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Palliative treatment of prostate adenoma
Palliative treatment of prostate adenoma
Prostate adenoma treatment
Treatment can be conservative or surgical. Acute urinary retention requires emergency care.
The stage of the disease is of primary importance. In stage I, when there is no residual urine or it is small (up to 50 ml), conservative tactics are preferable. If possible, everything that leads to hyperemia of the adenoma should be excluded. A mobile lifestyle is recommended, regulation of bowel function (for constipation - enemas or mild laxatives), limiting the use of atropine and other antispasmodics, refusing to drink fluids before bedtime.
In stage I of the disease, sometimes synthetic sex hormones work well. In some patients, the frequency and imperativeness of the urge to urinate decreases, although the size of the adenoma does not decrease. In view of conflicting ideas about the role of androgens and estrogens in the development of adenoma, these drugs are prescribed empirically and dosed depending on the therapeutic effect. Testosterone preparations are prescribed at 15-20 mg per day, estrogens - sinestrol or diethylstilbestrol - at 5-10 mg per day in tablets or as injections. The course of treatment is from 15 to 20 days. The result is temporary. Treatment courses can be repeated at intervals of 2-3 months, but the effect of repeated courses gradually decreases.
For acute urinary retention caused by incidental causes (overcontinence, diarrhea and constipation), a warm bath works well. If there is no effect, urine is released by a catheter.
Although, in principle, treatment in stage I of the disease is conservative, many patients undergo surgery at this stage, despite the absence of residual urine. This includes patients who often have acute urinary retention or bleeding from congestive veins of the bladder and posterior urethra, as well as patients in whom nighttime urination is sharply accelerated (up to 5-10 times) and is not amenable to conservative treatment. In all these cases, removal of the adenoma is indicated.
If the adenoma is accompanied by the formation of stones in the bladder, it is necessary to open the bladder with a high-section operation, remove the stones and exfoliate the adenoma. In some cases, when the stone is small, the adenoma protrudes little into the bladder and there are no indications for adenomectomy, one can limit oneself to stone crushing.
In the II and III stages of the disease, surgical treatment of adenomectomy is indicated. The operation is usually performed by the suprapubic route, which is the most simple and convenient. A typical high-section operation (sectio alta) is used to open the bladder, incise the mucous membrane over the adenoma and exfoliate it (121). If the adenoma is removed completely, bleeding is negligible. With profuse bleeding, a swab is left in the bed of the excised adenoma, which is removed after 1-2 days
121. Transvesical adenomectomy.
Adenomectomy can be performed in one or two stages (moments), which is why one- and two-stage adenomectomy is distinguished. With a general good condition of the patient, a moderate amount of residual urine (not more than 400 ml), good or satisfactory kidney function, a one-stage operation is performed. In case of poor general condition, cardiovascular insufficiency, the presence of pyelonephritis, the amount of residual urine over 400 ml, a significant decrease in renal function, it is advisable to perform the operation in two stages (two-stage adenomectomy). The first moment is the imposition of a suprapubic vesical fistula (cystostomy), followed by drainage of the bladder until the second moment of the operation - exfoliation of the adenoma. The latter is performed through the existing cystostomy opening, which at the beginning of the second moment of the operation is expanded with an incision of the lower edge towards the symphysis. The adenoma is exfoliated at various times (from 3-4 weeks to several months, and sometimes more) after the first moment of the operation, depending on the general condition of the patient and the state of renal function.
The division of the operation into two stages, proposed by B. N. Holtsov, is very appropriate for reduced kidney function, since the imposition of a suprapubic fistula, eliminating stagnation of urine and high pressure in the urinary system, improves renal activity. In the general serious condition of the patient, with a deep, impaired renal function, with irreversible disorders of the cardiovascular system, it is necessary to limit the surgical intervention to cystostomy alone and the imposition of a permanent suprapubic vesical fistula. The patient in such cases most often uses a capitate catheter such as Pezzera or Maleko.
A. T. Lidsky proposed exfoliation of the adenoma from the median suprapubic incision without opening the bladder. The operation of A. T. Lidsky, incorrectly attributed to the Englishman Millin, makes it possible to exfoliate the adenoma under the control of the eye under aseptic conditions, without irrigating the wound with urine; this operation is indicated mainly in patients operated on in stage I of the disease, when there is no need for drainage of the bladder.
