Prostate adenoma - symptoms, diagnosis and treatment

The most common urological pathology for which men over 45 years of age consult a urologist at the Yusupov Hospital is prostate adenoma. The presence of this pathology significantly worsens the quality of life of men. One of the most dangerous possible consequences of the pathological process is the degeneration of benign prostatic hyperplasia into a malignant tumor.

To combat prostate adenoma, surgical and drug treatment methods are used. Specialists at the Yusupov Hospital select the most effective medications or surgical methods taking into account the stage of the disease, the general condition and age of the patient, as well as the presence of concomitant pathologies. The surgery clinic has created comfortable conditions for treating patients.

Causes of development of prostate adenoma

The occurrence of adenoma is most often associated with age-related changes in the prostate, namely, changes in its structure and increase in size.
As a result of such changes, the urethra, which is located in the thickness of the prostate gland, is gradually compressed and disturbances in the urination process appear. Prostate adenoma in men develops as a result of hormonal changes in the body associated with age-related changes. The level of testosterone (male hormone) gradually decreases with age, while the concentration of the female sex hormone (estrogen), on the contrary, increases. This phenomenon is called male menopause.

The development of prostate adenoma may be due to the following risk factors:

• The age of the patient - an enlarged prostate gland is extremely rarely found in men under forty years of age, and after sixty years of age it is diagnosed in almost every second one;
• Hereditary predisposition - if prostate adenoma was diagnosed in close blood relatives of a man, he has a huge risk of inheriting this disease in adulthood;
• Diabetes mellitus, cardiovascular diseases - a benign tumor (adenoma) of the prostate can arise not only as a result of these diseases themselves, but also the harmful effects of medications for their treatment (for example, beta blockers);
• Improper lifestyle – the risk of developing prostate adenoma is increased in men with obesity and insufficient physical activity.

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Forms of BPH

Nodular form of prostate adenoma

• indicates that changes in prostate tissue are presented in the form of nodes.

Diffuse form

• implies that the process is evenly distributed throughout the prostate gland.

Focal prostatic hyperplasia

• may mean that the process is localized in a certain area,

Hyperplasia of the transition zones of the prostate

• indicates a shift in emphasis to the transitional areas of different lobes to the area of ​​the upper urethra.

Symptoms of prostate adenoma

Prostate adenoma in men can be suspected when a man develops the following symptoms, the most typical for this disease:

• increased urge to urinate;
• the need to tense the abdominal muscles to urinate;
• the presence of painful sensations, burning, sluggish stream of urine;
• discomfort and insufficient emptying of the bladder;
• increasing the duration of the urination process.

Prostate adenoma leads not only to a decrease in a man’s quality of life, but also to acute urinary retention, which requires the use of surgical treatment methods.
To avoid surgery, many patients use special medications to treat prostate adenoma, eliminating symptoms and restoring normal prostate function. However, only a qualified specialist can suggest the best remedy for prostatitis and prostate adenoma. You should contact him when the first symptoms of the disease appear. Treatment of prostate adenoma is individual for each patient. Drugs for the treatment of prostate adenoma, their dosage and duration of use are prescribed by the attending physician. Taking medications for prostatitis and prostate adenoma on your own can be not only ineffective, but also dangerous. Due to the presence of some “personal” chronic diseases in older men, drugs for the treatment of prostate adenoma in older people should be selected taking into account concomitant pathologies.

Complications

Frequent complications of prostate adenoma are acute urinary retention, hematuria (blood in the urine), and the formation of bladder stones.

Provoke complications:

• alcohol;
• hypothermia;
• constipation;
• the habit of putting up with going to the toilet “until the last minute.”

Among the inflammatory diseases, the patient is plagued by chronic urethritis, cystitis, which turns into inflammation of the kidneys - pyelonephritis. An even worse outcome is hydronephrosis and renal failure.

How does prostate adenoma develop?

Prostate adenoma is characterized by gradual development, which can be divided into three stages.

• The first stage of the disease occurs with minimal urination disturbances. There may be a slight increase in frequency, especially at night, and a sluggish stream of urine. The first stage can last from one year to 12 years or more.
• The second stage of prostate adenoma is characterized by more pronounced urination disorders: intermittent urine stream, the need to strain when urinating and a feeling of incomplete emptying of the bladder. Residual urine, which is retained in the bladder and urinary tract, causes an inflammatory process, which is accompanied by pain, a burning sensation when urinating, pain in the lumbar region and above the pubis.
• The third stage is characterized by periodic or constant involuntary leakage of urine, which forces the patient to use a urinal.

Stages of development

Conventionally, there are three stages of manifestations of prostate adenoma. The main criteria are the volume of the prostate and the presence of “residual urine” - the amount that remains in the bladder after complete urination (determined by ultrasound).

Symptoms of the disease are grouped according to the International Index of Prostate Symptoms (IPSS), presented in points:

• minor symptoms - 0–7 points;
• moderate - 8–19 points;
• pronounced - 20–35 points

In stage I - the volume of the gland is 30-40 cm3, residual urine is insignificant, up to 40 ml.

In stage II - the volume of the gland reaches 40-60 cm3, residual urine can be up to 100 ml.

In stage III - the volume of the gland is very large, 60-80 cm3 or more, residual urine reaches a volume of more than one liter. At this stage, paradoxical ischuria develops, when, through a very weak external sphincter, urine randomly leaks from an overstretched bladder.

It should be understood that the stage of prostate adenoma does not always depend on the size of the prostate gland; the location of the gland in relation to the area of ​​the urethra, as well as the time at which the process is neglected, is of great importance.

Complications of prostatitis

In some men, prostate adenoma does not impair the quality of life and proceeds without complications. However, in some cases, the disease can cause the following negative consequences:

• Acute urinary retention - it is characterized by a sudden inability to empty the bladder and pain in the suprapubic region. In such a condition, the patient requires emergency medical care with catheterization or minor surgery;
• The occurrence of infections in the urinary tract - stagnation of urine, which creates favorable conditions for the proliferation of pathogens, leading to the development of cystitis and pyelonephritis;
• The formation of stones in the bladder is also a consequence of stagnation of urine;
• Damage to the bladder - when the bladder is not emptied regularly, it stretches and formation of protrusions (pockets) in the walls of the organ in which urine stagnates;
• Kidney damage – increased pressure in the ureters and bladder has a direct damaging effect on the kidneys, resulting in renal failure.

