Non-surgical treatment of prostate adenoma by vascular embolization. Where and how do non-surgical treatment of prostate adenoma by vascular embolization. To whom the method is contraindicated

A distinctive feature of the operation is that the indications and the examination plan are carried out by the urologist, and the manipulation itself is carried out by vascular surgeons.

The standard prostate embolization procedure consists of several steps:

The man is brought to the operating room, the necessary medical equipment is connected and local or epidural anesthesia is administered.
At a distance of 2-3 cm from the inguinal fold, a small incision is made, an arterial catheter is inserted, after which the state and patency of the arteries are studied using angiography.
Equipment is installed for blood supply to the prostate during the operation and a device is launched that delivers emboli to the nearest artery.
After the introduction of the drug, angiography is repeated to monitor the effectiveness of the embolization of the prostate arteries.
All sensors and devices are removed, the incision is sewn up and processed, after which the patient is taken to the ward.

The duration of the operation rarely exceeds 2 hours and mainly depends on the experience of the surgeon. A man can go home the same day.

So, in what cases do surgeons use the prostate artery embolization method? The indication for use is benign prostatic hyperplasia, in which the size of the prostate with a tumor is more than 80 cubic centimeters.

By the way, embolization can be used not only for benign prostatic hyperplasia. Among the indications for use, prostate cancer, varicose veins of the prostate gland, and mechanical trauma to the prostate are also distinguished.

Surgeons also argue that the procedure is advisable to use if there is a rupture of the blood vessels through which the prostate gland receives blood.

Of course, the procedure may not be used in all cases. Recent studies have shown that embolization is extremely dangerous in cases where prostate adenoma is accompanied by an anomaly or occlusion of the iliac vessels.

Strict contraindications are conditions in which there are floating blood clots. What it is? Floating clots are clots that can break off at any moment.

Before surgeons begin embolization of the arteries of the prostate gland, the patient should undergo a comprehensive diagnosis. The patient will have to pass a general blood and urine test, a blood test for sugar, ultrasound of the veins of the lower extremities, and electrocardiography.

A rectal digital examination of the prostate is mandatory. Another patient is shown TRUS of the prostate gland and a blood test for PSA. If the patient has a tendency to allergic reactions, he needs to be tested to determine the sensitivity to anesthetics.

According to the results of the diagnosis, doctors decide whether it is effective in a particular case to resort to arterial embolization, or it is better to choose another procedure.

After arterial embolization, the size of prostate adenoma decreases by an average of 50-80%. The prostate also decreases in size by 30-50%. Thanks to this, it is possible to normalize the process of urination quickly.

Good results in urodynamics can be achieved in just a few days. The urge to urinate becomes much less, pain in the urethra and other symptoms characteristic of benign prostatic hyperplasia disappear.

What feedback do patients leave for embolization of the prostate arteries? In general, people respond positively to this procedure. Most patients note that within a few days after surgery, they feel much better.

In order to avoid relapse in the future, the patient must adhere to the following rules:

Monitor PSA levels in the blood and regularly visit a urologist for preventive examinations.
Eat a balanced diet. Foods that contain fats (saturated) and simple carbohydrates should be avoided.
Refrain from drinking alcoholic beverages. It is especially dangerous to drink beer, as it contains a large amount of phytoestrogens.
Do not smoke.
Do not use hormonal drugs unnecessarily. Any changes in the hormonal background are extremely dangerous, because with an imbalance of hormones, a relapse is quite possible.
To live an active lifestyle. This is especially true for men who have a sedentary job. Regular walking, swimming and jogging will be very beneficial for your health. In addition, exercise contributes to the stabilization of hormonal levels.

Is it necessary to use any drugs for prophylactic purposes? 5-alpha-reductase inhibitors and alpha-1-blockers are not recommended to be used unnecessarily, as they negatively affect sperm quality and potency.

For preventive purposes, it is best to use bioadditives. They are safe and may well be used after the body has undergone surgery. The best dietary supplement is the Chinese urological patch ZB Prostatic Navel Plasters.

This tool will be an excellent prevention of recurrence. Moreover, the Chinese urological patch can be used even in the treatment of compensated and subcompensated stages of adenoma. Among the indications for the use of bioadditives, prostatitis and other urological pathologies are also distinguished.

ASK A QUESTION TO THE DOCTOR

The operation is performed in a specialized X-ray operating room, which must be equipped with an angiographic complex, which makes it possible to obtain a high-quality picture during the entire procedure.

Embolization is performed not by urologists, but by X-ray endovascular surgeons.

This is explained by the fact that such a process involves precise action with vessels of small diameters using special equipment and tools. The described procedure belongs to the category of the least traumatic. There is no need for general anesthesia.

At the puncture point of the artery, only local anesthesia is used, so the patient does not hurt at all. The surgeon performs a puncture on the thigh just below the inguinal fold. During the entire operation, the patient may feel warmth in the abdomen, groin, buttocks.

The effectiveness of the procedure

Long preparation for the procedure is not required. However, the patient should shave the hair from the groin area and refrain from eating 4 hours before embolization. Liquids are allowed, but in moderation.

If necessary, the doctor prescribes a number of antibiotics to the patient before the procedure. Also, before the procedure, surgeons make an intramuscular injection with a sedative and anesthetic, after which a Foley catheter is installed.

Embolotherapy, like any other medical technique, has a number of indications and contraindications.