Palliative operations used in stage II of the disease include transurethral electroresection of adenoma. With the help of a cystoscope equipped with a loop-shaped electric knife, a tunnel is laid in the adenoma for the outflow of urine. In our country, this operation has not gained popularity due to the fact that it is not a radical intervention and it often causes complications - bleeding, narrowing of the urethra, pelvic vein thrombosis, urinary incontinence.
For the prevention of epididymitis, it is advisable to combine adenomectomy with vasorectomy (excision of the inguinal section of both vas deferens for 0.5-1 cm).
In the III stage of the disease, the only radical method of treatment is also adenomectomy, moreover, only two-stage. The operation is performed with great care due to severe violations of renal function and the general condition inherent in this stage of the disease. The interval between the first and second moment of the operation often has to be extended to several months, and in some cases it is limited to the imposition of a permanent suprapubic vesical fistula.
In case of acute urinary retention in stages I or II, bladder catheterization is performed, best of all with a Timan rubber catheter with a conical beak bent anteriorly. If the rubber catheters do not pass, a beak-shaped elastic Mercier catheter or, in extreme cases, a metal catheter can be used. The introduction of the latter in Prostate adenoma is associated with the risk of damage to the urethra and adenoma (formation of a false passage) and requires a lot of experience. It is safer to use a thick (20-22) metal catheter, which pushes the adenoma back and passes more easily into the bladder.
If catheterization is performed for acute urinary retention in stage I of the disease, when the bladder was completely emptied before the sudden delay, then after a single or repeated catheterization, urination is restored without residual urine.
In case of acute urinary retention in stage II, that is, against the background of chronic incomplete emptying of the bladder, urine should not be completely released. Rapid emptying of the bladder causes a sharp change in pressure in it and can lead to disruption of the integrity of the dilated veins of the bladder and profuse bleeding (hyperemia ex vacuo). Therefore, during the first catheterization, a certain amount of urine (from 200 to 300 ml) is left in the bladder, gradually reducing it during subsequent catheterizations.
Catheterization in acute urinary retention is sometimes not possible even for an experienced doctor. In such cases resort to capillary puncture of the bladder. A long thin needle for intravenous injections or lumbar puncture is inserted along the midline perpendicular to the long axis of the body, retreating one transverse palei upwards from the edge of the symphysis, to a depth of 4-8 cm, depending on the thickness of the skin, and urine is sucked out of the bladder with a syringe. Thick needles or trocars should not be used to avoid leakage of urine into the perivesical tissue after removing the needle (the puncture of the bladder is therefore called capillary).
Drug treatment of prostate adenoma
Conservative treatment of prostate adenoma
One or another method of treating patients with benign prostatic hyperplasia (BPH) is selected on the basis of indications and contraindications and is carried out strictly individually. This takes into account the age of the patient, concomitant diseases of other systems and organs, the degree of manifestation of clinical signs of the current pathology. Particular attention is paid to the size of the prostate gland (PG) and the direction of growth of the adenoma.
Who needs drug treatment of prostate adenoma
Drug therapy should be prescribed to patients with BPH with initial signs of urination disorders without involvement of the ureters and kidneys in the process, provided there are no complications, as well as contraindications to surgical intervention, both relative and absolute. Conservative treatment is carried out in patients who refuse surgical treatment or if it is postponed for various reasons.
Indications for drug therapy also include:
- maximum urine stream velocity of at least 5 and not more than 15 ml/sec;
- urinated volume of at least 100 ml;
- the volume of residual urine in the bladder is not more than 150ml;
- QOL-test result (Determination of the quality of life in connection with existing urination disorders) of at least 3 points;
- I-PSS (International Prostate Symptom Score System) score is greater than 8 and less than 19.
Drugs for the treatment of prostate adenoma
Thanks to a thorough study of the mechanisms of development of prostate adenoma at the molecular level, modern advances in the field of pharmacology have made it possible to create a wide range of drugs for the treatment of prostatic hyperplasia. The purpose of such drugs is to eliminate the cause of pathological growth in the gland.And this is very important - to fight the disease, "cutting it in the bud", which is fundamentally different from surgical methods of treatment.
There are three main groups of drugs with a pathogenetic mechanism of action: alpha-1-blockers, 5-alpha reductase inhibitors and special herbal preparations.
