Adenoma of the prostate gland — one of the most common urologic diseases. Suffers from it every second man over 50 years, and after 60 years — for 75% of men.
On what is dangerous BPH, and about which there are modern methods of dealing with it, we talked tochief physician of a multidisciplinary clinic "Capital Doktor", Doctor of Medical Sciences,
— Why there is BPH?
There may be a variety of factors play a role, but, as a rule, the development of adenomas associated with reduced levels of the male sex hormone — testosterone. Oh, and this, in turn, is associated with age-related changes in the male body.
— How is the disease manifests itself?
Some men sprawl adenomatous tissue in the prostate does not cause discomfort — such adenomas do not require surgical intervention. Others have overgrown tissue begins peredavlivat the urethra, and then the person starts serious problems with urination. If the tumor in the prostate gland benign, the main task of the surgeon — to remove adenomatous tissue and restore the patient to normal urination.
— And if you do not remove the adenoma in time?
If you run the disease, the consequences can be very sad.
After some time, the reserves are depleted, hypertrophied bladder, "tired", starts thinning and can not completely evacuate all the urine, respectively, accumulated residual urine. It is becoming more intravesical pressure rises to a level that the urine begins to fall back into the ureters into the kidneys and showered. Increased pressure within the kidney leads to the fact that it starts thinning parenchyma Previously such patients … died from renal failure. Their kidneys just stopped working.
— But now all this is treated?
Of course. There are several ways to restore normal urination with prostate cancer. First of all, this is a conservative approach. It is aimed at the removal of inflammation in the prostate gland and relaxation of smooth muscles of the urinary tract (for ease of urination).
However, it is necessary to take an individual approach to each patient. One situation that requires one treatment, the other — the other. It should be borne in mind that conservative methods are not fully heal from BPH, they only help to relieve the unpleasant symptoms.
— That is, no surgery can not do?
Unfortunately, more often than it is. Before surgical treatment of BPH was performed using open surgery: The surgeon cut through the abdominal wall, exposed the bladder, removed the adenomatous components, after which the patient recovered normal urination.
— And now? Is not there more high-tech methods of removing enlarged prostate?
Some time ago, have become popular methods of removing adenomas associated with the use of new energy sources. For example, the destruction of adenomatous tissue with ultrasound, microcurrent (microwave therapy) and liquid nitrogen (cryotherapy). However, all these methods have one major drawback — they are lightly managed, the surgeon can not accurately predict their impact and influence on the result.
— What a way to remove the prostate adenoma, in your opinion, the most effective?
Until recently, the gold standard in urology was considered a transurethral resection (TUR) — endoscopic surgery, in which the surgeon may cut prostate gland adenoma without incision of the abdominal wall, layer by layer from the inside. This is an effective technique, it is still widely used in urology.
— But she also has disadvantages?
Yes. The problem is that our reproductive organs are very well supplied with blood, so that all such operations are associated with severe bleeding. This is especially true of open transactions. Any urologist who has experience in surgery, knows that prostatectomy — the most traumatic operation. Previously, it could even lead to the death of a patient
Another shortcoming of the method — you can not handle too much cancer. Typically, the indication for transurethral resection — prostate weight of 60 grams. The measurement is performed using an ultrasound scanner that quickly and accurately takes measurements.
— And what kind of methods you choose?
Here are all individually. In any case, the decision is made taking into account the characteristics of the doctor of the disease and the patient's overall health.
In addition to these methods of surgical treatment of BPH, there is one about which I have not mentioned. Recently, in adenomatous tissue destruction began using laser radiation. First resection performed Holmium laser. This technique had both positive and negative aspects, but the negative side was larger, so it is not very much caught.
Multidisciplinary clinic "Capital Doktor"
- Operative Urology
- Male menopause
- photoselective laser vaporization
But progress does not stand still. About three years ago in America there was a so-called "green laser". The technique is based on laser radiation with a wavelength of 532 nm that passes through a special crystals
At the moment, PVP — the most modern and effective method of treatment of adenomas.
— What about the cons? Are they not?
Well, except that in the duration of the operation. Removal of the adenoma with "green laser" takes twice longer than transurethral resection. Laser surgery lasts one and a half hours, and TOUR — about forty minutes.
— Is that all? Why, then, urologists are not fully switched to "green laser"?
So far, only a few hospitals have the equipment for such operations.
Our clinic has bought equipment for a long time, so now we have a lot of experience of similar operations (done for more than a hundred). The doctor who makes them — perhaps the only one in Russia certified specialist in working with the "green laser", he was trained in Germany.
In addition, it must be said that the PVP — a relatively expensive operation: only one optical fiber, which is used only once for a single patient, it is worth more than 1,000 euros. However, it is worth it. It really is the most modern and effective treatment of BPH. You can apply it practically out — in the West, many physicians do so. The patient comes in the morning, he was in surgery, in the evening he goes home, and the next day already forgotten about how tormented previous years.