Treatment of prostatitis in the Botkin hospital

Veliyev Evgeny Ibadovich

Veliyev Evgeny Ibadovich operates in robotic clinics:

Veliyev Evgeny Ibadovich

Botkin DZ g

From 1990 to 1993 He studied in an adjuncture at the Department of Urology VMA. C 1994 to 2003 Currently - Professor of the Department of Urology of RMAPO, G. S.P. Botkin

Doctoral dissertation on the topic "Optimization of surgical treatment of patients with localized prostate cancer", Protection site: Military Medical Academy

Has repeatedly passed internships in the clinics of Germany, France, Belgium, Spain. He has certificates for urology and oncology, the highest qualification category on urology.

The main directions of professional and scientific activity: operational oncurology (prostate cancer, bladder cancer, kidney cancer and egg cancer), kidney surgery and urinary tract, reconstructive surgery of urinary tract and bladder, andrology. It is a recognized specialist in the operational treatment of localized forms of prostate cancer and invasive bladder cancer.

In the photo: Veliyev Evgeny Ibadovich

E.I

Evgeny Ibadovich operates patients in GUZ city clinical hospital named after S.P. Botkin and heads the urological department of the clinic. Robot-assisted operations in the clinic are held since 2013 at the da Vinci SI complex. Evgeny Ibadovich conducted more than 300 urological robot-assisted operations (radical prostatectomy, kidney resection, radical cystectomy, plastic of the ureter of the ureter), the greatest experience in conducting a robot-assisted radical prostatectomy.

Urological compartment

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Urology Clinic and Surgical Andrology of the Botkin Hospital

Clinic and the Department of Surgical Andrology and Urology GOU DPO RMAPO has ample opportunities for the modern diagnosis and treatment of various diseases of the genitourinary system. Also, the department offers those who wish to undergo postgraduate education in the framework of general urology and its persons wide opportunities for learning.

The central room of the clinic can be found in the 16th Hospital Corps to them S. P. Botkin. This building of the urban clinical hospital was renovated in accordance with all modern requirements and received the equipment required for a full-fledged hospital infrastructure.

On each of the three floors of the case are urological compartments, which are total ready to take up to 60 patients to the hospital in new comfortable chambers. There are two operational blocks for endovideosurgical, open and endoscopic surgery, as well as diagnostic cabinets. In the case there is a clinical diagnostic laboratory and a resuscitation compartment.

On the first floor there is a spacious conference room equipped with all the necessary multimedia techniques, which, among other things, allows you to view live surgery broadcasts from the operating room. As for the 10th Hospital Corps, it contains a branch of the urgent urology of Botkin's hospital, designed for 30 patients and equipped with its own operable and diagnostic departments.

ATTENTION It is worth paying the 22nd surgical corps that was equipped according to all modern standards. There are 9 urological beds and the whole technique necessary for remote lithotripsy and endovideosurgery. Also in this case there are full operational.

Key areas of work

At the moment, the department, as well as the urology clinic and surgical andrology has the status of a modern academic center representing all the persistentities of urology. A lot of attention in the center is paid to early diagnosis and screening. Moreover, the diagnosis is focused on the detection of actually the most common malignant tumor in the men's prostate cancer. As for the main direction of the department of the department and clinic, it is the diagnosis of neoplasms of the genitourinary system and subsequent surgical treatment, it is essentially operational oncurology.

In addition to the usual diagnostic measures (a transrectal ultrasound, blood test for the PSA) in the practice of the department was introduced stationary and multipoint biopsy of the prostate gland. Also, such healing operations are often performed as crotted and radical engaged prostatectomy (from the mini-seater including). Due to the fact that in the branch of the urology of the Botkin hospital, the newest small-scale surgical technique is used, after such operations, patients are discharged from the hospital within 4-5 days.

Another priority direction of the urology clinic is surgical treatment of bladder cancer.At different stages of this disease, surgeons perform both transurethral resection of the bladder and radical cystectomy (various methods of urine diversion are used, including orthopedic cytoplasty).

When working with kidney tumors, both organ-preserving surgical techniques for kidney resection and radical transabdominal nephrectomy are used.