Alpha-1-blockers (alfuzosin, doxazosin, tamsulosin, terazosin) are used to expand the prostatic part of the urethra, which narrows due to the binding of specific hormones to alpha-1-adrenergic receptors. The goal of therapy is to restore an adequate passage of urine, to exclude its stagnation in the bladder.
5-alpha reductase inhibitors (finasteride or dutasteride) prevent the direct growth of prostate tissue. 5-alpha reductase is the enzyme that converts testosterone to dihydrotestosterone (DGTS), which stimulates the growth of prostate cells. When the enzyme is blocked, the amount of DGTS decreases, growth slows down and the size of the prostate decreases (up to 20-30%).
Special herbal preparations or phytotherapeutic agents are natural substances that inhibit other growth factors (except for DHTS). These include "Serenoa Repens Lipid Sterol Extract" and "Pygeum africanum Root Extracts". The mechanism of action of such drugs has not yet been studied enough, but a positive effect in the treatment of prostate adenoma has been proven.
The greatest effect is observed with combined treatment, especially with the correct combination of drugs of the first and second groups. Herbal preparations have not yet entered clinical practice widely, but they should not be neglected.
The use of hormonal drugs and cytostatics is relegated to the background today, due to their serious side effects. These drugs are prescribed if the above are ineffective, or as an addition to them in small doses.
When an infection is attached to an adenoma, polyene antibiotics are prescribed.
In the case of progression of adenoma, drug therapy may not always give the desired effect, but with the timely use of these drugs, the condition of patients improves significantly and the quality of life increases. In order to prevent re-enlargement of the prostate gland with subsequent surgical treatment, it is necessary to regularly conduct preventive courses of conservative therapy.
Contraindications
There are also contraindications to Drug treatment of prostate adenoma:
- acute stage of inflammation in the lower urinary tract;
- bladder stones ;
- Severe degree of renal failure. accompanied by prolonged excretion of blood in the urine;
- Suspicion of a malignant process in the pancreas.
In such situations, the tactics of treating the patient are considered individually.
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Medicines for prostate adenoma in men
Treatment of prostate adenoma (more correctly, benign prostatic hyperplasia) with the help of medications sets the following tasks:
- stop the growth of tissues, nodes, if possible, achieve reverse development;
- relieve inflammation and swelling of the prostate;
- reduce pressure on the urethral canal to normalize the passage of urine;
- prevent kidney dysfunction.
Drugs for the treatment of prostate adenoma, which have an evidence-based database of effectiveness, are prescribed by a urologist after a full examination of the patient. Only a specialist can decide how to properly treat adenoma.
A big mistake of men is following the "tested" recommendations of acquaintances, advertising completely unknown medicines. It is impossible to engage in the healing process on your own. It should always be remembered that a cancerous tumor can have similar symptoms.
What medicines are considered the best?
Drug treatment of prostate adenoma is prescribed simultaneously:
- with dietary advice;
- prescribing exercise;
- applying massage.
The result is well supported with complex therapy. It takes a long time, requires patience and repeated courses. Drugs are prescribed:
- in tablets;
- injection;
- rectal suppositories;
- microclysters.
The drug effect does not lead to a radical destruction of the adenoma, but it allows you to achieve an effect in the first and second stages of the disease, when there are still no complications from the kidneys. If hyperplasia has reached a large size, then only surgery can be an effective remedy.
Sometimes the choice of conservative therapy is determined by the patient's fear for the safety of erectile function, the possibility of having offspring. In a serious condition of the patient associated with concomitant pathology, the attending physician cannot recommend surgery.
Medicines for prostate adenoma with pathogenetic action are considered to be of the highest quality. They are tested by research, the results are proven by observation of patients.
These drugs include 2 groups of drugs:
Drugs for the treatment of prostate adenoma in men of symptomatic action consolidate the effect, remove the negative consequences of the disease. These include:
- antispasmodics;
- painkillers;
- drugs to fight inflammation;
- decongestants;
- complexes of vitamins and microelements;
- immunomodulators to support the body's defenses.
Given the elderly age of patients with adenoma, before treating prostate adenoma in men with medications, the doctor needs to think about their negative effect on other organs and systems. The male body ages earlier than the female body. He is more concerned with atherosclerotic changes.