Indications

impossible to carry out endoscopic transurethral resection of the prostate;
benign prostatic hyperplasia (tumor volume over 80 cc);
lack of positive dynamics in therapy with conservative methods;
obstructive type of urination according to uroflowmetric study;
the presence of pathological disorders of the cardiovascular system;
nephrological diseases;
elevated blood glucose levels;
restoration of urinary function in patients with cystoma;
expansion of varicose veins of the prostate, accompanied by bleeding;

Contraindications

intolerance to medicines based on iodine;
anomalies of the iliac artery;
life history aggravated by coagulopathy;
elevated levels of creatinine in the blood;
malignant formations of the prostate;

Factors that directly affect the effectiveness of the procedure:

Age group of the patient.
Explication of the disease.
The presence of concomitant pathological processes in the body.
Infection of the urinary system.
urinary dysfunction.

Embolization of prostate arteries is a specific procedure that requires special skills and abilities. The procedure under consideration assumes significant experience of surgeons who perform manipulations on small-diameter vessels.

Thanks to narrowly focused specialists, as well as the availability of high-precision medical equipment and medical instruments, arterial embolization is not a problem.

malignant neoplasms (prostate cancer);
mechanical damage, trauma to the gland;
varicose veins of the prostate, profuse bleeding;
damage to the prostatic arteries;
intolerance to general anesthesia;
presence of a urinary catheter or cystostomy.

Embolization is prescribed in case of severe concomitant diseases in a man: diabetes mellitus, renal or hepatic insufficiency, impaired hematopoietic function, ischemia, myocardial infarction, stroke.

The procedure is performed when the patient refuses an open operation, or if the state of health does not allow an incision of the bladder, surgical intervention through the urethra.

Doctors insist on embolization when there is a rupture of the vessels through which blood enters the prostate.

The described type of treatment, like any other therapeutic technique, is distinguished by the presence of indications, contraindications for its implementation.

So, the main indications of the doctor's procedure include:

the presence of a ban on endoscopic transurethral resection of the prostate;
diagnosis of benign prostatic hyperplasia with a tumor size of more than 80 cm3;
there is no positive dynamics in the treatment with standard methods;
the presence of an obstructive type of urination according to the uroflowmetric study;
diagnosing pathological disorders of the cardiovascular system;
nephrological ailments;
increased amount of sugar in the blood serum;
regenerative process of urinary functions in patients with cystoma;
the presence of expansion of varicose veins of the prostate gland with bleeding.

Despite such a significant list of indications for the described procedure, it also has contraindications, which it is desirable for every patient with prostate adenoma to know.

The main contraindications for embolization include the presence of:

individual intolerance to drugs based on iodine;
anomalies of the iliac artery;
aggravated coagulopathy;
increased levels of creatinine in the blood;
malignant tumors of the prostate.

In addition to the contraindications listed above, there are some other factors that directly affect the effectiveness of the procedure. These include:

patient's age;
explication of the disease;
diagnosing a concomitant process in the body;
infection of the urinary system;
urinary dysfunction.

Regardless of the available indications, contraindications, embolization can only be prescribed by a qualified doctor.

Contraindications

One of the undoubted advantages of the embolization method is the complete absence of mechanical impact on the prostate tissue. The operation affects only the local arteries that feed the gland, which expands the list of indications for the application of the technique.

Initially, the method of intravascular blockage of the arteries was used to treat prostate adenoma. Gradually, the range of effective use of the technique was expanded. Embolization of the prostate arteries is carried out in case of diagnosing the following diseases and pathologies:

Prostate cancer. Restriction of food allows you to reduce the activity of cancer cells, stopping the growth of the tumor or slowing down its development.
Prostate injury. Damage to the parenchymal tissue is usually accompanied by prolonged bleeding, which is difficult to stop. Using the modern method of arterial embolization, it is possible to eliminate blood loss and restore the organ's performance.
The presence of concomitant heart diseases, diabetes mellitus, renal or hepatic insufficiency, diseases of the blood coagulation system are a contraindication for most surgical operations. Due to low trauma, embolization of prostate arteries becomes almost the only way out for such patients.

A good result is given by the technique in the presence of varicose veins in the pelvic area. The lack of effect of ongoing conservative therapy or surgical removal of the tumor with negative results is also an indication for intravascular embolization of the prostate arteries.

Limitations to the use of the method are associated with the presence of systemic diseases that interfere with the implementation of anesthesia or are accompanied by an increased risk of complications during surgery or during the rehabilitation period.

Embolization of the prostate arteries is contraindicated in patients who have a history of the following pathological conditions and disorders:

Individual intolerance to drugs that are used as a contrast agent to monitor the progress of the operation.
Acute infectious and inflammatory diseases that increase the risk of postoperative septic complications.
Chronic diseases of internal organs in the stage of decompensation.
Severe form of bronchial asthma.
Post-infarction or post-stroke condition.
Thrombosis of deep and superficial veins of the lower extremities.
Stenosis and blockage of arterial vessels.

Before embolization of the prostate arteries, the patient undergoes a full course of diagnostics to exclude the possibility of surgery in the presence of threatening conditions.

The decision on the advisability of embolization is made by the attending physician. In the case of additional diseases, a man needs to consult several specialized specialists. The procedure is not available to everyone, it has a number of contraindications:

individual intolerance to iodine preparations;
floating (capable of breaking off at any moment) blood clots;
occlusion of the iliac vessels;
pathological changes in the iliac vessels;
coagulopathy (blood clotting disorder).

Possible Complications

The most common complication after embolization of the prostate arteries is the formation of a hematoma at the site of catheter insertion. It does not require treatment, but for a speedy disappearance, you can use ointments or apply cold to the bruise.