Surgical urogynecology is actually one of the strengths of the clinic. All operations related to stress urinary incontinence and pelvic organ prolapse in women are performed at a high level of professionalism. The specialists working in the clinic have a wealth of experience, which, combined with the original methods of operations developed by Professor, Head of the Department Laurent O.B., allow achieving the maximum result in the treatment of urogenital fistulas in women.

Active development is also carried out in the field of reconstructive plastic surgery. The specialists of the clinic undertake the most complex types of reconstruction of the lower and upper urinary tract. Open and endoscopic plastics of the pelvic-ureteral segment, augmentation cystoplasty and various options for ureter reconstruction are performed. For the treatment of patients suffering from urogenital and ureteric fistulas, reconstructive plastic surgery is performed using the latest technologies and techniques.

The specialists of the clinic pay special attention to the development of surgical andrology. In addition to classical methods, the clinic also uses such modern methods of surgical correction of the male infertility factor as direct sperm sampling from the testicle and its epididymis, microsurgical varicocelectomy, as well as microsurgical operations aimed at reconstructing the vas deferens.

Doctors of the clinic widely use penile prosthetics, using modern models of implants in the case of diagnosing erectile dysfunction. The clinic also has departments of endourology and endovideosurgery (separate operating rooms are equipped for transurethral resection, laparoscopic operations, percutaneous interventions and contact ureterolithotripsy).

Surgeons of the Urology Clinic of the Botkin Hospital are able to offer minimally invasive removal of urinary stones of virtually any localization and size. This result became available due to the active use of the latest endovideo technologies. Since the treatment is carried out with the help of a competent combination of metaphylactic and preventive measures with new methods of lithoextraction, litholapaxy and lithotripsy, the clinic has the status of a full-fledged modern center for the treatment of urolithiasis. Professional diagnostics of the causes of stone formation, carried out individually for each patient, also deserves attention.

Regarding the work of the Department of Endovideosurgery, it is worth noting that it performs the following operations using laparoscopic techniques: radical and simple nephrectomy, resection of kidney cysts, hydronephrosis plasty, varicocelectomy, ureterolithotomy and pelvic lymphadenectomy.

Directly at the department itself, a lot of attention is paid to the diagnosis and effective treatment of urinary tract infections and inflammatory diseases of the urogenital area. Due to the fact that modern diagnostics, rational antibiotic therapy and competent drainage of the urinary system are used in the treatment process, patients after urological operations and procedures quickly go through the rehabilitation process.

As for the faculty of the department, they take an active part in the process of postgraduate medical education. Every year, up to 300 doctors at the department undergo advanced training in the specialization of urology with subsequent certification. Those specialists who intend to constantly improve their level of knowledge will definitely be interested in the thematic improvement cycles in surgical andrology, oncourology, outpatient urology and urogynecology. Moreover, the opening of a cycle in laparoscopic urology is already planned.

In addition, the specialists of the department are constantly active in scientific activities. Candidate's dissertations were defended by 26 specialists, and doctoral dissertations by 5.

Employees working at the department every year speak at the congresses of the European and American Urological Associations. The department is open to the transfer of experience and knowledge to colleagues, in order to increase the dynamics of the development of urology on a national scale, which will bring it closer to the level of international standards of treatment.

Department of Urology, 14th Botkin Hospital

This department is located on the 2nd floor of the 10th building of the hospital and is designed for 35 patients. It is noteworthy that the compact and cozy building 10 is located directly in the central part of the hospital and is easy to spot due to the bright red brick finish.

Urological patients are admitted in emergency mode every day and around the clock.In the urology department 14, both women and men suffering from various urological diseases are treated. To ensure that all the tasks assigned to the department were carried out as efficiently as possible, it was equipped with all the necessary modern equipment. There is an x-ray room, which is equipped with an electron-optical converter. Thanks to him, it becomes possible to carry out various manipulations under x-ray control. The department also operates an ultrasound diagnostic room, in which each staff member received the necessary work experience. For surgical treatment of patients, an operating room is equipped, designed for 2 tables, on which any surgical urological aids are performed, ranging from radical retropubic prostatectomy and cystoprostatvesicolectomy with the formation of various methods of urine diversion and ending with trocar cystostomy. Endourological operations on the urethra, bladder and prostate are constantly practiced.