Characteristics of drugs of the a-receptor blockers group
The group of drugs in its chemical structure is represented by a1-adrenergic receptor antagonists. It has been established that the receptors of this species are mainly located:
- on the neck of the bladder;
- prostate capsule;
- posterior urethra;
- composition of stromal tissue.
They are target "sites" for receiving signals from nerve fibers. By blocking the "receiving" surface, you can counteract the muscle contraction caused by the nerve impulse in the desired area.
Drugs for the Treatment of prostate adenoma in men of this group are divided:
- for superselective ones - they block only a1-A-adrenergic receptors, these are all drugs based on Tamsulosin (Silodosin and its stronger analogue Urorek);
- selective - antagonists of all (not only type A) a1-adrenergic receptors, these include Alfuzosin, Terazosin, Doxazosin.
Indications for the use of the group are determined by moderate or severe symptoms of prostate adenoma
In the treatment of a1-blockers in men, more free flow of urine from the bladder is observed. This is followed by:
- reducing the symptoms of urethral pressure;
- increasing jet speed;
- decreasing residual urine.
At the same time, it is not possible to achieve a reliable expected decrease in the volume of the prostate.
According to the negative effect on blood pressure (cause hypotension), drugs are distinguished in the group:
They have a hypotensive effect, therefore, they are not prescribed for hypotensive patients, and for patients with high blood pressure, a revision of the dosage of other drugs is required. Other drugs (Omnik, Flosin, Adenorm, Lokren, Fokusin) do not have pronounced hypotensive abilities, therefore they can be taken by patients with normal pressure.
The advantage of Tamsulosin derivatives is considered to be high efficiency in a fairly low dosage. The daily dose that has a therapeutic effect is ten times lower than when prescribing other drugs in the group.
A serious complication in patients taking drugs (especially Silodosin and Urorek) may occur during cataract surgery. Ophthalmologists call it the "flabby" iris syndrome, there is a threat to the postoperative course of the eye disease.
2 weeks before cataract surgery, the drug should be stopped
Urologists prescribe drugs along with Picamilon. The tool is considered a nootropic, includes the sodium salt of N-nicotinoyl-gamma-aminobutyric acid, is usually used for disorders of the brain. Thanks to antioxidant abilities, activation of metabolism in tissues, improvement of blood circulation, it helps to reduce the undesirable effect of drugs from the blocker group. Especially indicated in old age.
Features of the action of drugs from the group of 5a-reductase inhibitors
Reduced activity of the 5a-reductase enzyme disrupts the transformation of testosterone into dihydrotestosterone. Drugs of the group are the remedy for prostate adenoma, which can cause a reduction in the volume of the hyperplastic gland. Thus, the mechanical obstruction and compression of the urethra is reduced.
Inhibitors are currently used in the treatment of men:
The drugs of the group include:
They are prescribed for patients with prostate growth of more than 30-40 cm 3. The result is especially noticeable at an early stage of the disease. The course of treatment is long, not less than six months. Only long-term use gives the effect of reducing the volume. The result of therapy is the absence of reasons for surgical treatment in half of the patients.
The negative properties of the drugs of the group include:
- reduced sex drive;
- the occurrence of erectile weakness;
- a decrease in the concentration of PSA (prostate-specific antigen) in the blood, which is used to screen for prostate cancer.
Medicines for the treatment of adenoma work best when prescribing combinations of both groups of drugs.
Herbal preparations
Medicines from plants contain many active biological substances. Their action is much weaker than the above means. Urologists consider it as an auxiliary, symptomatic, allowing to influence the level of the patient's immunity.
Sabal palm extract has the ability to suppress the accumulation of dihydrotestosterone, eliminates the main cause of prostate hyperplasia
It is important that they can accumulate in the tissues of the prostate, add bactericidal properties to the urinary tract. The effectiveness of these funds has not been reliably confirmed. In practice, apply:
- Likoprofit - contains lycopene carotenoids, trace elements, vitamins;
- Perikson - fan palm extract;
- Tandenan - obtained from the bark of the African plum;
- homeopathic preparation Afala - well relieves pain in patients;
- herbal treatment.
Treatment courses with drugs are long, 4-5 months each.
