). Finasteride, which is a 4-azosteroid, becomes a competitive inhibitor of the enzyme 5? -P, predominantly of the second type, thereby blocks the conversion of testosterone to DHT at the level of the prostate gland. The drug does not bind to androgen receptors and does not have side effects characteristic of hormonal drugs. At present, there is experience of its use for more than 3 years without significant adverse reactions. Apart from synthetic drugs, property to inhibit 5 ? -P is also possessed by preparations of plant origin, containing, first of all, Serenoa repens extract

a-adrenergic blockers

First line drugs for the treatment of BPH. Reliably effective for any size of the prostate. Effective against obstructive and irritative symptoms. A significant improvement in symptoms occurs in most patients at 2-4 weeks of treatment - the fastest effect. Do not affect the level of PSA (diagnosis of prostate cancer). Efficacy has been confirmed by numerous placebo-controlled clinical studies. Convenient to use. Reason for appointment? -adrenergic blockers in BPH served as the accumulated data on the role of violations of sympathetic regulation in the pathogenesis of the disease. Of the side effects, hypotensive is serious, which can be excessive even against the background of basic arterial hypertension What often causes patients to refuse therapy? -blockers (J. Gillenwater, D. Mobley). In general, drugs in this group are recommended for patients with predominantly irritative symptoms of BPH (M. Caine, R. Kirby, G. Martorana, N. Seki, J. Wasson). BPH leads to an increase in the activity of sympathetic nerve fibers, which causes an increase in the tone of the smooth muscle structures of the base of the bladder, posterior urethra and prostate. The process of hyperplasia mainly occurs due to the stromal component of the prostate gland, which contains up to 60% of smooth muscle fibers, which are the point of application? - adrenoblockers. Based on the mechanism of action? -adrenergic blockers lies in the relaxation of the smooth muscles of the bladder neck and posterior urethra due to the blockade? 1-adrenergic receptors. This is the most popular and numerous group of drugs. Non-selective blockers? 1 / ? 2-adrenergic receptors are not currently used. Selective? 1 - adrenoblockers: - alfuzosin; - doxazosin; - terazosin; Selective? 1 A-blockers: - tamsulosin. Recent studies show almost the same effectiveness of using different? - adrenoblockers. Reducing the symptoms of BPH was noted on average by 50-60%; an increase in the maximum flow rate of urine by an average of 30-47%; and a decrease in the amount of residual urine by an average of 50%. However, due to the fact that the ability of tamsulosin to act on? 1 A-adrenergic receptors is 20 times greater than its ability to interact with? 1 B-adrenergic receptors, which are located in vascular smooth muscle, the drug does not cause any clinically significant decrease in systemic blood pressure as in patients with arterial hypertension and in patients with normal baseline blood pressure.

Additional Information: before coming? -blockers 60% of patients receiving this type of treatment would be subjected to surgery. However, it should be noted that in 13-30% of the effect of the application? -adrenergic blockers do not occur within 3 months of admission. In this case, further therapy with drugs of this group is inappropriate.

Phytotherapeutic agents

A number of clinicians as a result of the study concluded that Serenoa repens extract is also effective in reducing the symptoms of infravesical obstruction, as well as synthetic enzyme blockers 5? -P, and can be recommended for widespread use (L.M. Gorilovsky, N.A. Lopatkin et al., N. Bruchovski et al., C. Sultan et al., T. Tacita et al.). As a result of large-scale studies, a significant clinical efficacy of Pygeum africanum extract in the treatment of BPH was revealed, but without a significant reduction in prostate volume. Thus, the analysis of available data on the use of phytotherapeutic agents in the treatment of BPH allows us to state that these drugs can have a significant positive effect on the subjective and objective manifestations of the disease.