In turn, the diagnostic range of the department has many directions: they work with patients suffering from tumors of the bladder, prostate, kidneys, inflammatory diseases of the genitourinary system, urolithiasis, etc.

In addition to the scientific component of the work of the department, active pedagogical and scientific activities are carried out on an ongoing basis. The duties of the senior resident of the department are performed by Yengay V. A. He managed to defend his Ph.D. thesis, which was devoted to the diagnosis and treatment of kidney cancer.

PhD students and clinical residents are trained in the department on a permanent basis.

Urology Department 41

A 60-bed urogynecological department was opened at the Botkin City Clinical Hospital in 1976. 32 years after the repair work, it gained a new life as a urological one, designed for 24 beds in 10 wards with comfortable conditions of stay. There is a branch on the territory in building 16 on the 3rd floor. The department receives patients with various urological problems for examination and treatment (by conservative and surgical methods). Highly qualified surgeries of the widest profile are carried out here with priority areas in female urology, urological oncology, laparoscopic and reconstructive surgery.

The clinic of the International Center for Pelvic Surgery is based in the urology department of the Botkin Hospital to provide highly specialized care to patients with such ailments as:

• Enuresis or stress urinary incontinence in women (TVT and TVT-O sling procedures; Birch laparoscopic method);
• Pelvic organ prolapse (laparoscopic sacrocolpopexy, Prolift vaginal extraperitoneal colpopexy);
• vesicovaginal, ureterovaginal, vesico-vaginal-rectal fistulas;
• mechanical or postoperative injuries on the ureters, bladder and anterior wall of the rectum (reconstructive laparoscopy);
• tumors and cysts of paraurethral and vaginal;
• combined urogenital pathologies requiring surgical treatment.

Highly qualified care is also provided to cancer patients with diagnoses:

• cancer of the bladder and kidneys;
• Malignant and benign prostatic hyperplasia.

In addition, the department also hosts the laparoscopic department of the urological clinic of the Russian Medical Academy of Postgraduate Education. Laparoscopy is a very promising method of surgical intervention due to its low trauma, which can significantly reduce the length of stay in the hospital (on average, no more than 7 days) and the recovery period. The laparoscopic method can be used in various urological situations, including operations for the radical removal of organs (nephrectomy, prostatectomy) and pyeloplasty for hydronephrotic transformation of the kidney. Moreover, few centers in the world can perform microlaparoscopy through instruments with a 3mm lumen and a single access to the surgical field, which avoids noticeable postoperative scars on the patient's body.

Thus, the following types of operations are performed in the department:

• radical removal of the prostate (prostatectomy), including laparoscopic extraperitoneal removal;
• removal of a kidney (nephrectomy), incl.laparoscopic method;
• kidney resection for oncology;
• removal of the bladder (cystectomy);
• sparing surgery for enuresis and prolapse of the pelvic organs in women (TVT, TVT-O, Prolift);
• plasty of the renal pelvis with hydronephrotic transformation by abdominal and laparoscopic methods;
• transurethral surgery for prostate adenoma and bladder tumors;
• any general urological intervention.

The stay in the clinic is also very comfortable due to the conditions created for patients: most of the wards of the urology department are designed for 1 or 2 people, there is a refrigerator, TV, shower and toilet rooms, a communication system with staff and oxygen access. Postoperative boxes are equipped with modern panels for round-the-clock monitoring of the patient's vital signs with data output to the computer display of the resuscitator on duty. Comfortable spacious waiting rooms complete the picture of the department.

Urology Department 56

This department is located on the 4th floor of the 22nd medical building. Here, patients are offered various types of reconstructive plastic and oncourological surgical interventions. The key activity of the department's specialists is the surgical treatment of patients with oncourological diseases (cancer of the kidney, prostate, testicle and bladder). In addition to the effective treatment of oncology, the surgical department is aimed at maintaining the level of quality of life and functionality of patients who have undergone treatment.