Other symptomatic agents
To eliminate pathological changes in the tissues of the prostate and urinary tract, doctors use symptomatic agents that do not have a direct effect on the prostate gland. In order to relieve spastic contraction of the urethral canal and the neck of the bladder, anticholinergics or antispasmodics are prescribed.
Belladonna derivatives have the most pronounced effect - Atropine in injections, drops, candles with belladonna. Platifillin is less active. Drugs help relieve pain, muscle tension of the bladder. They are prescribed only by a specialist in limited doses (we remember that in the II-III stages of the disease, muscle atony sets in anyway).
To reduce swelling of the prostate tissue, diuretic groups of loop diuretics (representative - Furosemide) are recommended. Do not use drugs that irritate the urinary system. If there is a threat of inflammation in the bladder, kidneys, the doctor prescribes antibiotics for adenoma. These medicines also eliminate the symptoms of prostatitis, which often accompany gland hyperplasia.
Most commonly used antibiotics:
- cephalosporins (Cefuroxime, Cefaclor, Cefixime);
- aminoglycosides (Gentamicin);
- Fluoroquinolones (Norfloxacin, Ofloxacin, Ciprofloxacin).
In severe inflammation, it is necessary to make combinations of anti-inflammatory drugs. Consider the presence of signs of renal failure. In the event of chronic organ failure, aminoglycosides and tetracyclines are contraindicated due to the toxic effect on the renal parenchyma.
To activate the protective forces, patients are prescribed complexes of vitamins and microelements. They help restore metabolism in the glandular tissue of the prostate, reduce oxidation, improve blood circulation.
After consulting an experienced nutritionist, the patient can be prescribed orthomolecular therapy with high doses of vitamins and dietary supplements
Symptomatic therapy should not be put on the same level with special treatment of neoplasms. Information of an advertising nature, as experience shows, is able to deceive the patient's hopes for a full recovery, forcing him to considerable financial costs. But at the same time, the necessary time for conservative therapy will be missed.
The Chinese urological patch for prostate adenoma is best left for treatment by the Chinese themselves. No convincing data on its effectiveness yet exists. The set of herbal remedies given in the instructions is not able to penetrate the prostate tissue.
How useful is herbal treatment?
Herbs for prostate adenoma are recommended to be used with caution. Knowledgeable healers and herbalists never insist on the most effective action of herbal recipes. Nutritionists agree with popular recommendations for inclusion in the diet of patients:
- parsley;
- bow;
- linseed, pumpkin seed oil or juice.
After all, pumpkin seeds are rich in the trace element zinc. And this is the "main" mineral that affects the process of cell division, and hence the hyperplasia of prostate tissue.
The list of useful plant materials for the preparation of decoctions, infusions includes:
How to treat prostate adenoma with folk remedies?
The properties of celandine are known in the treatment of warts and other formations on the skin (papillomas, callus growths, cracks).
All parts of the plant are poisonous and should be handled with care. In the treatment of prostate adenoma, it is important:
- antimicrobial;
- antitumor;
- diuretic;
- An antispasmodic effect.
It must be remembered that with prolonged use and overdose, intestinal dysbacteriosis with diarrhea, nausea and vomiting is possible, and in severe cases, convulsions, hallucinations, dizziness with fainting.
Healing oil is prepared from celandine
From decoctions of herbs, additives are prepared in sitz baths, for microclysters. They help with pain, spasms of the urethra. Known anti-inflammatory plants are recommended in the form of herbal tea:
- lingonberries (berries and leaves);
- chamomile flowers;
- birch sap and buds;
- knotweed;
- licorice root.
To decide on the full treatment of prostatic hyperplasia, the doctor has to consider:
- stage of disease;
- patient's age;
- comorbidities in an elderly person.
Drug therapy is used by surgeons in the preoperative and postoperative period to consolidate the effect, prevent recurrent growth of nodes. Patients should trust the appointments of experienced professionals and not self-medicate.
Drug treatment of prostate adenoma: drugs for therapy
Is the drug treatment of prostate adenoma really effective? Everything will depend on the severity of the disease. At the initial stages, with the help of medicines, it is really possible to stop pathological processes.
If the adenoma is running, then the drugs will help only temporarily improve the quality of life. In severe cases, it is more appropriate to use radical surgical interventions or minimally invasive manipulations.