Other medicines

Clinical Application Studies mepartricin - a derivative of a polyene antibiotic are few and indicate a moderate significant decrease in the symptoms of BPH. Thus, drug therapy is undoubtedly an integral element of the treatment of BPH and can be used in patients with clinically significant symptoms of the disease with compensated dynamic bladder outlet obstruction. IN last years A large number of researchers come to the conclusion that it is necessary to conduct combined treatment of BPH . Conducted in the world of multicenter placebo-controlled studies confirm the validity of such treatment (H. Lepor, 1996; MTOPS, 2001; V.I. Kornienko, 1997; O.B. Loran, 1995 and 2002). Do the data obtained indicate a greater effectiveness of combined treatment? -blockers and finasteride compared with monotherapy. The effectiveness of combined treatment was up to 96%, while in the monotherapy groups? -blockers - 84% and 74% in the finasteride monotherapy group. The treatment of BPH is an important and not yet fully resolved problem of urology. To determine treatment tactics, develop indications for conservative and operational methods, in addition to knowledge of clinical symptomatology, data from ultrasound, x-ray, functional studies are needed. The widespread use of non-invasive diagnostic methods in urological practice enables the doctor to detect early forms of the disease and use appropriate therapy, which in the future will undoubtedly require correction in connection with the development and implementation in clinical practice.

BPH(benign prostatic hyperplasia,) is a benign proliferation of gland tissues, an increase in its volume. The overgrown gland compresses the urethra passing through it, causing urination disorders - this is the main symptom of the disease.

Benign prostatic hyperplasia is detected in 20% of men aged 40, 70% - 60 years, 90% - 80 years. The main reason for the development of BPH is a change hormonal background men (decrease with age in testosterone levels).

Possible complications of BPH

• Attachment of inflammation
• stone formation
• Formation of diverticula (protrusions of the bladder wall)
• Acute urinary retention
• Development of kidney failure

A study of patients with prostate cancer showed that in 80% of cases the development of a malignant process occurred against the background of long-term benign prostatic hyperplasia.

Diagnosis of BPH

The diagnosis of BPH is established urologist based on complaints, anamnesis, medical urological examination of the patient and the results of the examination. Accurate information about the frequency of urination and its volume during the day (with time indication) is important.

Signs of prostate hyperplasia

• Difficulty urinating, sluggish urine stream
• The need to make an effort to start urination
• Feeling of incomplete emptying of the bladder, forcing the man to repeatedly return to the toilet
• Frequent, persistent urge to urinate, including at night

Analyzes and research

General clinical blood and urine tests

Biochemical blood test (urea, creatinine)– exclusion/assessment of renal failure

Determination of the level of prostate-specific antigen (PSA) in the blood (a marker of inflammation and prostate cancer). PSA in benign prostatic hyperplasia is examined regularly. The level and rate of increase of PSA matters.

Biopsy of the prostate(at elevated PSA) to rule out/confirm prostate cancer

Uroflowmetry(measurement of urine flow rate). Double when detecting deviations.

Ultrasound examination (ultrasound) of the kidneys and urinary system, prostate gland- transabdominal and transrectal (TRUS), including the study of the volume of residual urine. Allows you to identify / exclude urolithiasis, expansion of the pyelocaliceal apparatus, tumors of the urinary system, diverticula of the bladder, assess the size and shape of the prostate gland.

Echosigns of BPH (detected by ultrasound)

• An increase in the volume of the prostate up to 20 cm3 or more.
• The heterogeneous structure of the prostate gland, the presence of seals (scars), stones - calcifications (traces of inflammation), nodular formations.
• The volume of residual urine more than 50 ml is regarded as pathological.

Survey urography, excretory, retrograde urography- X-ray examination of the urinary system - kidneys, ureters, bladder, urethra, including the use of X-ray contrast agent. Evaluation of the function, structure of the urinary system, the position of the kidneys, etc.

Stages of BPH

BPH 1 - stage of compensation- the prostate gland is 30 or more cm 3 in volume, symptoms from the bladder are absent or minimally expressed. Due to a slight compression of the urethra, the detrusor muscle in the wall of the bladder is hypertrophied, but completely copes with its emptying.