Prostate adenoma and potency

Prostate adenoma and potency are closely interrelated. Adenoma disrupts the structure of the gland tissue, which, in turn, leads to damage to another, no less important organ - the testicles, which are responsible for the production of androgens. Thus, prostate adenoma can cause impotence, requiring long-term and complex therapy.

What is the prostate

The content of the article

The prostate is a unique organ located in the male pelvis between the bladder and rectum at the beginning of the penis. The organ surrounds the cervical part of the bladder and the initial part of the urethra. It consists of connective tissue, smooth muscle and glandular tissue.

The glands of the prostate produce secretions, which during ejaculation (the release of sperm during sexual intercourse) penetrate the urethra and mix with the secretion of the seminal vesicles. The role of the secretor is to ensure the viability and fertilization of sperm cells with the carbohydrates, enzymes, minerals and other ingredients it contains.

Diagnosis of the prostate gland in men

A simple and effective way to establish a preliminary diagnosis is for the patient to keep a diary of urination, recording quantitative and qualitative parameters: volumes of urine excreted, characteristics of fluid consumed, imperative urges, night urges. The main physical examination method for suspected prostate adenoma is a digital rectal examination of the prostate to detect its enlargement and exclude some other pathologies. Diagnosis of prostate adenoma at the Yusupov Hospital is carried out using the following laboratory and instrumental methods:

• General blood and urine tests;
• Biochemical blood test for markers of kidney condition, urea and creatinine levels;
• PSA level analysis (to rule out prostate cancer);
• Transrectal ultrasound examination (ultrasound);
• Uroflowmetry (to determine the speed of urine flow);
• Determination of residual urine volume (using ultrasound);
• Electromyography of the pelvic floor;
• Urethrocystoscopy;
• Excretory urography.

Prostate Exam – What to Expect

The most unpleasant, but quick and painless part of the examination is a rectal examination of the prostate, which provides very important information for the urologist.

As a first step in assessing a patient for BPH symptoms, the urologist will ask you for detailed information about urinary and genital complaints and previous medical conditions.

An important element of the subsequent physical examination is careful palpation of the abdomen, which allows the expert physician to confirm that the bladder is full.

Treatment of prostatitis - the most effective methods

Treatment of prostate adenoma is aimed at relieving symptoms of the lower urinary tract, improving the patient’s quality of life and preventing the development of complications of the disease. Patients with mild symptoms that do not impair the quality of life are often prescribed dynamic monitoring with regular examinations by a urologist, who monitors the course of the disease and gives recommendations on how to stop the growth of prostate adenoma. During this period, attention is focused on non-drug therapy. The methods described above can be an addition to conservative treatment, which consists of taking the following medications:

• Alpha blockers (Tamsulosin, Alfuzosin);
• 5-alpha reductase inhibitors (Finasteride);
• Phosphodiesterase type 5 inhibitors (Sildenafil);
• Combinations of 5-alpha reductase inhibitors and alpha blockers;
• Muscarinic receptor blockers or M-anticholinergics.

For patients with advanced stage prostate adenoma, surgical treatment is recommended, which can be performed by several methods: transurethral excision, transurethral resection and removal of the prostate.
There are certain indications for the use of surgical treatment:

• Recurrent urinary retention;
• Renal failure caused by prostate adenoma;
• Bladder stones;
• Recurrent urinary tract infections;
• Recurrent hematuria.

In addition, surgical intervention is necessary for patients in the absence of effectiveness of drug treatment.
During conservative therapy or in the postoperative period, patients require constant medical supervision with standard studies (determination of urine flow rate, ultrasound, analysis of PSA levels).

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"Ethnoscience

Many patients with prostate adenoma use herbal preparations for therapy. Herbal preparations undoubtedly have some effect, but extensive clinical international studies have not been conducted on them! Therefore, the use of these drugs is of an auxiliary nature. In Russia, products isolated from African palm trees are widely used: Serenoa repens (Prostamol UNO, Permixon), Pigeum Africanum (Pidgeum), Hypoxisrooperi (Hypoxis).

Of the domestic traditional medicines, the following are most often used as additional restorative therapy for prostate adenoma:

• Beekeeping products (honey, bee bread, dead bees, propolis) - inside;
• A decoction of young aspen bark;
• Decoction of fireweed (angustifolia fireweed);
• Red root decoction (Altai endemic - forgotten kopeck) decoction;
• Pumpkin seeds (contain zinc, so necessary for the prostate) up to 50 pieces per day orally;
• Burdock root decoction.

In addition, in Russia, products from animal raw materials are actively used - the prostate of bulls, in suppositories and injections.

Such drugs as Vitaprost, Prostatilen, Prostakor and Samprost. There are only Russian studies on these drugs, and a certain effect occurs, especially with concomitant prostatitis, but, again, there have been no broad international research programs.

Hirudotherapy (leech treatment), which reduces inflammatory edema and improves blood circulation in the prostate area, is of some importance in terms of symptomatic treatment of prostate adenoma. However, such therapy is fraught with bleeding and should be carried out only by qualified specialists.

Important! It should be clearly understood that all of the above remedies have a rather uncertain effect, therefore, if symptoms of prostate adenoma develop, a visit to a urologist is mandatory!

Useless remedies and contraindications

The following have a completely incomprehensible effect: shock wave therapy, Sytin's moods, salt dressings, urine therapy, Thermex, magnetotherapy, microenemas, Vitafon, Almag, hydrogen sulfide baths, phonation, Chinese urological patch, radon baths, various dietary supplements, homeopathy, treatment salt according to the method of Professor Okulov, hydrogen peroxide according to Neumyvakin, beaver stream, indigal, adenorphine and other “exotic” agents.

Important! In case of prostate adenoma, are contraindicated , otherwise this can lead to progression of the disease and even the development of oncology.

Drugs for the treatment of prostatitis and prostate adenoma

There is a certain scheme according to which specific drugs are prescribed for the treatment of prostatitis and prostate adenoma.
High effectiveness of treatment is achieved through the use of drugs from the group of alpha-reductase inhibitors and alpha-blockers. These drugs for the treatment of prostate adenoma in men help eliminate the main symptoms of the disease, as well as restore sufficient urination. What are the most effective and widely used tablets for prostate adenoma? The list is topped by alpha1-adrenergic receptor blockers. In addition, this list includes 5-alpha reductase inhibitors, vitamins and minerals.