In addition to the hematoma, urination disorders develop:

Urinary retention;
Frequent, false urge to urinate;
Painful urination.

The risk of developing infectious diseases is minimal due to the small area of intervention and the use of sterile instruments. Prophylactic antibiotics also help prevent infection.

The use of local anesthesia can cause an allergic reaction at the injection site. It manifests itself immediately after using the medication, and 3-4 days after the operation.

There is also a risk of complications that are associated with the inexperience of surgeons.

Since embolization is one of the least traumatic procedures, it does not lead to any very serious complications. However, they are possible.

Since large hematomas are instantly emptied, such a consequence as suppuration is usually superficial and does not require an enhanced course of therapy.

Price

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After the age of 40, the vast majority of men begin to have problems with the prostate gland. Prostatitis is not just the most common male problem. It would seem that a man is in the prime of life, and should enjoy life and get maximum pleasure from sex, but prostatitis changes everything!

The easiest, cheapest and most effective way to get rid of prostatitis…

Embolization of the prostate arteries in BPH can only be done on an outpatient basis without hospitalization. True, the patient may remain in the hospital until the next morning.

Since the procedure is quite effective and is performed by a highly qualified specialist, its cost for some can be very solid.

Thus, the cost of prostate artery embolization in Moscow reaches 60-100 thousand rubles. In general, the cost of the operation consists of several points. It includes the cost of embolization material, which ranges from 15-30 thousand rubles. for 1 bottle. And they need 1-2 pieces.

The whole process is not at all routine. Since it is problematic to perform manipulations with a single catheter, microcatheters are usually used to prevent the onset of various complications. The cost of the 1st microcatheter is about 70-100 thousand rubles.

Prostate adenoma is difficult to treat, as it is a consequence of age-related changes in the tissues of the prostate. One of the effective methods of treatment is embolization of the arteries of the prostate. The essence of this procedure is to limit the flow of blood to the organ, which effectively slows down the progression of adenoma.

Embolization of prostate adenoma involves limiting blood flow to the diseased organ. This is achieved by blocking the blood vessels. In addition to the treatment of adenoma, the method is widely used in the treatment of various diseases of the male and female reproductive system.

The procedure belongs to minimally invasive methods, is characterized by rapid rehabilitation and low risks of complications. After emobilization of the arteries of the prostate, the size of benign hyperplasia is reduced by a third, which has a positive effect on the patient's well-being.

The procedure is effective in more than 90% of cases of severe adenoma in men. Despite the safety and proven efficacy, embolization is still not widely used in clinics in Russia, Ukraine and Belarus.

The purpose of the procedure is to limit the blood supply to the prostate. The malnourished adenoma will gradually shrink

Benefits of the procedure

Embolization of the arteries of the prostate gland has a number of advantages, the main of which is an effective reduction in the volume of the adenoma. Among the positive aspects of the procedure:

conduct safety;
high efficiency;
low trauma;
no side effects.

The disadvantages of the method include the difficulty in choosing a clinic for the procedure.

Embolization differs significantly from traditional surgical methods for the treatment of adenoma. Specialists' forecasts suggest that embolization is the most preferred method of surgical treatment of adenoma today. The procedure belongs to minimally invasive methods, which eliminates the risk of dangerous complications.

Indications for the procedure

Embolization of prostate vessels is indicated for adenoma and prostatitis. It is used when other methods of treatment are ineffective, or the patient has contraindications to traditional operations to remove the adenoma.

Indications for embolization:

large adenoma;
the age of the patient is over 60 years;
intolerance to general anesthesia;
ineffectiveness of drug therapy;
a decrease in the quality of life on the background of adenoma.

Benign prostatic hyperplasia or adenoma is a disease of older men, the development of which is due to the natural aging of the body. Adenoma is accompanied by a number of symptoms that significantly worsen the life of the patient. It is impossible to cure the disease without surgical intervention, since in fact it is not a pathology, but a feature of the male body. Drug therapy for adenoma is always aimed at maintaining normal health and slowing down the rate of progression of the disease.

At the same time, vascular embolization allows you to quickly and painlessly get rid of the symptoms of adenoma and stop the progression of the disease without long-term medication, many of which cause side effects. X-ray endovascular embolization of prostate arteries contributes to:

reduction of adenoma by 30%;
reduce the rate of progression of the disease;
improvement of urodynamics;
normalization of well-being.

After the procedure, men cease to be disturbed by urination disorders and frequent urge to go to the toilet at night. Embolization significantly improves the patient's quality of life.

Multiple night trips to the toilet are an unpleasant manifestation of adenoma. After embolization, urination disorders are reduced

To whom is the method contraindicated?

Prostate artery embolization (abbreviated PAE) is contraindicated in older men with a high risk of thrombosis. Restrictions apply to cases of the presence of blood clots that can come off during the procedure.

Also, the method is not used to treat patients with anomalies of the iliac vessels.

In all other cases, an EAP is possible according to the doctor's prescription. The patient must inform the specialist about all chronic diseases. A comprehensive examination of the body and an assessment of the state of the cardiovascular system are also carried out to analyze possible risks and complications during the operation.

Features of preparation

Specific preparation for the intervention is not required. The doctor will tell the patient in detail about the course of the procedure and warn about the possible consequences. The operation is performed under general anesthesia, and a test for sensitivity to the anesthetic is carried out beforehand. If you are allergic to any medication, be sure to inform your doctor.