BPH 2 - stage of subcompensation- the prostate enlarges, the pressure of the urethra increases, the muscular wall of the bladder ceases to cope with the complete expulsion of urine, its hypertrophy is replaced by hypotrophy, thinning. Incomplete urination - >80 ml of residual urine remains in the bladder. Difficulty in diverting urine causes its stagnation and expansion of the higher departments - the ureters, calyces and renal pelvis. Gradually, kidney failure develops.

BPH 3 - stage of decompensation - the inability to empty the overflowing bladder, since its stretched detrusor muscle is no longer able to contract. At the same time, there is a drip of urine. It is spontaneously squeezed out drop by drop from the bladder into the urethra due to the constant intake from the kidneys. There is a real threat of acute urinary retention - the impossibility of emptying the bladder with an irresistible desire to urinate. This situation requires emergency surgical care.

Treatment of BPH

conservative

• improving urine flow by relaxing the bladder neck, urethra,
• reduction in the size of the gland
• improvement of the detrusor muscle of the bladder.

Combined pharmacotherapy is used, which is selected individually and adjusted in the course of treatment by a urologist observing the patient.

Surgical

With the ineffectiveness of conservative therapy, the progression of BPH, severe urinary disorders, an increase in the volume of residual urine, the development of complications (stone formation, hematuria - erythrocytes in the urine, renal failure, etc.), an operation is necessary.

The Clinical Hospital on Yauza practices a modern method of surgical endoscopic laser vaporization, in which access to the prostate gland is carried out through the urethra, and excess gland tissue is evaporated by a laser.

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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 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 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. sympathetic division of the autonomic nervous system has branches in the muscles of the prostate, the body of the bladder, the neck of the bladder, and the 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. Reject the negative impact of abuse alcoholic beverages, 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 is not worth it.

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. Clear signs begin to worry 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 education male hormones, in particular testosterone, and to increase the production of female.

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 causes for the development of adenoma, there are several provoking factors, under the influence of which the risk of formation benign tumor rising is:

• 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;
• excess in environment maximum permissible concentrations of harmful chemical compounds;
• 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.

Sudden retention of urine stream causes sharp 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.

Prostate cancer progresses to 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 prostatic hyperplasia of the 2nd and 3rd degree spreads bad smell urine, dry oral mucosa. 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 - inflammatory disease and an 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.

TO characteristic symptoms indicating prostate adenoma, urologists include:

• 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. defines 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 choose an effective therapy, the doctor needs to establish whether there is inflammatory process in the gland and the stage of adenoma development.

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 supply nerve impulses(spine injuries, strokes, multiple sclerosis, Parkinson's disease, etc.).

Physical examination

The physical examination of the patient begins with an examination of the skin, general condition 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 performance 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 increases and depending on the weight of the tumor - each increase of 1 gram benign education 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 overall indicator 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- pills 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 diabetes 1 type;
• 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.

Perceptible therapeutic effect when taking the drug, it 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 the patient's chronic hypotension, the drugs described, with the exception of Hyperprost, further reduce arterial 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 secretory function prostate.

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.

Hypertrophan 40 is prescribed when it is necessary to eliminate functional disorders 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 elimination of dysuria, pain, activation 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. prescribed for the treatment of prostatitis chronic form, 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 later on its implementation. 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 analysis blood tests, coagulation tests, 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;
• Opportunity effective treatment with accompanying 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 coagulates during the operation 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 coagulation with a laser is less common than all other methods laser treatment. 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 carried out by introducing small pieces of medical plastic with a size of 100-400 microns through 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 in a symptomatic way BPH therapy, 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 antibiotic therapy after operation;
• 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 disfunction. 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 surgical removal organ and the TUR method (endoscopic transurethral resection).

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. Keeping calm allows you to achieve fast healing 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.

Not proven effective folk remedies against tumor growth. 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 spoon of quality tomato paste per day fully 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 in dried mushrooms, sunflower seeds, dates, coconut, pistachios, pig kidneys, tuna, 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.

Allowed to use electrophoresis, which improves penetration medicinal substances to the prostate.