The complex of drug therapy includes not only drugs. For prostate adenoma, conservative treatment can be supplemented with biologically active additives - dietary supplements, which enhance the therapeutic effect of drugs and ensure a speedy recovery. Some of them contain zinc. This macroelement is directly involved in spermatogenesis and testosterone synthesis. Plant phytosterols normalize urination.

Treatment with drugs from the group of alpha1-adrenoceptor antagonists

These drugs for the treatment of prostatitis and prostate adenoma provide relaxation of the smooth muscles of the urinary system and improve the process of urine discharge.
Tamsulosin, with the same name as the active substance, which is included in other drugs (Alfuzosin, Omnic, Silodosin, Urorek, etc.), is a highly selective drug that has a selective effect on alpha1-adrenergic receptors of the muscles of the prostate gland, prostatic urethra and bladder. Due to the decrease in muscle tone, the outflow and excretion of urine is facilitated. Tamsulosin, like all selective drugs, has minimal side effects, does not affect vascular tone and can be prescribed to patients with chronic hypertension. Alpha-adrenergic antagonists must be used continuously, thereby achieving a gradual reduction in irritation and obstruction in prostate adenoma. The drug Omnic in the treatment of prostate adenoma occupies a well-deserved priority in the prescriptions of urologists. It is produced by the Japanese company Astellas Pharma in the form of capsules and tablets (Omnic Okas). How long can you take Omnic without interruption? This directly depends on the stage of the disease. It is strongly recommended that for the risk of exceeding the dosage, consult your doctor about taking the drug and its dosage limits.

The tablet form of the drug is considered more progressive, since thanks to the controlled release of tamsulosin, the active substance is in the body in a constant concentration. The medicine enters the bloodstream evenly, thereby reducing the likelihood of developing the main side effect of drugs from the adrenergic blocking group - a sharp decrease in blood pressure.

An equally effective drug with the active ingredient tamsulosin is Urorek. Taking this drug is not accompanied by the following undesirable effects: orthostatic hypotension, tachycardia, increased frequency of angina attacks in patients with coronary heart disease, so it can be prescribed to men with cardiac pathologies. Properly selected dosage and compliance with all rules for the use of drugs from the alpha-blocker group make it possible to achieve a good therapeutic effect with an almost complete absence of side effects.

Medicines from the group of reductase inhibitors (blockers)

Drugs of this pharmacological group (Finasteride, Penester, Alfinal, Dutasteride, Avodart) help facilitate the outflow of urine, and, therefore, eliminate the main symptoms of the disease.
A stable therapeutic effect occurs within two to three weeks after the start of the course. All symptoms disappear completely after three months. According to the results of clinical studies, maximum effectiveness is achieved after six months of therapy with these drugs. Finasteride and Dutasteride are specific inhibitors of type 2 5-alpha reductase (the cellular enzyme responsible for the transformation of testosterone into dihydrotestosterone). The growth of the prostate gland in prostate adenoma is directly related to a similar transformation of testosterone. Thanks to 5-alpha reductase inhibitors, the production of intraprostatic dihydrotestosterone is blocked and its concentration in the blood is significantly reduced.

Finasteride and Dutasteride are used for the following purposes:

• Treatment and control of prostatic hyperplasia;
• Improving the outflow of urine and eliminating the symptoms of prostate adenoma;
• Reducing the risk of developing acute urinary retention and the need for surgical intervention.

Finasteride and Dutasteride have a pronounced antiandrogenic effect, i.e. help reduce the level of male hormones in the blood. In addition, these drugs have a teratogenic effect, so they should be taken with caution. With the help of modern medications, it is possible to stop the growth of the prostate and prevent the need for surgical treatment.

Surgery

The purpose of surgery in the late stages of prostate adenoma is to eliminate compression at the level of the prostatic urethra.

Indications for surgical treatment :

• severe compression of the urethra;
• ineffectiveness of taking medications;
• painful symptoms of adenoma (for example, frequent debilitating urge to urinate);
• complications of adenoma (renal failure, urinary stones, blood in the urine, chronic urinary retention).

Indications for emergency hospitalization in a urological hospital :

• Acute urinary retention - manifested by a complete cessation of urine flow from the urethra, bloating of the lower abdomen, and an increase in pain in the bladder area;
• The development of acute renal failure, which is clinically manifested by a sharp decrease in urination, an increase in edema, deterioration of the condition, up to loss of consciousness, an increase in the concentration of potassium, urea, and creatinine in the blood;
• Blood in the urine and the possibility of blockage of the bladder with clots.

Types of surgical interventions

Prostate TOUR

Transurethral resection of the prostate gland.

It is the “gold standard” for surgical treatment of BPH. TUR is the main type of surgical intervention for medium-sized prostate adenoma.

It is used for prostate volume from 30 to 80 cm3.

Performed under general anesthesia or spinal anesthesia, it is a very gentle method of surgical treatment in terms of complications. It involves burning out the prostate tissue that has blocked the lumen of the urethra using a special device using an electric resectoscope.

The average operation time is up to 1 hour. Rehabilitation may require 4 to 6 weeks. In the postoperative period, discomfort may appear during urination, blood in the urine, signs of inflammation, and sexual activity may be delayed.

In the postoperative period, the patient takes tablets: adrenergic blockers and anti-inflammatory drugs, antibiotics.

Open adenomectomy

Removal of the prostate gland. The operation is performed through the bladder, but an operation through the perineum is also possible.

It was first performed more than 100 years ago, but is still used in patients with large prostate sizes greater than 80 cm3.

Open adenectomy is recommended as the standard of care for such adenomas by the European Association of Urology.

Prostate removal is performed under general anesthesia or spinal anesthesia. This type of operation is more traumatic, but the effect is more lasting and there are no relapses. The operation time is more than 1.5 hours, longer than with TUR, the recovery period is up to 3 months.

During the operation, a catheter is inserted into the abdomen to drain urine, which is removed after 2 weeks. Time spent in hospital is 2-3 weeks.

Laparoscopy

Gentle surgical techniques for large prostates are becoming increasingly popular - laparoscopic removal of the prostate gland using special instruments and several small holes in the abdomen. Such operations reduce the operation time and the likelihood of complications.

One of the options for laparoscopic surgery is robot-assisted radical prostatectomy (RARP) using the Da Vinci robot. RARP is actively “displacing” open prostatectomy in the treatment of large prostate adenoma throughout the world.