Immediately before the procedure, the patient must remove the hair in the groin area. The operation is performed on an empty stomach. A light dinner is allowed in the evening, but 5-6 hours before the procedure, you should refuse to eat.

Order of conduct

Interventional EAP is carried out with the help of the introduction of embolizing preparations, which literally seal certain vessels, preventing blood flow to the organ. This is done in the following way.

The patient lies on the couch, he is fitted with sensors that allow him to control the heart rate and blood pressure during the manipulation. Then a small puncture is made in the thigh area, through which a catheter is inserted. The puncture is usually done in the common femoral artery. A contrast is injected through the catheter, allowing you to monitor the progress of the procedure through x-ray equipment.

Embolization is a low-traumatic procedure, only a small puncture is made

When the artery supplying the prostate gland is found, a special drug is injected through the catheter, interrupting the blood flow in this area. In this case, the patient may feel slight flushes of heat or a quickly passing undulating burning sensation.

An embolizing drug is a mass of small balls of medical plastic that reliably clogs an artery. The control of the procedure is carried out by repeated injection of contrast.

Manipulation is carried out not by a urologist, but by an endovascular surgeon. This is due to the fact that only such a specialist can intervene in the circulatory system.

The whole procedure takes no more than half an hour and is performed under local anesthesia. The patient at this time is conscious and freely observes the progress of the operation.

Recovery after PEA

After the operation, the patient is observed in the hospital for no more than three days. After the procedure, a catheter remains at the site of the blockage of the artery. It is removed after 10-12 days. All this time, the patient may feel discomfort at the site of the catheter, aggravated by exertion.

On average, two weeks after the procedure, the size of the adenoma begins to decrease, which is accompanied by an improvement in well-being. You can evaluate the effectiveness of the procedure one month after its implementation.

Embolization of prostate arteries is a modern method of treatment of adenoma and hyperplasia of prostate tissues. This is a low-traumatic procedure in which the doctor places special balls into the lumen of the vessels that feed the tumor. Because of this, there is a violation of blood circulation, the tissue eventually collapses and resolves.

Keep in mind that this method of treatment is suitable for use only in the initial stages of the disease. It is not used in the presence of at least one contraindication. Embolization takes place in a planned manner, before the intervention, the patient is sent for an extended medical examination.

Technology Benefits

Embolization of the arteries of the prostate is a low-traumatic method for the treatment of adenoma and prostatitis. This method is being used more and more frequently. Doctors themselves send their patients for this procedure, as it is quite safe and highly effective. The operation was previously performed exclusively in a hospital, but now it is also possible to perform it on an outpatient basis. In general, 1 day after the intervention, a person can safely return to his usual way of life.

The advantage of embolization of the prostate arteries can also be called the complete absence of sutures on the skin, you will not need to process them and regularly check the healing rate.

Subsequently, you will not encounter painful sensations that will not distract you from your affairs. Due to the lack of incisions, there is no need for dressings or intensive care. The procedure is completely safe, complications and negative consequences are extremely rare.

Indications and contraindications

Usually, embolization of the arteries of the prostate is resorted to in the following cases:

With injuries of the prostate;
With rupture of blood vessels in the prostate gland;
With benign hyperplasia;
In the presence of aggravating diagnoses: heart attack, stroke, ischemia, kidney or liver failure, diabetes mellitus or insufficient blood clotting;
In the absence of effectiveness from drug treatment;
With cystostomy.

Despite the positive effect on the body, prostate artery embolization is not possible in all cases.

Absolute contraindications include:

Occlusion of the iliac vessels;
Anomaly of the iliac vessels;
Floating thrombi.

Preparation and conduct of the operation

As such, embolization of the arteries of the prostate does not require preparation. Before going to the doctor, the man must completely shave off the hair in the groin, and also refuse food 4 hours before the intervention. Only a small amount of clean water is allowed.

If any pathogenic microorganisms are present in the blood, antibiotics are prescribed to the man. Also, before taking a man to the treatment room, he is given a small dose of sedatives and painkillers.

When the specialist checks all the indicators, the Foley catheter is inserted into the patient.

Embolization of the arteries of the prostate is carried out in the following way:

The patient is placed on the operating table. After that, sensors are connected to his chest, with the help of which it is possible to control the state of the body. Also, a device for measuring blood pressure is installed on the hand, and a sensor on the finger that determines the amount of oxygen in the peripheral sections;
A small puncture is made at a distance of several cm from the inguinal fold;
After that, the specialist performs the procedure of arteriography of the branches of the artery. They allow you to study the patency of blood vessels;
A small blood supply device is placed for the prostate gland;
In the incision, the specialist installs a small microcatheter, the diameter of which does not exceed 1 centimeter;
In this device, he introduces an embolization device. It releases medical plastic particles into the blood vessels;
After the introduction of these small particles, the specialist conducts repeated control contrasting. This is necessary so that he is convinced of the correctness of the actions;
At the end of the procedure, the patient returns to the room.

The effectiveness of the procedure

The effectiveness of prostate artery embolization has been evaluated by numerous experts from around the world. A large number of documents were compiled, thanks to which specialists from the World Health Organization managed to include embolization in the list of low-traumatic effects. Typically, this effect is prescribed for men aged 50-90 years.

Also, embolization allows you to get rid of adenoma and prostatitis in people who are overweight.

Statistics show that as early as 1 month after the intervention, men show persistent improvements. The size of the tumor is significantly reduced, the process of urination returns to normal. In 30% of patients, significant changes appear after 1 week. In general, it takes 1 year to show the full effect. During this time, the tumor will completely subside, the process of urination will improve.