• Follow the rules healthy eating. 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. Simultaneously left leg extended to the side, left hand forward. You need to alternate limbs 7-10 times.
  • Lie on your back on a flat surface, bend your legs in knee joints. 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 risk of developing malignant tumors 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 exercise exclude 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 )

Prostatic hyperplasia occurs predominantly in older men. According to statistics, in people over 65 years of age, pathology is detected in 85% of cases and is expressed in the formation of a benign tumor, which increases in size over time. As a result, the representatives of the stronger sex have difficulty urinating due to squeezing of the urethra. In the absence of timely medical care the disease gives serious complications.

What is this pathology?

Benign prostatic hyperplasia is a change in the tissues and cells of the prostate and a further increase in this organ. The neoplasm is formed from the glandular epithelium, which at the initial stage of development looks like small nodules. But over time, the nodules increase in size, leading to the growth of a benign tumor. The development of the tumor does not lead to the growth of metastases, but with advanced pathology and the absence of timely treatment prostatic hyperplasia can develop into a malignant tumor (carcinoma). In medical terminology, there is another common name for this disease - prostate adenoma or prostatitis.

BPH of the prostate - causes

One of the most common factors in the development of adenoma is heredity. If the family has close relatives suffering from prostatitis, then the likelihood of the disease increases significantly. This category of men is recommended to undergo an annual examination from the age of thirty for the timely detection of pathology. In addition to the genetic factor, risk sources also include:

• hormonal disorders (changes in the balance between female and male hormones);
• inflammatory processes of the pelvic organs and the urogenital region;
• old age;
• sedentary lifestyle, lack of physical activity;
• frequent hypothermia;
• bad habits (tobacco, alcohol);
• malnutrition (the predominance of fatty meat food and lack of plant fibers);
• transferred venereal diseases;
• unfavorable ecological situation and other environmental factors.

Prostatic hyperplasia - diagnosis

Timely diagnosis, especially in the early stages, is very important for a quick and successful cure. Typically, it involves comprehensive examination and includes an examination of the patient, as well as a number of instrumental studies and laboratory tests. During the medical examination, the method of palpation is used, which makes it possible to determine the condition of the prostate gland, pain, compacted areas, etc.

Diagnostic methods are selected individually for each patient, depending on complaints and a pronounced clinical picture:

• examination by palpation;
• urinalysis for erythrocytes, leukocytes, protein, glucose;
• blood analysis;
• uroflowmetry (volume and speed of the jet during urination);
• contrast urography (X-ray) is prescribed if you suspect the presence of stones in the bladder;
• cystomanometry allows you to determine the pressure on the walls of the bladder;
• Urethrocystoscopy makes it possible to see the structure and condition of the urethra and bladder.

Prostatic hyperplasia - symptoms

The main feature of prostate adenoma is that it is almost asymptomatic for a long time. This is the danger, since the man does not even suspect the presence of a benign formation in the body. Sensations and discomfort become pronounced only when pathological changes in the organ have occurred and the tumor has grown.

The following are the main signs of BPH, which can manifest themselves at any stage of the disease:

• frequent urination, sudden onset of urges;
• emptying with small drops, weak jet pressure;
• jet when urinating intermittent;
• pelvic muscles tense during emptying;
• sensation of urine remaining in the bladder;
• pain when going to the toilet;
• involuntary emptying;
• chronic retention of urine resulting from narrowing of the canal;
• blood in the urine.

If the patient noticed at least one symptom in himself, he should take it seriously and immediately consult a doctor. Do not take it lightly and self-medicate.

Stages of development of prostatitis

In the clinical picture of the development of pathology, 3 stages are distinguished.

Prostatic hyperplasia of the 1st degree (compression) is characterized by problems with urination, mainly in the evening and at night. At the same time, the urge to go to the toilet is frequent, and the stream is very sluggish. The duration of the stage can last up to 3 years, while the main symptoms are practically not expressed. At this stage, the neoplasm responds very well to drug therapy.

The second stage of hyperplasia (subcompensatory) begins with serious violations of the bladder, when its release presents serious difficulties. The patient feels a constant urge to urinate and spontaneous discharge of cloudy urine, often with an admixture of blood. At this stage of the disease, chronic renal failure may develop.