For the treatment of BPH, it is customary to use alpha-1-blockers, 5-alpha-reductase inhibitors and dietary supplements. Pain medications can be used to relieve the symptoms of adenoma.
Adenoma: definition and symptoms
In order to understand what an adenoma is, you need to remember the anatomy. So what is the prostate gland? The prostate is a glandular unpaired organ located directly below the bladder.
The urethra passes through the prostate gland. With the development of pathological processes, the prostate gland increases in size, thereby preventing the normal flow of urine.
Prostate adenoma (abbreviated as BPH) is a disease in which benign tumors form in the prostate gland. According to statistics, this pathology is most common among men over the age of 55.
A huge number of factors can lead to adenoma, ranging from an unhealthy lifestyle to inflammatory diseases of the pelvic organs. Moreover, adenoma quite often becomes the result of inflammation of the prostate gland.
In the presence of a benign neoplasm in the prostate, a person is concerned about the following symptoms:
To eliminate the above symptoms, you need to use certain medications that your doctor selects.
Alpha-1-blockers
Alpha-1-blockers are drugs widely used in urology. These medicines help to reduce the tone of the bladder, improve the outflow of urine, eliminate the symptoms of obstruction and irritation of the urinary tract.
Moreover, when using alpha-1-blockers, the tone of the smooth muscles of the prostate is stabilized. Simply put, medications in this group help improve the process of urination and reduce swelling of the prostate. Moreover, these drugs can be used in the treatment of chronic prostatitis.
Drug treatment of prostate adenoma involves the use of selective or non-selective alpha-1-blockers. The selective type is used much more frequently.
Selective alpha-blockers can be used even after radical surgery. Tamsulosin is considered the best medicine in this group. In the treatment of adenoma, it is enough to use 1 capsule daily.
It is worth noting that selective alpha-1-blockers have a number of contraindications for use. First, they cannot be combined with phosphodiesterase type 5 inhibitors. Still, such drugs should not be used if a person suffers from low blood pressure, liver failure or urolithiasis.
Non-selective alpha-1-blockers are used somewhat less frequently due to their lower effectiveness. But many patients prefer these particular products, as they are quite inexpensive.
Alfuzosin is considered the best non-selective alpha-1-blocker. The daily dose of this remedy for adenoma is 5-10 mg. Alfuzosin also has a number of contraindications for use. The drug is contraindicated in men suffering from chronic renal failure, coronary heart disease, liver failure.
Any alpha-1 blockers should not be taken for too long. The duration of treatment therapy is set strictly on an individual basis.
5-alpha reductase inhibitors and pain medications
The treatment of prostate adenoma necessarily involves the use of 5-alpha reductase inhibitors. Why is that? The fact is that the drugs of this group will stop the further growth of a benign neoplasm.
5-alpha reductase inhibitors help reduce the effect of male hormones on the prostate gland. This favorably affects the course of the disease. The prostate adenoma stops increasing in size, and over time, the prostate ceases to be edematous.
By the way, 5-alpha reductase inhibitors reduce PSA levels in adenoma. It is worth noting that the use of drugs in this group is completely pointless if the prostate does not increase in size with BPH.
The following side effects may occur with the use of 5-alpha reductase inhibitors:
- Weak potency.
- Breast enlargement
- Reducing the amount of sperm.
As noted above, adenoma is often accompanied by the appearance of a pronounced pain syndrome. Therefore, drug treatment is often supplemented by the use of painkillers.
You can quickly stop the pain syndrome with the help of such means as Ibuprofen, Movalis, Diclofenac. Painkillers produced in the form of suppositories are considered more effective.
Vitaprost, suppositories based on propolis, Voltaren are considered the best analgesic suppositories.
Phytopreparations for adenoma
Treatment of prostatic hyperplasia with herbal remedies is possible. Such medications must be prescribed by the attending physician. The advantage of naturopathic remedies is the fact that they can be safely combined with 5-alpha-reductase inhibitors and alpha-1-blockers.
Peponen is considered a good herbal medicine. The active ingredient of the drug is pumpkin seed oil. The medicine also contains sorbitol, water, gelatin and glycerin.
When using Peponen herbal medicine, you can:
How to take the medicine? The daily dose is 1800 mg. The frequency of taking the drug is 3-4 times a day, and the duration of treatment is 1 month, but the duration of therapy can be adjusted by the attending physician. By the way, we must remember that Peponen has a number of contraindications for use.