With RARP, compared with conventional adenomectomy, the volume of blood loss is significantly reduced, and there are advantages in assessing the restoration of urinary continence and erectile function.

Alternative treatments for prostate adenoma :

All these methods have a certain significance and can constitute a worthy alternative to surgical treatment of the prostate gland.

• Stenting of the prostatic part of the urethra with temporary and permanent devices - stents;
• Hyperthermic effects on the prostate gland with temperatures from 40 to 100 degrees;
• Laser technologies: vaporization (evaporation) of the prostate gland with a “green” laser beam,
• laser resection of the prostate,
• laser coagulation,
• holmium enucleation HoLAP - a variant of evaporation of the affected prostate gland with two different laser radiations, developed by New Zealand urologists;

Despite their good effectiveness, alternative methods of treating prostate adenoma are quite expensive, are not included in the compulsory medical insurance system, and there are few clinics performing these methods in Russia.

Antispasmodics and painkillers for exacerbation of the disease

The main purpose of antispasmodic and analgesic drugs during exacerbation of prostate adenoma is to alleviate the general condition of the patient and eliminate pain.
Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) have an anti-inflammatory and analgesic effect. They help fight not only the pain that occurs during urination, but also the constant pain in the groin and perineum. Thanks to the action of non-steroidal anti-inflammatory drugs, the inflammatory process is reduced, swelling of the prostate gland is reduced, body temperature is normalized, and unpleasant symptoms are eliminated. Non-opioid analgesics, available in the form of tablets or suppositories, help relieve pain during exacerbation of prostate adenoma. The most accessible of them is Analgin. However, this drug is intended rather for one-time use, since it can only affect mild pain. In addition, analgesics with lidocaine, benzocaine, anesthesin and novocaine (Ichthyol, Anestezol, Procto-Glivenol) are effective.

Rectal ultrasound, abdominal ultrasound

Rectal ultrasound examination of the prostate gland gives a clear picture of the prostate gland, its size and structure. An experienced urologist may also look for other conditions, such as prostate cancer.

At the same time, an ultrasound of the abdominal cavity is performed. It is necessary to evaluate the kidneys, bladder and, to a lesser extent, the prostate gland.

Abdominal ultrasound

Vitamin E 400

Tocopherol acetate or vitamin E is often included in the complex treatment of prostate adenoma as an antioxidant, radioprotective agent and an indispensable link in reproductive processes.
Vitamin E in a dosage of 400 mg is prescribed by urologists to patients with disorders of erectile function and spermatogenesis associated with prostate adenoma. Treatment of such a serious chronic disease as prostate adenoma should be prescribed and monitored by a urologist. Taking certain medications on your own, without prior consultation with your doctor, is strictly prohibited, since self-medication in this case may not only be ineffective, but also dangerous for men’s health. Only a qualified specialist can tell you which tablets for prostate adenoma are the most effective in each specific case, and which of them can cause negative consequences.

Blood tests

When examining for any prostate pathology, blood tests are required. The results may indicate certain diseases and also provide important information about kidney function.

Determining the amount of a specific protein, prostate-specific antigen (PSA), is important for the study of prostate diseases. PSA is produced in the body only by prostate cells, and its concentration in the blood is proportional to the size of the prostate. However, the test is not specific for BPH and the results may be elevated in other prostate diseases.

PSA blood test

PSA can increase with inflammation of the prostate gland, cancer, and even immediately after ejaculation. Some treatments (such as transurethral resection of the prostate) and some medications lower the amount of PSA in the blood. PSA comes in two forms, free and bound, and it is important for your doctor to know the amount of both.

Operations

Urologists at the Yusupov Hospital masterfully perform classical and minimally invasive surgical interventions and use innovative methods of surgical treatment of prostate adenoma.
Each patient is selected for the operation that suits him best. The generally accepted standard in the surgical treatment of prostate adenoma is transurethral resection of the prostate. The operation is highly effective. After the intervention, patients get rid of bladder outlet obstruction (narrowing of the urethra) and associated symptoms. The rehabilitation period is short. During or after surgery, bleeding and “water intoxication” syndrome may develop in the body.

Alternative methods of treating prostate adenoma include the following surgical interventions:

• Stenting;
• Balloon dilatation;
• Hyperthermia;
• Thermotherapy;
• Ultrasound, laser and needle ablation;
• Interstitial coagulation.

After them, complications occur less frequently, but these techniques are inferior to transurethral resection in terms of effectiveness, both clinically and economically.
Laparoscopic removal of prostate adenoma is used when the tumor has grown significantly, and removing it using transurethral resection is problematic. This operation is more complicated and is performed under anesthesia. Through small incisions, the surgeon inserts special instruments into the body cavity, which are used to remove the prostate adenoma. The operation is carried out using images from video cameras, which are displayed on the screen. The main advantages of the intervention are minimal blood loss and low likelihood of complications. After the operation, the patient does not need long-term rehabilitation.

When there are signs of prostate adenoma in men, doctors use a high-tech method of treating adenoma - laser enucleation. The intervention is carried out when the tumor is large. Excess tissue is removed using a laser. The operation is performed through the urethra. The tumor is separated, divided into small parts, and then removed. The method is considered minimally invasive. It has a number of significant advantages: it does not violate the integrity of cavities and does not cause unnecessary damage.

Laser vaporization involves destroying the adenoma by laser evaporation. The urologist inserts a special device through the urethra, brings it to the tumor and precisely targets it with a strong green laser. The depth of penetration of the laser and the accuracy of its impact make it possible to avoid damage to neighboring areas. The method is minimally invasive, bloodless, fast and effective. Its only drawback is the inability to take tumor tissue for histological examination.

In some situations, the inevitable method of treating prostate adenoma is abdominal surgery - adenomectomy. It is performed when other methods cannot help the patient. During surgery, the surgeon uses a scalpel to access the prostate gland and manually, using surgical instruments, removes the adenoma. As a result of the operation, significant blood loss and complications may develop. After surgery, the patient needs long-term rehabilitation.

Removal of prostate adenoma using transvesical (transvesical) adenomectomy involves radical excision of hyperplastic prostate tissue through a longitudinal incision in the anterior abdominal wall and bladder. The operation is performed in advanced stages of the disease, when the tumor reaches a large size, the bladder is overstretched due to its overflow with accumulated urine, and renal failure develops.