ORDER

The third stage (decompensation) is the most difficult and dangerous, since there is a complete impossibility of self-emptying of the bladder. And this is fraught with a rupture of its walls. Urine is characterized by turbidity with an admixture of blood. A man during this period feels constant fatigue and loss of strength. He suffers from constipation, the skin becomes pale, weight loss occurs. In people suffering from 2 and 3 degrees of prostatitis, a persistent smell of ammonia is felt from the mouth.

Forms of the disease

Depending on the direction of neoplasm growth, hyperplasia has several forms:

• subvesical (the tumor grows near the rectum). With this form, the patient often experiences discomfort not during urination, but during the act of defecation;
• intravesical (formation grows in the direction of the bladder). The ingrowth of the prostate into the bottom of the bladder leads to deformation of the neck of the upper urethra;
• prevesical - expansion of the lateral parts of the prostate adjacent to the bladder.

Types of adenoma according to the form of growth

According to the form of tumor tissue growth, prostate adenoma is classified into 2 types.

Diffuse prostatic hyperplasia is characterized by a uniform increase in the organ during the development of the disease without pronounced foci. Adenomatous prostatic hyperplasia is marked by the formation of nodules within the prostate. They can be from one to several, depending on the stage and course of the disease.

Prostate hyperplasia - treatment

The treatment regimen is selected by the doctor strictly individually after the diagnosis and history taking. Currently, there are 3 methods of treatment of prostatitis.

1. Medical (conservative) therapy. Medicines are used, as a rule, with a mild course of the disease, as well as with contraindications to surgical interventions.

At the disposal of specialists are several groups of drugs:

• alpha1 - adrenergic blockers help relax smooth muscles and improve urine outflow;
• blockers 5 - alpha - reductase stops the growth of prostate cells, which further leads to the normalization of the gland;
• phosphodiesterase blockers - 5 relax the muscles in the urogenital region, which greatly facilitates the outflow of urine;
• herbal preparations contain natural extracts and extracts medicinal plants(African plum bark, rye, nettle, pumpkin seeds, etc.).

1. Surgical treatments for prostatitis are indicated in cases where drug therapy does not bring the desired result. The following types of surgery are used:

• transurethral resection of the prostate is the most commonly used and standard method. A tube with a metal loop and a camera is inserted into the urethra. Under the action of an electric current, the loop removes the overgrown formation layer by layer;
• transurethral notch of the prostate is used when the gland has not grown too much. The overgrown tissue is removed between the prostate and bladder neck;
• Holmium laser enucleation is the most advanced method of treating pathology. A laser is inserted into the urethra, which, under the influence of high power, gradually exfoliates the tissue of a benign tumor;
• open surgery is performed in advanced stages of the disease or in the presence of stones in the bladder. It is carried out through an incision in the bladder and is traumatic, but at the same time guarantees a complete cure.

1. Benign prostatic hyperplasia - treatment by non-surgical methods:

• the introduction of prostatic stents (spirals) into the urethra for a long or short period of time. Over time, stents should be removed, as untimely removal provokes worsening of symptoms;
• microwave coagulation of the prostate - microwaves heat the prostate tissue up to 70 degrees, as a result of which it is destroyed;
• prostate lifting with an implant - this method expands the diameter of the urethra and improves the quality of life of many patients;
• cryodestruction, needle ablation, focused ultrasound, etc. are also performed.

Forecast

With timely seeking medical help and following all the recommendations of the attending physician, the prognosis of the cure is very favorable. Many men put off a visit to the doctor for a long time, because they are afraid that due to surgery they will have to forget about the pleasures of sexual life forever. But this is a common misconception - on average, after a month, sexual function is completely restored.

Prevention

In order to stop the disease in the early stages, it is advisable for men to undergo an annual medical examination by a urologist, starting at the age of 40. Since the exact reason why an adenoma develops cannot be specified, all preventive measures are purely general in nature.

They consist in observing, first of all, a proper and balanced diet - less fatty and starchy foods, and more fiber and protein. It is also necessary to drink plenty of pure water, and in the evening its intake must be limited.