Patients who have been diagnosed with urological diseases of any complexity can count on effective treatment and a quick recovery. Such results are actively promoted by the high level of comfort in the department, the constant clinical practice of the hospital specialists that meets international standards, and, of course, the dedication of the team to their work.

Robot-assisted surgery has been at the forefront of operative urology for the past few years. Thanks to the fact that digital equipment, computer technology and robotic instruments are constantly being improved, the specialists of the department were able to bring minimally invasive surgery to a fundamentally new level of visualization and accuracy.

Operating Block 56 uses the latest generation of the da Vinci Si system. This robotic system has two components:

The robot itself consists of a rack equipped with four manipulators, one of which is used for the camera, and the rest for working tools. The surgeon, who is behind the remote control console, controls the movements of the manipulators and the camera. Small robotic instruments are placed into the abdominal cavity through special ports, which are incisions with a diameter of 1-1.5 cm. Thanks to the ability to use high-definition 3D magnification (3D HD), the surgeon is able to visualize the anatomical structures in maximum detail. Combined with the use of precision instruments that have high freedom of movement, this technique provides extremely accurate tissue dissection.

The following types of robot-assisted surgical interventions are performed in Urology Department 56:

Robot-assisted adenomectomy (in case of severe infravesical obstruction and large prostate);

Radical prostatectomy (if indicated, a nerve-sparing technique is used);

Robot-assisted sacrocolpopexy in case of diagnosing pelvic organ prolapse in women;

Robot-assisted nephrectomy (kidney resection in the presence of a tumor lesion);

Robot-assisted Boari operation for diagnosing strictures of the lower third of the ureters;

Robot-assisted plasty of the ureteropelopelvic segment (hydronephrosis, UMS stricture).

Urological diseases

Subcategories

Prostate cancer

Bladder cancer

Prostate adenoma

Male infertility

Inflammatory diseases

Hydronephrosis

Angiomyolipoma. Unique observation.

Patient K., 63 years old, came to our department for a consultation on angiomyolipomas of the right kidney of large size (8cm). An additional examination was performed, according to which a cyst of the right kidney with a tissue component suspicious of a tumor (4 cm) was also found, as well as a small tumor of the right kidney 1.5 cm. After passing all the necessary tests for hospitalization, she was admitted for planned surgical treatment. The indications for the operation were a large angiomyolipoma (with possible spontaneous rupture and bleeding), as well as the presence of a cyst suspicious of a tumor, and a small tumor itself.Intraoperatively, the presence of three kidney formations was confirmed, a decision was made to perform an organ-preserving operation: resection of the right kidney with angiomyolipoma, resection of the right kidney with a cyst (a tumor in the cyst was confirmed), resection of the right kidney with a tumor. Which was done. Blood loss 40 ml. next

Consequences of prostate biopsy

• Posted in Urological Diseases

The Prostate biopsy procedure is usually well tolerated and does not cause serious complications. After the procedure, patients are most often worried about minor discomfort in the rectal area, which disappears on its own a few hours after the biopsy. Also, within 3-7 days after a prostate biopsy, there may be a slight admixture of blood in the urine (gross hematuria) and an admixture of blood during defecation. Hemospermia (an admixture of blood in the ejaculate) can be observed within 1-2 months. All of the above symptoms are a normal consequence of a prostate biopsy and usually do not require medical intervention or medication. Infectious complications after a biopsy are quite rare, in approximately 1% of cases.

How is a prostate biopsy performed

• Posted in Urological Diseases

Prostate biopsy is performed on an outpatient basis, i.е. in most cases, does not require hospitalization. The procedure is performed under local anesthesia with lidocaine. The duration of the biopsy is from 5 to 10 minutes. With proper anesthesia and preparation of the patient, the procedure is comfortable and painless. With the help of a Transrectal ultrasound probe inserted into the rectum under ultrasound control, several injections are made into the prostate gland with a small column of tissue taken. The resulting tissue columns, placed in separate vials, are marked according to the localization of the injection and sent for pathomorphological examination.

Conditions necessary to perform a proper prostate biopsy.