The bladder is pre-catheterized and filled with a sterile solution of furatsilin or another substance. Then it is isolated and taken in two places on special holders, for which the wall of the organ is lifted. The surgeon cuts through the resulting fold and opens the bladder.

Along the inner end of the installed urinary catheter, the area of ​​the bladder neck is determined and around the urethral opening that appears in the field of view, stepping back from it by 0.5-1 cm, an incision is made in the mucous membrane. After this, the operating urologist penetrates the thickness of the prostate with his finger, enters it between the tumor capsule and adenomatous nodes, and removes the latter. At the same time, with the finger of the other hand, which is first inserted into the patient’s rectum, the doctor moves the gland towards the anterior abdominal wall. It becomes more accessible to manipulation. Thanks to this technique, the operation time is reduced and blood loss is reduced.

Then the surgeon performs hemostasis (stopping bleeding) of the bed of the removed adenoma and suturing the bladder, leaving a thin drainage in the wound. It is designed to wash its cavity from formed blood clots. The urinary catheter inserted before the operation is not removed for 7-10 days. A new section of the urethra is formed around it instead of the prostatic part of the urethra excised during the operation.

Transvesical adenomectomy is one of the most traumatic of all techniques used for prostate adenoma. It is accompanied by the risk of developing the following complications:

• Bleeding from the tumor bed;
• Congestive pneumonia;
• Violation of the motor-evacuation function of the intestines, manifested by constipation.

To avoid complications, after surgery at the Yusupov Hospital, the patient undergoes early activation. The following undesirable consequences of surgery to remove prostate adenoma may occur:

• Insufficient drainage of the bladder;
• Narrowing of his neck;
• Urinary infiltration of peri-vesical tissue;
• Formation of a “pre-bladder” (residual cavity in the place where the prostate adenoma was removed);
• Formation of narrowing of the lumen of the urethra;
• Urinary incontinence.

This negatively affects the quality of life of patients and prolongs the time required to restore adequate urination.
The consequences of the operation are less pronounced when the intervention is performed using a laparoscope. Laparoscopic surgery to remove prostate adenoma is one of the less invasive options for surgical interventions on the prostate gland. Urologists at the Yusupov Hospital use this technique if the patient has a sufficiently large prostate adenoma.

If the size of the prostate gland of a patient with adenoma does not exceed 120 cm3, transurethral resection of the prostate adenoma is recommended. But for 10% of patients who need surgical intervention, this option is not suitable, since the gland reaches a size of more than 120 cm3. Laparoscopic surgery to remove prostate adenoma is not performed for urolithiasis, inguinal hernia, bladder diverticula, or ankylosis of the joints of the lower extremities. In this case, the decision on the possibility of performing an operation is made collectively by a urologist, andrologist, abdominal surgeon and other specialists at the Yusupov Hospital.

With laparoscopic access, general anesthesia is used. Laparoscopic removal of prostate adenoma is carried out using specialized equipment. The surgeon uses trocars through which he passes laparoscopic instruments to the prostate gland. The trocar is equipped with a small video camera that transmits the image to the screen. This way, surgeons have the opportunity to perform all actions as accurately as possible.

Laparoscopic surgery to remove prostate adenoma has the following advantages over open adenomectomy:

• During the operation, bleeding and complications occur much less frequently;
• The pain syndrome is less pronounced, the patient does not need a large amount of analgesics;
• Bladder catheterization does not last long;
• Physical activity is restored faster, the next day after the operation the patient can walk without difficulty.
• Hospitalization after laparoscopic adenomectomy takes much less time. The patient quickly returns to normal life. He has no cosmetic problems. The length of scars after surgery does not exceed one centimeter.

After laparoscopic removal of prostate adenoma, the need for repeated surgery is minimized, since a significant part of the prostate tissue is removed.
Embolization of prostate arteries is one of the most modern methods of treating adenoma. It is used more often abroad. The operation involves blocking the blood vessels supplying the prostate adenoma. An endovascular surgeon for large blood vessels brings a microcatheter to the source of blood supply to the tumor and injects a special composition that blocks the blood flow. As a result, the tumor does not receive oxygen and nutrients, and it decreases in size. Contraindications to the use of this method are malignant tumors, allergies to contrast and embolic agents, cardiovascular pathology, some chronic diseases of internal organs, and acute diseases.

Transurethral resection of the prostate (TURP) is a method of removing prostate adenoma without external incisions. The intervention is performed using a special instrument (resectoscope). The urologist inserts it into the patient’s bladder through the urethra. After examining the urethra, bladder and the actual area where the prostate adenoma is located (the border of the urethra and bladder), the surgeon removes the prostate adenoma using a special device - a loop. Transurethral resection of the prostate requires good visibility. It is ensured by a constant flow of fluid through one of the resectoscope channels and outflow through the other channel. Visibility may be impaired due to bleeding from blood vessels. During the operation, the surgeon stops the bleeding in order not to lose orientation in the tissues.

Transurethral resection of the prostate is used if the size of the prostate gland does not exceed 80 cm3. The adenoma is removed until the tissue of the gland itself is visible. After the prostate adenoma is removed, the tissue is washed from the bladder using a special instrument, and a control examination of the surgical site and the bladder is carried out. If necessary, additionally stop bleeding from blood vessels. After this, the surgeon removes the operating instrument (resectoscope). A special Foley catheter is passed through the urethra into the bladder. An inflating balloon is located at the bladder end of the catheter. After the catheter is inserted into the bladder, the balloon is filled with fluid. It takes the place of the removed adenoma, which helps stop bleeding from small vessels and prevents the catheter from falling out of the bladder. In this case, minimal consequences are observed after removal of the prostate adenoma. Patient reviews of the operation are excellent. Recovery after removal of prostate adenoma occurs quickly.

Transurethral resection of the prostate is one of the most complex and precious operations in the entire spectrum of endoscopic urological surgery. Urologists at the Yusupov Hospital have undergone special training. Surgeons are fluent in the technique of this surgical intervention.

Transurethral electrovaporization combines the advantages of standard transurethral resection (the possibility of immediate removal of tumor tissue, optical control of the intervention, clinical and economic efficiency) with a significant reduction in blood loss during and after surgery, preventing “water intoxication” of the body. Electrovaporization of the prostate also has disadvantages. “Roller vaporization” is technically simple, there is good endoscopic visibility, there is no bleeding, but, compared to monopolar transurethral resection, it has a lesser ability to remove hyperplastic tissue. Roller vaporization is used as monotherapy for prostate adenoma with a volume of no more than 40 cm3. Vaporizing resection is not inferior in efficiency and speed to standard transurethral resection. It is just as difficult to master, since the hemostatic effect of the vaporizing loop is not as pronounced as the “roller vaportrode”, and the technique of cutting and removing prostate adenoma requires considerable experience of the surgeon.