An active lifestyle, playing sports can normalize blood circulation in the pelvic organs, which helps prevent stagnant processes. At the same time, you should be careful about lifting weights and other increased loads.

To create a normal and comfortable psychological environment, stress and other conflict situations should be avoided. But it is better to refuse from taking sedatives.

Quality regular sex will help to ensure a good condition of sexual function and prostate. But bed excesses and promiscuity can adversely affect a man's health.

In case of malfunctions in the work of the prostate gland, doctors recommend to massage it. It not only has a beneficial effect on sexual activity and the duration of sexual intercourse, but also removes harmful substances and pathogenic microorganisms.

With age, prostate tissue, under the influence of certain sex hormones, begin to increase in size. This condition is commonly called prostatic hyperplasia (formerly -). Although pathologists do not belong to oncological diseases, it can threaten the life of the patient. Consider what means for the treatment of hyperplasia modern medicine has and list the names of some drugs.

What is prostatic hyperplasia

Even if a man did not have problems with the genitourinary system in old age, irreversible changes begin. Under the influence of testosterone and dihydrotestosterone, the glandular tissue of the prostate grows and takes the form of a nodule.

Increasing in size, it compresses the prostatic urethra, which causes dysuric disorders. In this case, the symptoms will depend precisely on the size of this benign neoplasm - if it is small, a man may not be aware of the problem for a long time and live a normal life.

A few decades ago, BPH was considered incurable, but now the opinions of doctors have changed. According to recent reports, the following statements apply to the disease:

1. It occurs more often in older men.
2. It has nothing to do with prostate cancer, it is not a precancerous condition.
3. Signs may gradually change, including intensifying, weakening, and disappearing.
4. Conservative therapy able to give a positive result.
5. The best option treatment of men outside the reproductive age - transurethral resection.

Half of men over the age of 60 have benign prostatic hyperplasia, and one in ten will need surgery. Without medical help, acute urinary retention develops, then acute renal failure, which often ends in death.

Modern methods of treatment and their possibilities

As of the first decade of this century, there are three methods of medical care for benign prostatic hyperplasia - observation of changes in dynamics, drug treatment and surgery. There are alternative methods that are recognized by some doctors. Each of them has its own characteristics, including in relation to the expediency of application.

Dynamic Surveillance

The essence of the method lies in the systematic monitoring of the patient's health, which is comparable to a medical examination. If the area of ​​hyperplastic tissue does not increase in size and does not threaten organ dysfunction, no treatment is prescribed. This is due to the fact that in some cases, prostatic hyperplasia can be reversible - over time, the symptoms will go away on their own.

Dynamic observation is characterized by:

• annual examination of the patient;
• assessment of the state on a special scale in points;
• control of the rate of urine outflow in the terms established by the doctor.

Most often, hospitalization is not needed for observation. A man can live a normal life, work, go about his business and visit a doctor only on appointed days. However, it is impossible to take any drugs without his knowledge, especially for the treatment of sinusitis or. Some drugs can interfere with urination, which will increase the symptoms of hyperplasia. The same applies to tranquilizers and antidepressants.

Treatment with herbal extracts

Easy access to a variety of information has led to a surge in the popularity of herbal treatment for benign prostatic hyperplasia. Men brew teas and infusions, buy dietary supplements, put candles with sea buckthorn extracts and wait positive result.

Meanwhile, the effect of such actions is unpredictable. Some of the products, especially those based on the extract of the dwarf palm (seenoa), have not been studied. Neither doctors nor pharmacists can predict what mechanism of action these drugs have, whether they can be trusted and whether there will be any complications.

modern medicine phytotherapy does not recognize. However, if benign hyperplasia is complicated, rectal suppositories may be prescribed. These include Prostatilen, propolis suppositories or sea ​​buckthorn oil. These medications a doctor should choose, self-treatment is unacceptable here.

Treatment of hyperplasia with drugs

At the initial stage of growth of the glandular tissue, alpha-blockers and 5-alpha reductase inhibitors are especially effective. They act on various receptors and affect urination, but they can also affect other organs, disrupting their functionality.