Studies have shown that embolization of the prostate arteries can achieve the following results:

The volume of the neoplasm has noticeably decreased;
The size of the adenoma has decreased by about 2 times;
The PSA level dropped to 5.37 ng/ml if the man had a bladder catheterization;
The PSA level dropped to 3.5 ng/ml if the man was not catheterized;
The rate of urination recovered to the level of 13-16 ml/s, the duration was reduced to 30 seconds.

If embolization of the arteries of the prostate was performed in those men who suffered from the problem of acute urinary retention, they needed to have a catheter placed to drain this fluid. However, in 30% the restoration of the natural process of urination is carried out without outside help.

Only 2% of men had serious disorders that required surgical intervention to solve the problem. In most cases, the normal outflow of urine was restored somewhere after 1-1.5 months.

Rehabilitation

Embolism of the prostate arteries is a fairly safe intervention, which is performed under general anesthesia. It is prescribed for the treatment of prostate adenoma or prostatic hyperplasia. After the balls are placed in the lumen of the blood arteries, tumor markers enter the body, after which they are excreted along with the urine.

Usually the operation does not require a recovery period, it is transferred quite easily. During the rehabilitation period, a man does not need to do dressings, go for procedures or process stitches.

With the normal course of the operation, a man can be discharged from the hospital the very next day. It takes only 3 days to carry out a full-fledged treatment: examinations, operations and recovery. Embolization of the arteries of the prostate is a fairly safe procedure, which occasionally causes side effects.

There may be discomfort in the groin, disturbances in urination and sexual function. Usually such phenomena require symptomatic therapy. In rare cases, getting rid of the negative consequences of the intervention occurs with the help of surgical treatment.

– Doctor of Medical Sciences, twice Laureate of State Prizes of the Government of the Russian Federation in the field of science and technology, Laureate of the Lenin Komsomol Prize, author of more than 350 scientific papers in medicine, 7 monographs, and 10 patents for inventions in medicine, over 30 years of personal experience has spent more than 10,000 different endovascular surgeries

Why is prostate adenoma dangerous?

Prostate adenoma (benign prostatic hyperplasia) is a common disease in men over 40 years of age.

A characteristic sign of the occurrence of this disease of the prostate are problems with urination. The fact is that the enlarged prostate gland partially blocks the urethra. Men complain of sluggish urination and its increased duration - up to 5 minutes or more. The urge to urinate noticeably increases: up to 10-15 times during the day and 5-6 times at night, while going to the toilet does not alleviate the patient's condition, since no more than 30-50 ml of urine is excreted at a time.

Gradually, pain is added to problems with urination. At first tolerable, it tends to intensify, the discomfort increases, and the painful sensations become almost unbearable. With grade 3 adenoma, patients also suffer from:

dehydration;
constipation;
vomiting;
apathy.

In addition, the disease leads to a significant deterioration in erectile function. In most cases, this negatively affects the moral well-being of a man.

Indications for treatment with prostate embolization

Vascular embolization is performed if:

The neoplasm has a volume of more than 50 cm3.
Medical therapy is ineffective.
The patient developed an obstructive type of urination according to uroflowmetry.
There are bleeding from varicose veins of the prostate gland.
The patient wants to get rid of the cystostomy found in him.

The decision to carry out embolization of the prostate vessels is made by doctors, while the opinion of the patient himself is necessarily taken into account.

Traditional Treatments

Many men aged 45-50 are diagnosed with this disease. In the early stages of the disease, traditional means of treatment are used - drug therapy in combination with an individual diet. However, with a significant size of the tumor or the absence of the effect of drug therapy, surgical intervention is necessary.

The traditional operation of endoscopic transurethral resection is performed by a doctor through the bladder. The disadvantages of this method of treatment are:

Serious injury.
Increased risks from using general anesthesia.
The occurrence of postoperative complications.
Possible violations of sexual activity.
Many contraindications.

The modern technique - embolization of prostate vessels - is devoid of all the above disadvantages.

Advantages

Embolization of prostate vessels is a minimally invasive procedure that effectively eliminates all symptoms of the disease, relieves a man from discomfort and pain. The essence of the embolizing technique is to stop the blood flow through the artery, which supplies the adenoma with nutrients and oxygen.

Embolization of prostate vessels with the help of X-ray surgery has the following undeniable advantages:

no complications;
the use of local anesthesia only;
minimum procedure time;
short recovery period;
the ability to embolize the prostate artery in elderly patients with concomitant diseases.

Prostate embolization (PEA) is most often an elective operation. The patient can deliberately decide on the intervention, discuss with the doctor all the nuances of the procedure, and conduct the necessary examination.

Contraindications

A preliminary examination of the prostate gland and the whole body allows you to identify the presence of contraindications and the general health of the patient. This type of operation is not performed if during the examination the patient has:

Anomalies in the development of the iliac vessels or their occlusive lesion.
Thrombi in the basin of the veins of the lower extremities.

For diagnostics, the whole range of traditional and modern methods is used.

Embolization of prostate adenoma - stages

The intervention takes place in an operating room equipped with an X-ray machine and an angiographic complex, which allows obtaining a high-quality image of the arteries in real time. The operation is performed by a highly qualified surgeon.

The operation on the prostate gland is carried out in several stages:

A puncture is made on the patient's thigh (1-2 cm below the inguinal fold).
A microcatheter with a diameter of 0.6-0.8 mm is inserted into the sources of blood supply to the prostate gland.
Through the installed catheter, special spherical particles of medical plastic (emboli) are introduced.
Control contrasting is carried out, confirming reliable blockage of all arteries of the prostate.