New methods of transurethral endoscopic treatment of prostate adenoma include rotoresection. The technique combines electrovaporization, coagulation and mechanical removal of the prostate tumor with a rotating electrode. Due to sufficient depth of coagulation, good bleeding control is ensured during surgery, and the simultaneous mechanical removal of dehydrated and carbonized tissue with a rapidly rotating rotoelectrode allows the urologist to continue effective ablation by evaporation. Patients of the Yusupov Hospital have the opportunity to receive all complex methods of treating prostate adenoma at partner clinics.

Prostate adenoma is a benign tumor that develops from the stroma or glandular epithelium of the prostate.

In 30-40% of men over 50 years of age and 75-90% over 65 years of age, changes occur in the form of proliferation of glandular tissue in the area of ​​the bladder neck.

What kind of disease is this, why does it occur in men after 40 years of age, what are the first symptoms and what is prescribed as treatment, we will consider further.

What is prostate adenoma?

BPH is a benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of prostate adenoma is difficulty urinating due to gradual compression of the urethra by one or more growing nodules.

With adenoma, the organ enlarges, which causes compression of the bladder and urethra. This disrupts the flow of urine and leads to the accumulation of residual urine. Additionally, a man may develop a genital tract infection or bladder stones. The increase occurs painlessly, which is dangerous for the rapid diagnosis of the disease.

Prostate gland: what is it?

The prostate gland, also known as the prostate, is an organ located slightly below the bladder. The main purpose of the prostate is to produce a specific secretion that is part of sperm. The secretion of the prostate gland, determining the consistency of the ejaculate (in particular, contributing to its liquefaction), contains vitamins, enzymes, immunoglobulin, zinc ions, etc.

The prostate gland for men is a “second heart”, psycho-emotional state and general health.

The main functions of the prostate gland include:

• liquefaction of sperm - thanks to this, sperm acquire active motility and generally become viable;
• secretion production - it contains enzymes, proteins, fats, without which the reproductive system will not function normally;
• ejection of semen - the smooth muscles of the prostate gland are capable of contraction, which ensures the entry of semen into the urethra, and this is how ejaculation occurs.

Causes

Prostate adenoma develops and grows gradually. Although this disease occurs mainly among older men, the initial symptoms can be detected as early as 30-40 years of age. It is interesting that at first cell nodules form en masse and only after a long time begin to grow in size.

Reasons for development:

1. The first group includes reasons due to a person’s lifestyle, which increase the likelihood of prostate enlargement. For example, this could be sedentary work or active mental stress in the absence of physical activity. That is why the role of regular physical exercise cannot be overestimated.
2. The second group includes objective reasons that do not depend on a person’s lifestyle. It has been proven that prostate adenoma occurs due to changes in the hormonal background of a man. If we consider that these changes inevitably occur in old age, we can come to the conclusion that only some men are lucky enough to avoid problems with the prostate gland.

There are a number of associated factors that may contribute to the development of adenoma. These include:

• Excess weight (accumulation of adipose tissue contributes to the production of female hormones);
• Hereditary factor;
• Atherosclerosis;
• Smoking and alcohol abuse;
• Inflammatory processes in the kidneys and urethra;
• Physical inactivity and poor nutrition;
• High blood pressure.

Types of prostate adenoma

Based on their structure and location, there are three types of adenoma:

1. The tumor penetrates the bladder through the urethra, deforming the internal sphincter and disrupting its function.
2. The tumor enlarges towards the rectum, urination is slightly impaired, but the loss of contractility of the prostatic part of the urethra does not allow the bladder to be completely emptied.
3. With uniform compaction of the prostate under the pressure of the adenoma without its enlargement, neither urinary retention in the bladder nor urinary disturbances are observed. This is the most favorable type of adenoma.

Symptoms of prostate adenoma in men

There are two groups of symptoms of prostate adenoma: irritative and obstructive.

The first group of symptoms for prostate adenoma includes:

• increased frequency of 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,
• feeling of incomplete emptying,
• urination in an intermittent sluggish stream,
• the need for straining.

The first signs you need to pay attention to:

• The first signs of prostate adenoma are a sluggish stream of urine, an increased urge to urinate, which does not always result in emptying the bladder.
• As the tumor acquires serious dimensions, the patient no longer has the desire to find out what the causes of prostate adenoma are; he is more concerned about how to get rid of the disturbing symptoms. Urination becomes difficult, you need to strain to urinate, engage your abdominal muscles.

With the complication of prostate adenoma and its transition to a severe stage, all symptoms will intensify, which will negatively affect the patient’s life. In severe cases, only surgery can help, which is why it is so important to pay attention to the symptoms. Even if they are repeated 1-2 times, you need to undergo a full examination.

Prostate adenoma in men goes through several stages , each of which is accompanied by increasing symptoms and complications.

Compensated form

The most characteristic changes in urination at this stage:

• more frequent
• less free
• not as intense as before (the stream of urine no longer looks like a characteristic parabola, but falls almost vertically).

As the prostate continues to grow and pressure on the urethra increases, the following symptoms appear:

• increased urge to urinate during the day,
• decrease in urine output,
• increased incidence of an uncontrollable desire to urinate (the so-called imperative urge),
• participation of auxiliary muscles: the patient, for better emptying, strains the abdomen from time to time at the beginning or end of urination.

Subcompensated stage

Subcompensated - prostate enlargement has reached levels where it has severely affected the function of the bladder to remove urine from the body. Violations occur:

• the bladder is released in portions,
• the walls of the bladder increase in thickness,
• some urine is retained,
• when the bladder is full, involuntary release of urine may occur,
• urine may be cloudy and contain blood.

Stage 3 prostate adenoma - decompensated

There is a decrease in the contractility of the bladder to minimal limits, and an increase in residual urine can be of the order of two liters. Also relevant is a sharp stretching of the bladder, in which its contours are visible in an oval or spherical shape, reaching the navel, and in some cases rising much higher.

Meanwhile, at night, and then during the day, urine is systematically or constantly released, this happens in an involuntary manner, due to drops from a full bladder.