1. Specialized medical institution 2. Experience and qualifications of the specialist 3. Availability of special equipment: a modern ultrasound machine with a special transrectal sensor with the possibility of biplanar scanning and adapted for biopsy.4. Adequate antibacterial prophylaxis can reduce the risk of inflammatory complications by a factor of ten. Adequate anesthesia, allowing you to make the necessary (at least 12) number of injections into the prostate gland.6. Injection topping: special marking of each obtained biopsy on the prostate diagram, which provides an accurate location of the identified histological changes. 7. Pathological examination should be performed in accordance with international standards and criteria: correct assessment of the Gleason sum, calculation of the % of damage to the biopsy column, perineural and perivascular invasion.

Why is this needed?

The above criteria for performing a biopsy of the prostate allow you to adequately choose the method of treatment. And in the case of operational tactics, plan the operation taking into account the best oncological control and preserving the maximum number of structures responsible for urinary retention and erectile function.

Hydronephrosis

Impaired outflow of urine from the kidney due to obstruction in the area of its connection with the ureter (hydronephrosis) is the most common congenital disease of the ureter. This can lead to pain, urinary infections, kidney stones, hypertension, and a gradual decline in kidney function. In about two out of three patients with hydronephrosis, obstruction in the area of the ureteropelopelvic segment is caused by congenital narrowing in the ureter and in another third by a bend in the ureter over the vessel supplying the lower pole of the kidney.

Inflammatory diseases

• Saturday, 14 September 2013 11:16
• Posted in Inflammatory Diseases

Infectious-inflammatory urological diseases are a complex problem, both for diagnosis and for treatment. There are many congenital and acquired diseases of the urinary tract. One in five women suffer from recurrent urinary tract infections. Despite the use of modern methods of diagnosis and treatment, in 30-40% of patients, the inflammatory process acquires a relapsing course. Therefore, this problem is very relevant.

Persistent dysuria, pain during urination, pain over the womb, persistent changes in urine tests, do not allow women to lead a normal life, cause social, sexual, maladaptation and psycho-emotional disorders.

Despite the well-known and developed diagnostic criteria, patients do not receive adequate treatment for a long time.

Urological diseases require increased attention from complaints, anamnesis, thorough examination and timely treatment.

The causes of persistent dysuria can be diseases such as:

Specific and non-specific inflammatory diseases of the urinary tract (Acute / chronic cystitis, sexually transmitted infections (STIs))

Post-inflammatory changes in the urothelium (leukoplakia, bladder neck pseudopolyposis, etc.

Interstitial cystitis/Bladder Pain Syndrome.

Overactive bladder

Urinary tract tuberculosis, etc.

In our department, under the guidance of highly qualified doctors, and thanks to proven diagnostic principles, we successfully carry out complex treatment of patients with these diseases, helping to cope with the disease.

We also carry out active scientific work, paying attention to morphological studies, which allows us to differentiate cystitis from other diseases of the bladder, as well as to improve or obtain new information about these diseases.

Prostate adenoma

Benign prostatic hyperplasia (BPH, or prostate adenoma) is a common morphological diagnosis that is established in 90% of men over 80 years of age, i.e. the prevalence of this disease increases with age. By the age of 60, according to various authors, from 13 to 50% of men suffer from benign prostatic hyperplasia. On average, half of these patients have a macroscopic enlargement of the gland, and 25% of patients develop clinical symptoms requiring treatment.

Diagnosis of prostate adenoma

• Wednesday, 20 June 2012 07:05
• Posted in BPH

Symptoms and methods for diagnosing prostate adenoma

Benign prostatic hyperplasia leads to various urinary disorders. Lower urinary tract symptoms (LUTS) are the main clinical manifestation of prostate adenoma and significantly impair the quality of life of patients. A number of studies have shown that severe LUTS bother patients more than such serious diseases as arterial hypertension, diabetes mellitus, exertional angina, etc. If left untreated, the symptoms usually progress due to a gradual increase in the volume of the prostate gland, an increase in symptoms of infravesical obstruction leads to the development of formidable complications requiring emergency surgical intervention. The choice of treatment method in each case should be based on the data obtained as a result of a thorough examination of the patient.