The clogged artery remains in the patient's body without any harmful effects. Emboli can also be in the patient's body throughout his life.

Efficiency of embolization of prostate vessels

The high efficiency of minimally invasive intervention for blocking the vessels of the prostate gland has been proven by major international studies. In the first month after the procedure, the majority of patients of the Center for Endovascular Surgery of Professor S. A. Kapranov have a reduction in the size of the prostate gland and the disappearance of the unpleasant sensations accompanying the adenoma. About 30% of patients report progress in the first week after the procedure. Approximately one year after the intervention, the diagnosis shows that the patient is healthy!

One of the leading specialists of the team of Professor S.A. Kapranov, B. Yu. Bobrov, today is the only doctor in Russia who has undergone special training in the use of EPA and received the appropriate international certificate.

BPH disease

Prostate adenoma has been replaced by the updated diagnostic name of benign prostatic hyperplasia (BPH). Hyperplasia refers to the processes of increasing tissue or organ by quantitative multiplication of cells.

Their accumulation in certain places causes a narrowing of the path for the urinary outflow. BPH does not belong to oncological diseases and is not associated with the development of cancer.

Traditional methods of treatment. Briefly tell us about the treatment options, at what stages of prostate adenoma they can be used, folk, drug options, operations - what are, what complications are possible.

Treatment of BPH involves the use of funds to increase urinary outflow.

To achieve this goal, apply:

drug treatment;
invasive and laser procedures;
surgical intervention with partial removal of the prostate.

In the initial stages of the disease, the use of folk remedies is acceptable. Exercises that strengthen the pelvic floor muscles are recommended.

To do this, in the process of urination, the muscles are strained and the flow is stopped. Hold for 20 seconds and then relax. Exercises are 5-15 contractions 4-5 times daily.

Exploratory survey

To choose a method of treatment, the patient is carefully examined.

To do this, the following activities are carried out:

the patient takes urine and blood tests to determine the general condition and possible other health problems;
uroflowmetry method observes the degree of violation of the flow of urine,
a urologist performs a rectal examination of the prostate,
transrectal ultrasound of the gland is the main way to obtain detailed information about the size of the adenoma and other features of the pathology;
determination of the PSA level- a method that clarifies the possibility of the presence of oncology.

Embolization of vessels in prostate adenoma

Embolization involves the selective occlusion of blood vessels with the deliberate introduction of emboli into the artery of the prostate. In other words, a blood vessel is intentionally blocked. This leads to the effectiveness of treatment and a minimally invasive effect on the organs of the human body.

The procedure is performed using special angiographic equipment. The operation is not performed by a urologist. She is trusted by an endovascular surgeon.

He has manipulative experience in dealing with vessels of the smallest diameter (less than 1 mm) and skills in working with X-ray television (angiographic apparatus).

The essence of the treatment is the actual blockage of the arterial vessels that supply blood to the enlarged prostate gland. Restriction of the blood supply leads to a decrease in the size of the prostate gland.

Embolization of the arteries of the prostate in BPH is effective when the volume of the adenoma exceeds 80 cm3.

This operation is applied when:

blood clotting disorders;
severe course of diabetes;
diseases of the cardiovascular system;
concomitant kidney disease;
desire to get rid of the cystostomy.

Contraindications for embolization are:

the presence of floating thrombi in the venous basin of the lower extremities;
anomaly and lesion of the iliac vessels.

How is it going?

The decision on the need for embolization is made by a council of doctors (urologist, endovascular surgeon), taking into account the wishes of the patient. The operation is performed in an office equipped with X-ray television.
Usually embolization for BPH is carried out on the day of hospitalization. On the eve of the groin and thigh area (10 cm below/above the inguinal fold) shaved. It is recommended not to eat for 4 hours before the operation.
Immediately before the operation, premedication is done (sedative and analgesic drugs are administered intramuscularly) and a urinary catheter is installed. Local anesthesia is used during the operation. A contrast agent is injected through the catheter.
The operation lasts within 40 minutes - 5 hours. Much depends on the individual anatomical features of the patient. After the end of the procedure, the doctor presses the puncture site with his fingers (10-15 minutes). This prevents the formation of a hematoma.

It is common practice to discharge a patient 6 hours after vascular embolization in BPH. But for greater safety, it is better to stay in the hospital until the next day.

What is the effectiveness of the procedure?

International research programs have confirmed the high level of effectiveness of embolization in BPH. Most patients experience an improvement in urination due to prostate reduction within 1 to 4 weeks after surgery. Complete normalization of urination and regression of the symptoms of the disease occur by the end of the year.

After a successful operation:

the physiological frequency of urination is restored;
false urge to urinate disappear;
adenoma decreases by 40–80%;
the total size of the prostate gland is reduced by 30-50%.

With prostate adenoma, embolization does not lead to inhibition of sexual function. In some cases, even contributes to its restoration.

Possible Complications

Embolization is a painless intervention. Complications after embolization of the arteries of the prostate, in some patients (approximately 5%) appear in the form of a hematoma. Its formation is possible at the site of arterial puncture. No special treatment is required.

In rare cases, there is a short violation of urination (dysuria). Eliminated by catheterization of the bladder (within 1-2 days).

The method of vascular embolization for BPH is recognized as the most modern method of treatment. It has been intensively used in technologically advanced countries since 2009.