Associated symptoms of adenoma:

• weakness,
• nausea and lack of appetite,
• constipation,
• thirst and dry mouth.

Consequences for a man

Complications of prostate adenoma:

• Acute urinary retention. The complication appears at stages 2 or 3 of the disease due to compression of the urethra by the hypertrophied prostate gland.
• Inflammation of the urinary tract. Stagnant processes in the bladder lead to the proliferation of bacteria. They provoke the development of cystitis, urethritis, pyelonephritis, CKD
• Urolithiasis disease. Incomplete emptying of the bladder leads to the appearance of microliths, stones or mineral deposits in the bladder. They can cause bladder blockage and urinary retention.
• Hematuria. The appearance of red blood cells in the urine, which is caused by varicose veins in the neck of the bladder.

Diagnostics

It will not be an exaggeration if we say that successful diagnosis of prostate adenoma directly depends on the patient himself. At the earliest stages, it is the survey that can provide the indicators by which a specialist can suspect the presence of a disease.

Diagnostics consists of:

1. The doctor performs a digital examination of the prostate.
2. In order to assess the severity of symptoms of prostate adenoma, the patient is asked to fill out a urination diary.
3. A study of prostate secretions and urethral smears is performed to exclude infectious complications.
4. An ultrasound of the prostate is performed, during which the volume of the prostate gland is determined, stones and areas of congestion are identified, and the amount of residual urine, the condition of the kidneys and urinary tract are assessed.

PSA analysis for prostate adenoma is an important indicator in determining the extent of the disease and prescribing treatment. It is recommended that every man over 40 years of age undergo this study annually, because... it diagnoses any abnormalities in the prostate and will help determine even prostate adenoma cancer.

Each gram of benign prostate adenoma increases PSA levels by 0.3 ng/l, and each gram of malignant tumor increases PSA levels by 3.5 ng/ml. With prostate adenoma, the level of prostate-specific antigen almost never rises above 10 ng/ml. If this happens, then cancer is suspected.

Treatment of prostate adenoma

Standard treatment of prostate adenoma in men can be carried out with medications, surgery and minimally invasive procedures. The main method is surgery, which is prescribed to all patients with bladder outlet obstruction.

Treatment of prostate adenoma depending on the stage:

1. The first stage can often be managed with conservative treatment, which, however, does not exclude manifestations in the form of acute and frequent urinary retention, increased frequency of urination (up to 10 times), the formation of bleeding in the stagnant veins of the bladder or the appearance of large stones in it. All this, in turn, leads to a forced measure in the form of surgical intervention, even in the absence of residual urine.
2. Second stage. The gold standard of care at this stage is removal of the adenoma through surgery using various minimally invasive and classical techniques.
3. Third stage. The main tasks here are to ensure good urine flow in order to relieve azotemic intoxication. In this case, percutaneous puncture nephrostomy, cystostomy, etc. are used. Next, the condition of the liver, kidneys, and cardiovascular system is normalized, and then the issue of possible further surgical treatment is decided.

Medications

Taking medications while eliminating symptoms and manifestations of the disease is a gentle treatment method that makes it possible to avoid surgical intervention. How effective medications are depends on the severity of the adenoma.

Despite the fact that medications help many patients and significantly improve their quality of life, in almost 100% of cases, unpleasant symptoms return some time after stopping the medications.

Preparations:

Before using any medications, be sure to consult your doctor, as... there are contraindications for use.

Operation

Surgical measures are used when conservative therapy is ineffective or when the disease is advanced. For prostate adenoma, surgery is prescribed for absolute indications:

• Inability to urinate;
• Massive hematuria;
• Stones in the bladder;
• Pathological processes in the prostate gland;
• Enlargement of the middle lobe of the prostate;
• Kidney failure;
• Large accumulation of residual urine.

An unscheduled (emergency) operation is performed within 24 hours after the development of complications has been established: in case of severe bleeding that threatens the patient’s life, and in case of acute urinary retention.

Preparation for surgery:

1. A general blood test is carried out to determine anemia (reduced amount of hemoglobin and red blood cells), leukocytosis (indicates some kind of inflammatory process).
2. Before surgery, it is necessary to check kidney function using a biochemical blood test. If renal dysfunction is present, creatinine and urea in the blood will be increased.
3. A blood clotting study is necessary to exclude the risk of thromboembolism or bleeding both during and after surgery.
4. ECG (electrocardiogram) - in order to exclude possible complications from the heart during surgery.

There are different methods of surgical treatment of prostate adenoma:

• Transurethral resection or TUR is a widely used method, because such an operation is performed through the urethra without incisions. However, it can only be used if the adenoma weighs up to 60 g. Also, this method is not allowed to be used if the patient has renal failure.
• Adenomectomy (open prostatectomy) is a popular method of surgical treatment of prostate adenoma due to the fewest contraindications. It is important to use it when the prostate weight is over 40 g and the amount of residual urine is from 150 ml. Various pathological complications do not interfere with the operation.

Probability of relapse

After surgery for prostate adenoma, relapses of an inflammatory nature are possible. In this regard, during the postoperative period it is necessary to observe precautions, which will be indicated by the doctor:

• don't get overtired
• don't get too cold,
• follow a diet
• be under the supervision of a specialist.

Minimally invasive methods of treating prostate adenoma

1. Thermal method - the size of the prostate gland decreases under the influence of high temperatures. Radiofrequency and microwave radiation, and less commonly ultrasound, are used to heat organ tissue.
2. Cryodestruction - pathological tissue cells are destroyed by exposing them to extremely cold temperatures.
3. Laser technique - laser radiation affects the water in the tissues of the prostate gland, heating it. The organ tissue folds (coagulates).
4. Balloon urethral dilatation - a catheter with an inflating balloon at the end is inserted into the urethra, with the help of which the lumen of the urethra is expanded.
5. Stenting of the prostatic urethra - a stent (a frame in the form of a cylinder) is inserted into the urethra, which makes it easier for the patient to urinate.

Diet for adenoma

The diet is selected for each patient individually, taking into account the degree of neglect of the pathology, the general condition of the patient and his medical history, as well as the patient’s taste preferences. But, as practice shows, you can’t do without changing your diet and balancing your diet.

Particular attention is paid to products rich in selenium (Se) and zinc (Zn), which have a beneficial effect on the tumor, reducing its size. During illness, a man should receive 25 mg of zinc and at least 5 mcg of selenium throughout the day.