Digital rectal examination is an important diagnostic procedure that allows you to assess the size of the prostate gland, the presence of areas of compaction (differential diagnosis with prostate cancer in combination with determining the level of PSA), pain (indicates the presence of chronic prostatitis), etc.

A blood test for PSA is mandatory when examining a patient with benign prostatic hyperplasia. PSA is used not only for differential diagnosis with prostate cancer, but also plays a role in predicting the progression of symptoms of prostate adenoma (BPH), enlargement of the prostate gland and the occurrence of complications, such as acute urinary retention.

Ultrasound examination (ultrasound) is one of the main and highly informative methods for diagnosing prostate adenoma (BPH). It is used to determine the size of the prostate gland, determine the amount of residual urine, the presence of calculi (stones) in the bladder, the condition of the upper urinary tract. The use of transrectal ultrasound (TRUS) for prostate adenoma (BPH) often does not provide more information than a standard transabdominal examination.

Uroflowmetry is a method that allows you to determine the speed, time and volume of urination. Used to assess the symptoms of infravesical obstruction and monitor ongoing treatment for prostate adenoma (BPH).

There are also various questionnaires to individually determine the severity of urinary symptoms and monitor treatment. The most commonly used in clinical practice is the international system of summary assessment of diseases of the prostate (IPSS).

Diagnosis of prostate cancer

• Posted in Prostate Cancer

Diagnosis of prostate cancer

The main methods for diagnosing prostate cancer are the determination of blood PSA levels, digital rectal examination (DRE) and transrectal ultrasound (TRUS).Diagnosis Prostate cancer is established only on the basis of histological examination in the presence of adenocarcinoma (PC cells) in prostate biopsy columns or cytological conclusion after fine needle aspiration biopsy.

Digital rectal examination (DRE)

Digital rectal examination is a mandatory method of examination when a man contacts a urologist. Suspicions arising from DRE are an absolute indication for prostate biopsy. Approximately 18% of all prostate cancers are identified based on suspicious changes on digital rectal examination alone, regardless of PSA levels.

Transrectal ultrasound (TRUS)

The diagnostic value of TRUS in the diagnosis of prostate cancer is low, however, a number of experts attach great importance to the presence of hypoechoic areas in the peripheral parts of the prostate gland and the presence of areas of hypervascularization (increased blood supply) in TRUS with Doppler ultrasound.

Prostate biopsy

Prostate biopsy is performed to diagnose and stage prostate cancer. Prostate biopsy is performed on an outpatient basis, i.e. in most cases, does not require hospitalization in a hospital, local anesthesia is the method of anesthesia. The duration of the procedure is from 5 to 10 minutes. Using a transrectal ultrasound probe inserted into the rectum under ultrasound control, several injections are made into the prostate gland with a small column of tissue taken. The resulting tissue columns (placed in separate vials) are marked according to the localization of the injection and sent for pathomorphological examination. Of great importance in establishing the correct diagnosis is the qualification of a doctor who performs a prostate biopsy and the experience of a pathologist who examines the material obtained.

Repeated prostate biopsy

In some cases, after the initial prostate biopsy, a second procedure is necessary. The main indications for a repeat biopsy include:

• atypical small acinar proliferation - ASAP
• high-grade prostatic intraepithelial neoplasia (PIN) in more than 1 biopsy core

Computed tomography (CT) and magnetic resonance imaging (MRI)

CT and MRI are currently the standard high-tech examination methods and can be used to assess the local spread of the tumor process, however, none of these methods is mandatory and completely reliable. In terms of detecting metastatic lesions of the pelvic lymph nodes, CT has greater accuracy compared to MRI, however, neither method is reliable, because in some cases the enlargement of the lymph nodes has a different reason.

Osteoscintigraphy

This diagnostic method is used to detect metastatic bone lesions not only in prostate cancer, but also in tumors of other localizations. The essence of the method lies in the intravenous administration of a special substance (radiopharmaceutical) followed by registration of its distribution and accumulation in the skeleton using gamma radiation of an isotope that is part of the drug. Timely detection of damage to the skeletal system in prostate cancer can prevent the development of bone tissue destruction by drug therapy. Osteoscintigraphy has a high sensitivity and specificity in the diagnosis of bone metastases in prostate cancer. The indication for this diagnostic method is a PSA level of more than 20 ngml (with histologically verified prostate cancer), the presence of a non-differentiated locally advanced process.