Among them are cholelithiasis, fructose intolerance, exacerbation of gastric and duodenal ulcers, allergies to pumpkin seed oil, glycerin or other components of the drug.
Peponene cannot be combined with anticoagulants. It must be remembered that the phytopreparation is relatively safe, but in case of an overdose, allergic reactions, ringing in the ears, and dyspepsia may occur.
Is there a drug of complex action that is convenient to use and does not have any contraindications? To date, there is such a tool - this is the Chinese urological patch ZB Prostatic Navel Plasters. It should be noted that dietary supplements can be used even by elderly patients.
This dietary supplement, unlike synthetic medicines, has absolutely no contraindications and side effects. The patch is very convenient to use - you just need to glue it on the navel and remove it after a certain time.
The phytopreparation can be used in the treatment of adenoma, prostatitis, weak potency and many other pathologies of the genitourinary system. The Chinese urological patch helps not only to stop the symptoms of adenoma, but also prevents further tumor growth.
Prostate adenoma
Prostate adenoma is an overgrowth of the glandular tissue of the prostate, leading to a violation of the outflow of urine from the bladder. Characterized by frequent and difficult urination, including nocturnal, weakening of the urine stream, involuntary excretion of urine, pressure in the bladder. Subsequently, complete urinary retention, inflammation and the formation of stones in the bladder and kidneys may develop. Chronic urinary retention leads to intoxication, the development of renal failure. Diagnosis of prostate adenoma includes ultrasound of the prostate, the study of its secret, if necessary, a biopsy. Treatment is usually surgical. Conservative treatment is effective in the early stages.
Prostate adenoma
Prostate adenoma is a benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of Prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. Prostate adenoma is characterized by a benign course.
Prevalence of BPH
Only a small part of patients suffering from prostate adenoma apply for medical help, however, a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 years and in half of men aged 50 to 60 years. Prostate adenoma is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 years and more than 90% of men over the age of 80 years. The severity of symptoms can vary significantly. Studies conducted in the field of urology suggest that problems with urination occur in about 40% of men with BPH, but only one in five patients in this group seek medical help.
Causes of prostate adenoma
The mechanism of development of prostate adenoma has not yet been fully determined. Despite the widespread opinion linking prostate adenoma with chronic prostatitis, there is no data that would confirm the relationship of these two diseases. Researchers have not found any relationship between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.
There is a pronounced dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that prostate adenoma develops as a result of hormonal imbalances in men during andropause (male menopause). This theory is supported by the fact that prostate adenoma never affects men castrated before puberty and, extremely rarely, men castrated after it.
Symptoms of prostate adenoma
There are two groups of symptoms of prostate adenoma: irritative and obstructive. The first group of symptoms in prostate adenoma includes increased urination, persistent (imperative) urge to urinate, nocturia, urinary incontinence. The group of obstructive symptoms characteristic of prostate adenoma includes difficulty urinating, delayed onset and increased time of urination, a feeling of incomplete emptying, urination with an intermittent sluggish stream, the need for straining.
There are three stages of prostate adenoma:
The dynamics of the act of urination is changing. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia at stage I of prostate adenoma does not cause concern in a patient who associates constant nighttime awakenings with the development of age-related insomnia.
During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after a night's sleep. Then the frequency of daytime urination increases, and the volume of urine released per urination decreases. There are imperative urges. The urine stream, which previously formed a parabolic curve, is released sluggishly and falls almost vertically.
At stage I of prostate adenoma, hypertrophy of the bladder muscles develops, due to which the efficiency of its emptying is maintained. There is little or no residual urine in the bladder at this stage. The functional state of the kidneys and upper urinary tract is preserved.
- Subcompensated stage of prostate adenoma (stage II)
At stage II of prostate adenoma, the bladder increases in volume, dystrophic changes develop in its walls. The amount of residual urine reaches 100-200 ml and continues to increase. Throughout the act of urination, the patient is forced to intensely strain the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure. The act of urination becomes multi-phase, intermittent, wavy.
The passage of urine along the upper urinary tract is gradually disturbed. Muscle structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are worried about thirst, polyuria and other symptoms of progressive chronic renal failure. When the compensation mechanisms fail, the third stage begins.