Approximate menu:

• Meat: lean young lamb, rabbit, beef, turkey, chicken.
• Fish: all lean types.
• Soups: milk soup, beet soup, vegetable and vegetable soup, vegetarian cabbage soup, fruit soup, borscht.
• Vegetables: except sorrel, radishes, spinach, garlic, mushrooms, onions and pickled ones. If the cabbage is sauerkraut, it is not sour.
• Bread: preferably wheat, not fresh, but yesterday’s baked bread.
• Dairy: yogurt, milk, kefir, cottage cheese and cheese (low-fat), a little sour cream.
• Cereals: different.
• You can also prepare a protein omelet; milk sausages and various fruits, fresh and dried, are allowed. Drinks such as compote, infusion, juice, jelly. Sweets include mousses and jellies, and candies not made from chocolate. Exclude cream, ice cream and chocolate.

The diet after removal of prostate adenoma will be similar. That is, it is also important to eat more fresh foods, no unhealthy foods. Proteins and vegetable fats take advantage.

Prevention

It is important to follow the following medical recommendations:

• completely give up bad habits;
• increase physical activity;
• visit a urologist once a year;
• follow a therapeutic diet;
• control your own weight.

Bottom line

Prostate adenoma is a serious disease that requires timely treatment. Treatment of prostate adenoma should be strictly individual and only under the supervision of a specialist. No self-medication is allowed here. You can’t start taking this or that drug “because it helps my neighbor in the country, Ivan Ivanovich, who seems to have the same disease”! By following this tactic, you can miss some much more severe pathology, for example, prostate cancer, which has many symptoms similar to adenoma. The ideal method of treating a particular patient should be determined by a qualified urologist who knows the basic methods of combating this disease (both medicinal and surgical). All the best to you and take care of your health!

Head of the urological department of the 4th City Clinical Hospital named after. NOT. Savchenko Buldyk Yu.T.

Prevention of the prostate gland in men

There are certain rules for the prevention of prostate adenoma, following which you can maintain the health of this important organ:

• Follow a diet - reduce consumption of red meat and fatty foods. A man's diet should be dominated by vegetables, fruits, and omega acids;
• Increase physical activity – physical exercise has a positive effect on prostate health;
• Control your body weight – this will significantly reduce the risk of developing prostate adenoma;
• Minimize stress – will improve hormonal levels and slow down the development of the disease;
• Have an active sex life;
• After 45-50 years, be systematically examined by a urologist and take an analysis of the dog’s blood level.

Prostate adenoma, detected in the early stages of development, can be corrected with medication and non-surgically without any problems.
Timely contacting a urologist and unquestioningly following all his instructions for treating the disease in almost all cases guarantees stopping the growth of the gland and preventing urinary disorders. Late stages of the disease with symptoms that significantly reduce a man’s quality of life will require the use of surgical treatment methods. Therefore, early diagnosis of prostate adenoma is of great importance, which can be done in the modern medical center of Moscow - the Yusupov Hospital. The clinic’s high-tech diagnostic equipment ensures the most accurate research results, thanks to which Yusupov Hospital specialists select an effective individual treatment regimen for each patient, whenever possible, giving preference to non-surgical, gentle treatment methods.

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What causes prostate hyperplasia?

Until now, the exact causes of this disease are not known. There is no clear relationship between the occurrence of prostate adenoma and excessively high or low sexual activity, alcohol abuse and smoking. The main role is played by imbalance in the levels of androgens and estrogens.

With age, against the background of hormonal imbalance, paraurethral glands grow in the central zone of the prostate. Histologically (under a microscope), the number of not only the glands themselves, but also the connective tissue may increase, so histologists distinguish glandular, stromal and glandular-stromal forms of prostate adenoma. Macroscopically, a nodule (or many nodules) forms in the prostate gland, which grows and gradually deforms not only the prostate gland itself, but also compresses the urethra. At the same time, the middle and lateral lobes are formed in the prostate depending on the number of nodes and their direction of growth. Therefore, the main symptom of the disease is primarily a deterioration in the quality of urination. Prostate hyperplasia itself is a benign process. It does not metastasize or grow into other organs, like prostate cancer. However, one way or another, the risk of the cells inside it degenerating into malignant ones exists. Therefore, it is necessary to monitor PSA levels and be sure to undergo regular examinations with a urologist.

What happens during prostate surgery?

The most common type of prostate enlargement surgery is the so-called transurethral resection of the prostate (TUR). One of the most important arguments in favor of TURBT is the low incidence of complications and the avoidance of a surgical incision. The patient needs to spend no more than 3-5 days in the hospital.

The operation is performed using a device called a resectoscope. The device is inserted through the urethra to the prostate gland. The prostate gland is “cut” and removed.

During an open prostatectomy, an incision is made in the abdominal wall to access the prostate through the bladder. The advantage of this method is that it is possible to remove a large prostate. The disadvantage of this method is a higher number of possible complications, longer recovery and hospital stay.

After surgery, a histological examination of surgically obtained prostate tissue is always performed. If malignant prostate cancer is detected, it can be effectively treated if detected at an early stage.

Will herbs help with hyperplasia?

Some natural drugs have good activity in the mildest forms of BPH, but their mechanism of action is not well understood and is unpredictable. Their use can reduce irritating symptoms and increase urine flow. Some compounds also have weak antiandrogenic, antiestrogenic, anti-inflammatory, analgesic and diuretic effects.

Most of these formulations have been shown to work well, but their use may pose risks. Therefore, you can drink herbal infusions only as prescribed by a urologist.

When purchasing over-the-counter medications, the patient feels “safe”, believing that they have solved the problem. But such treatment ends with the patient seeing a doctor only after the complaints become painful, when secondary disorders or complications may develop. The situation can be even more serious if the complaints are not caused by BPH, but by prostate cancer, in which early diagnosis can decide the fate.

Other tests

• Intravenous urography.
  The urinary system (kidneys, urinary tract, bladder, urethra) can be examined using intravenous urography. The patient is given an injection of a contrast agent, then an x-ray of the abdominal cavity is taken.
• Endoscopic examination
  . Lower urinary tract endoscopy is also not a routine test. The test involves inserting a small device with a small camera at the end through the urethra and into the bladder. The image transmitted by the camera appears on the screen, allowing the doctor to assess the condition of the lower urinary tract. The method is also suitable for histological sampling if a malignant process is suspected.