How is it going?

Embolization of prostate adenoma reviews is positive, as the procedure can reduce education by 80%. This is a relatively new method of treating a disease, which is prescribed in the absence of the effect of conservative therapy.

Only highly qualified specialists can carry out embolization. Thanks to this procedure, a stable remission is achieved, but for this, all the recommendations of the doctor should be followed in the postoperative period.

The mechanism of development of the disease and symptoms

An adenoma is a benign neoplasm that is located in the tissues of the prostate gland. In most cases, the development of the disease is associated with a violation of the balance of hormones in the body.

For this reason, men are usually diagnosed after the age of 50. In connection with age-related changes in the body, testosterone levels decrease, while estrogen and estradiol, on the contrary, increase.

Under the influence of these hormones, a tumor grows in the prostate.

Traditional methods of treatment of prostate adenoma

This method of adenoma removal is considered not only minimally invasive, but also effective. Several small incisions are made to insert the necessary instruments. The surgeon monitors the progress of the operation on the monitor.

In the postoperative period after the removal of prostate adenoma, the main thing for the patient is to follow all the instructions of the attending physician. For this you need:

Get checked regularly.
Eat a balanced diet and completely exclude fried, spicy, salty dishes and smoked meats from the diet.
To drink a lot of water.

Avoid strenuous exercise or sudden movements.
In order to prevent the development of an infectious process, the patient may be prescribed a course of antibiotic therapy.
Refuse sexual intimacy for 1.5-2 months.
Lead a healthy and active lifestyle. Take daily walks in the fresh air.
Perform special exercises that the doctor will show.

The cost of the operation depends on the type of intervention.

Table 1. Prices for surgery to remove prostate adenoma

Since embolization is one of the least traumatic procedures, it does not lead to any very serious complications. However, they are possible.

Since large hematomas are instantly emptied, such a consequence as suppuration is usually superficial and does not require an enhanced course of therapy.

To date, there are a great many different methods of treatment for benign prostatic hyperplasia. In the event that the disease was diagnosed at an early stage of its development, the patient may be prescribed certain medications.

But with a serious increase in prostate adenoma, such therapy is not effective. In such a situation, the patient needs urgent surgical intervention.

Common treatments for this disease include:

Medical treatment.
Surgical intervention.

Medical treatment

The purpose of this technique is to slow down the growth of tissue structures of the prostate gland, reduce its volume and normalize the process of urination. For this, the following drugs are used:

herbal preparations;
5-alpha reductase inhibitors - they affect the hormonal background of the male body and reduce the growth of prostate tissue;
alpha-blockers - affect the tone of the muscular apparatus of the urethra and prostate, as a result of which it is much easier to urinate.

Surgical intervention - involves the treatment of prostate adenoma surgically. This method is used only at a late stage of development of benign prostatic hyperplasia, and includes two main types of surgical interventions - transurethral resection and prostatectomy.

Transurethral resection of prostate adenoma - involves the removal of prostate tissue using a special medical instrument - a resectoscope, which is inserted into the patient's urethra. This operation can be attributed to the endoscopic type, so the risk of complications in this case is much less than with an "open" surgical intervention.

Prostatectomy is the removal of prostate tissue by an “open” method. This method of treating this disease differs from others in the development of a large number of complications and a rather long rehabilitation period.

Embolization of the prostate arteries - this method of treating prostate adenoma, although it appeared not so long ago, is already actively used in more developed countries of the world. It is often used when drug therapy does not give the desired result, the disease has pronounced symptoms, and the volume of the affected organ exceeds 60 cm3.

Embolization of the arteries of the prostate is performed through a small hole, which is made by the doctor in the groin area. A special catheter is inserted into a large arterial vessel, after which it is directed to the smaller arteries of the prostate gland.

When the catheter is in the arterial vessel that feeds the adenoma, the surgeon blocks the artery using emboli, tiny particles that are inserted through the catheter. It is emboli that create an obstacle that disrupts the normal blood flow of the affected organ.

After that, the embolization of the prostate arteries is repeated on the other side. Thus, the blood supply to this organ is blocked immediately from both sides.

The embolization procedure usually takes 1-4 hours, the duration of this operation depends on the size of the affected organ.

As a result of surgical intervention, there is a significant decrease in blood flow to the gland on both sides, and the areas of the prostate into which emboli have fallen die and become necrotic. Since it is impossible to completely prevent the flow of blood into this organ, the prostate gland does not die completely.

Necrosis of some of its sections leads to a gradual softening of the prostate, as a result of which its pressure on the urinary system of the patient decreases and the process of urination normalizes.

After some time (3-4 months), the dead tissue of the prostate is replaced by connective or scar tissue. After 6 months, the size of the gland is significantly reduced - by an average of 20-40%, which in turn improves the quality and reduces the number of urination.

Embolization of the arteries of the prostate is relatively easily tolerated by patients. In this case, there is no need for general anesthesia, because the operation itself is almost painless. Patients associate the feeling of discomfort after such a surgical intervention, first of all, with the fact that they have to lie on their back throughout the entire time of this procedure.

Usually the operation does not require a recovery period, it is transferred quite easily. During the rehabilitation period, a man does not need to do dressings, go for procedures or process stitches.

Embolization of the prostatic arteries is a safe operation. Complications and adverse effects after it are extremely rare. Sometimes after surgery, patients may experience side effects such as:

hematomas at the puncture site of the skin and vessel;
bleeding from the femoral artery;
dysuric disorders (difficulty urinating);
pain in the groin, perineum;
numbness of the skin of the thigh of the leg on which the puncture was made.