- Decompensated stage of prostate adenoma (Stage III)
The bladder in stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with intense tension of the abdominal muscles. The desire to empty the bladder becomes continuous. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or very small portions. In the future, the pain and urge to urinate gradually weaken. A paradoxical urinary retention characteristic of prostate adenoma develops (the bladder is full, urine is constantly excreted drop by drop).
At this stage of prostate adenoma, the upper urinary tract is dilated, the functions of the renal parenchyma are impaired due to constant obstruction of the urinary tract, leading to increased pressure in the pelvicalyceal system. The clinic of chronic renal failure is growing. If medical care is not provided, patients die from progressive CRF.
Complications of BPH
If therapeutic measures are not taken, a patient with prostate adenoma may develop chronic renal failure. With prostate adenoma, acute urinary retention sometimes develops. The patient cannot urinate with a full bladder, despite an intense desire. To eliminate urinary retention, bladder catheterization is performed in men, sometimes emergency surgery or bladder puncture.
Another complication of prostate adenoma is hematuria. A number of patients have microhematuria, but intense bleeding from the adenoma tissue (in case of trauma as a result of manipulation) or varicose veins in the region of the bladder neck are not uncommon. With the formation of clots, it is possible to develop bladder tamponade, which requires emergency surgery. Often the cause of bleeding in prostate adenoma is diagnostic or therapeutic catheterization.
Stones in the bladder with prostate adenoma may appear as a result of stagnation of urine or migrate from the kidneys and urinary tract. With cystolithiasis, the clinical picture of prostate adenoma is supplemented by increased urination and pain radiating to the glans penis. In the standing position, when walking and moving, the symptoms become more pronounced, in the prone position - it decreases. The symptom of "laying the stream of urine" is characteristic (despite the incomplete emptying of the bladder, the stream of urine is suddenly interrupted and resumes only when the position of the body changes). Often, with prostate adenoma, infectious diseases develop (epididymo-orchitis, epididymitis, vesiculitis, adenomitis, prostatitis, urethritis, acute and chronic pyelonephritis).
Diagnosis of prostate adenoma
The doctor performs a digital examination of the prostate. In order to assess the severity of symptoms of prostate adenoma, the patient is asked to fill out a urination diary. Perform a study of prostate secretion and smears from the urethra to exclude infectious complications. An ultrasound of the prostate is performed, during which the volume of the prostate gland is determined, stones and areas with congestion are detected, the amount of residual urine, the condition of the kidneys and urinary tract are assessed.
Reliably judge the degree of urinary retention in prostate adenoma allows uroflowmetry (urination time and urine flow rate is determined by a special apparatus). To exclude prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), the value of which should normally not exceed 4 ng / ml. In controversial cases, a prostate biopsy is performed.
Cystography and excretory urography for prostate adenoma have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes, to exclude diseases with similar symptoms or in preparation for surgical treatment of prostate adenoma, cystoscopy is performed.
Prostate adenoma treatment
The criterion for choosing treatment tactics for prostate adenoma for a urologist is the I-PSS symptom scale, which reflects the severity of urination disorders. According to this scale, if the score is less than 8, therapy is not required. At 9-18 points conservative treatment is carried out. If the score is more than 18, an operation is necessary.
- Conservative therapy for BPH
Conservative therapy is carried out in the early stages and in the presence of absolute contraindications to surgery. To reduce the severity of the symptoms of the disease, 5-alpha reductase inhibitors (dutasteride, finasteride), alpha-blockers (alfuzosin, terazosin, doxazosin, tamsulosin), herbal preparations (African plum bark extract or sabal fruit extract) are used.
Antibiotics (gentamicin, cephalosporins) are prescribed to fight infection, often associated with prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore the normal intestinal microflora. Immunity is corrected (alpha-2b interferon, pyrogenal). Atherosclerotic vascular changes that develop in most elderly patients with BPH prevent the flow of drugs into the prostate gland, so trental is prescribed to normalize blood circulation.
- Surgical treatment of prostate adenoma
There are the following surgical methods for the treatment of prostate adenoma:
There are a number of absolute contraindications to surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc.).If surgical treatment for prostate adenoma is not possible, bladder catheterization or palliative surgery - cystostomy is performed. It should be taken into account that palliative treatments reduce the patient's quality of life.