Alpha blockers act on alpha receptors that control the smooth muscles of the bladder and prostate. Already after the first dose of drugs, the tone of these muscles decreases, which leads to an increase in the rate of urine outflow.

The most popular of this group are:

• doxazosin;
• Terazosin.

Means are prescribed in case of progression of symptoms of hyperplasia, with residual urine in the amount of 300 ml and in the absence of indications for surgical intervention. After a course of treatment, the intensity of symptoms decreases by 30-60 percent, men feel much better.

However side effects can be dangerous: 10% of men experience a sharp drop in pressure and dizziness.

5-alpha reductase inhibitors prevent the conversion of testosterone to dihydrotestosterone. As a result, the volume of the prostate gland decreases and urination is gradually restored. However, the effect is observed only after six months, in addition, there are risks of developing complications:

• growth of glands in the chest area;
• erectile disfunction;
• decrease in sperm volume.

Most often, men are prescribed Finasteride, but its use is advisable only in cases where, according to the results of the tests, the transition of testosterone to dihydrotestosterone is clearly visible, and according to the results, there is either reason to fear further growth of the prostate.

Partial prostatectomy

If the enlarged gland completely blocks the lumen of the prostatic urethra and threatens the development of acute urinary retention, a prostatectomy can be performed. During surgery, part of the glandular tissue of the prostate will be removed, which will lead to an improvement in well-being.

The indications for surgery are:

• renal failure due to a violation of the outflow of urine;
• absent urination;
• ineffective drug therapy;
• detection of stones in the bladder;
• increased value of residual urine.

This method is not always surgical treatment prostate hyperplasia gives the desired result, because another technique is considered the gold standard.

Transurethral resection of the prostate

During the operation, a special device, a resectoscope, is inserted through the urethra. Under visual control, an electrode is inserted into the prostate, to which an electric current of certain parameters is applied. As a result, the hyperplastic tissues of the organ are burned out, and the blood vessels are cauterized.

It has been established that 93% of men feel better after this technique. After the operation, the patient is in the hospital, in the general ward. Three days later he is discharged. TURP (abbreviation for surgery) may cause some discomfort, but usually no pain. In general, men tolerate such surgery well, the death rate is 0.25%, and erectile disorders are possible in only 5% of those operated on.

A variation of TURP is laser vaporization. In this case, areas with benign hyperplasia are evaporated by a laser beam, and the risk of complications is much less.

open prostatectomy

If, as a result of the growth of glandular tissue, the prostate increases to 80 g, a prostatectomy is performed through an open access. A man under general anesthesia makes an incision in the lower abdomen, which serves as an operating access. The capsule of the gland is dissected, and the hyperplasia is removed.

Such a surgical intervention is more difficult for men than when removing hyperplasia by the methods described above. In addition, you will have to stay longer in the hospital, wear a urinary catheter and strictly monitor the rehabilitation period.

If a man cannot have an operation, and there is no positive result from the drugs, a catheter is placed in the urethra, which is constantly in it. This measure will restore the normal outflow of urine, although it will bring some inconvenience.

Physiotherapy treatment

In advanced cases of prostate hyperplasia, operations give a good result, but are associated with various risks. Therefore, scientists are constantly looking for alternative methods, including those based on some physiotherapy techniques.

These include:

1. microwave therapy.
2. Ultrasound treatment.
3. transurethral ablation.

The most promising are the developments in the field of application of holmium crystals. These techniques also include the currently practiced HoLEP effect, which makes it possible to isolate the entire prostate in an anatomically correct projection with a minimal risk of violating the integrity of its capsule. Exposure to the HoLEP laser allows the surgeon to work with prostatic hyperplasia of any size, the risk of internal bleeding and other complications will be negligible.

Conclusion

Most often, prostatic hyperplasia is a natural process that develops in an aging body. It is impossible to warn him. The only way a man can help himself is an annual examination by a urologist. The sooner the treatment of hyperplasia is started, the more likely it is to maintain a habitual lifestyle and not suffer from dysuric symptoms.