In our department, you can get advice on the results of a blood test for PSA and other methods of research, perform a TRUS and, if necessary, be hospitalized for a prostate biopsy. In our department, prostate biopsy is performed according to European standards under ultrasound guidance. The material for the study can be sent both to the pathoanatomical department of the GKB. S.P. Botkin and to most oncological institutes g

Prostate cancer treatment

The choice of tactics for the treatment of prostate cancer directly depends on the stage of the disease, the degree of tumor differentiation (Gleason sum), PSA level, age and somatic status of the patient (general health).

The preoperative (clinical) stage of prostate cancer is established on the basis of prostate biopsy data (presence of adenocarcinoma in biopsy columns), digital rectal examination data (presence or absence of a palpable focus in the prostate gland) and, if necessary, data from CT, MRI, scintigraphy skeleton and other research methods.

Prostate adenoma treatment

• Wednesday, 20 June 2012 06:29
• Posted in BPH

Methods of treatment of prostate adenoma

Modern urology has numerous methods of treating this disease. Currently, there are methods of both conservative and surgical treatment of prostate adenoma (BPH).

Thanks to the development of pharmacology, well-chosen conservative drug therapy for prostate adenoma.

Currently, to alleviate obstructive and irritative symptoms of prostate adenoma (BPH), drugs of the alpha-blocker group are used. The most modern drugs selectively block alpha-adrenergic receptors located in the prostatic part of the urethra and bladder neck, significantly alleviate the symptoms of adenoma and have a minimal number of side effects.

Also, for the treatment of patients with prevailing irritative symptoms (frequent, difficult to control the urge to urinate, frequent nighttime urination), combined drug therapy for prostate adenoma combining the use of alpha-blockers and 5-alpha-reductase inhibitors is successfully used.

Despite the success of conservative therapy, the frequency of operations for adenoma has not significantly decreased in recent years. With the ineffectiveness of drug therapy, the progression of symptoms of adnenomas of the prostate, the large size of the prostate gland and the occurrence of complications, surgical treatment is used. Recently, the transvesical technique for performing adenomectomy has given way to the retropubic technique due to less trauma, quick rehabilitation, less blood loss, and the absence of the need for additional drainage of the bladder through a cystostomy. The Clinic of Urology and Surgical Andrology of RAMPO has developed its own improved technique for performing retropubic adenomectomy, which has been introduced into our practice. Through a small median incision in the lower abdomen (6-8 cm), access to the prostate gland is made. The capsule of the prostate gland is opened and the adenomatous nodes are exfoliated. The operation ends with the installation of a urethral catheter, which is removed after 8-10 days. Retropubic adenomectomy is less traumatic, since the entire operation is under visual control and is characterized by fewer postoperative complications. The advantage of open surgery is the extremely low percentage of recurrences of prostate adenoma. The disadvantages include the risk associated with surgery, the occurrence of urethral stricture (narrowing of the urethra), urinary incontinence, however, with the improvement of surgical technique, the risk of complications is minimal.

In addition to open operations, minimally invasive endoscopic methods for the treatment of prostate adenoma are widely introduced into practice. The latter in many urological clinics minimize the percentage of open interventions. Among endoscopic techniques, the "gold standard" against which the effectiveness of other methods is compared is transurethral resection of the prostate (TURP). Removal of adenomatous tissue is performed using a resectoscope - a special instrument inserted into the urethra. Using a loop and electrocoagulation, sections of the prostate tissue are made. The duration of the operation is 60-90 minutes. The operation ends with the installation of a urethral catheter for 3-5 days. Complications after this operation are extremely rare. Transurethral resection of the prostate is one of the most effective methods of minimally invasive treatment of prostate adenoma.

In our clinic, you have access to all possible types of examination and effective treatment of prostate adenoma, which modern urology has.