As a rule, these postoperative complications are short-lived and disappear on their own.

Despite little experience in using prostate embolization techniques, the effectiveness of the operation has been clinically confirmed. In most patients, clinical improvement is observed within the first week after surgery. It manifests itself, first of all, by the normalization of urination.

During the first 8 weeks after embolization, doctors record a decrease in the size of the entire glandular organ by 30-50%, as well as a decrease in the benign tumor in it by 40-80%. A decrease in subjective pathological symptoms is confirmed by additional research methods (urofluometry, transrectal ultrasound).

Feedback from patients who have undergone embolization of the prostate arteries allows us to conclude that this procedure is highly effective. As a rule, in the first month occurs:

reduction of hyperplasia by a third of the original volume;
normalization of urination;
reduction of pain and discomfort;
improving the quality of life.

The effectiveness of the procedure can be assessed by a blood test for PSA. As a rule, one and a half months after the PSA, the PSA level decreases significantly. If before the operation PSA was in the range of 8-9, after blockage of the artery, its level is within the normal range and does not exceed 5.

The disease usually develops gradually. It starts with problems with urination. Men complain about the weakening strength of the urine stream. Often, the duration of urination increases to 5 minutes or more. This increases the urge to urinate. A man may feel the desire to go to the toilet up to 10-15 times a day. Moreover, no more than 30-50 ml of urine is excreted at a time.

Patients also suffer from nocturnal urge to urinate. Often a man has to get up to go to the toilet up to 5-6 times a night. Of course, all these symptoms are very unpleasant. They disrupt the usual way of life, cause many difficulties. But all this is only the beginning of the development of pathology.

After the adenoma increases in size, urination is even more difficult. And the calls to him are becoming more frequent. A man can no longer go to visit, go to a play, go on a trip. Adenoma can turn life into a real nightmare.

Conclusion

The success of embolization is not affected by the increased size of the prostate gland. If the patient later requires conventional surgery, the earlier embolization will facilitate the operation and reduce the risk of bleeding. The new technique often prevents further intervention.

This is an endovascular intervention, the meaning of which is to stop the flow of blood to the prostate. The operation is performed using a special tool - embolospheres (microspheres), which is introduced under angiographic control into the artery that supplies the prostate.

As a result of its blockage (occlusion), the adenoma involutes and the size of the glandular organ decreases. This manipulation is carried out by interventional cardiac surgeons or endovascular surgeons.

Pros and cons of the operation

Benign prostatic hyperplasia. What are the current alternatives to surgical treatment and transurethral resection?

This technique is the most common today. Estimated duration of the operation does not exceed 1 hour. The indication for its implementation is the size of the prostate, not exceeding 80 ml in volume.

This is one of the most used ways to help patients with prostate adenoma. For the appointment of a transurethral resection, the indications are:

the volume of the prostate is up to eighty milliliters,
the surgeon predicts the duration of the operation no more than an hour.

What is endovascular embolization of the prostatic arteries?

X-ray endovascular embolization is a manipulation to limit blood flow to the affected organ. This effect is achieved by blocking the blood vessel.

It should be noted that in addition to the treatment of adenoma, the technique is often used in the treatment of various ailments of both male and female genital organs.

The operation itself is minimally invasive, characterized by a short rehabilitation period, as well as minimal risks of any complications. At the end of the procedure, benign hyperplasia is reduced in size by 1/3, which is reflected in the patient's positive state of health.

The effectiveness of the procedure reaches 90% in men suffering from prostate adenoma. EAP is distinguished by the presence of a number of advantages, one of which is the reduction in the size of the adenoma.

The advantages of the doctor's procedure also include:

complete absence of danger of carrying out;
significant performance;
low percentage of trauma;
no side effects.

Surgeons of X-ray endovascular embolization of arteries report a lot of advantages of this operation. It allows you to effectively eliminate all the symptoms of adenoma, relieve a man from discomfort, pain. The technique consists in ensuring the cessation of blood flow through the artery that supplies prostate adenoma.

Indications for operation:

Lack of positive dynamics during drug therapy.
An impressive volume of the prostate (up to 60 cm3).
Severe symptoms of the disease, urinary retention, high concentration of residual urine.

Prostate embolization (PEA) is most often a planned operation to stop blood flow through the artery. This means that the patient, together with the doctor, can slowly decide on the intervention, identify and consider all its nuances, and conduct the necessary examination.

Note! Interventions on the arteries are not performed if during the examination the patient is found to have:

Anomalies in the development of the iliac vessels, their occlusive lesion.
Thrombi in the basin of the veins of the lower extremities.

The decision to intervene is made by the doctors. Moreover, the opinion of the patient must be taken into account.

The pre-screening is also important. It allows you to determine the general state of health of the patient, as well as the presence of indications and contraindications.

For diagnostics before intervention on the arteries, not only traditional, but also modern methods are used. They give the most complete picture necessary for professionals.

Adenomectomy

Not so long ago, this was the only way to remove an adenoma. Today, the doctor can prescribe it only in the case when other operating methods are unacceptable. Indications for such an operation:

A significant increase in the size of the prostate (exceeds 80 mm).
During the examination of the patient, various complications were identified:

Stones in the bladder.
The diverticulum in the bladder needs to be removed.

Only a qualified surgeon should perform the operation in this way, since it is associated with a high risk of various, including dangerous complications.

More recently, it was the main type of surgery to remove prostate adenoma. Now such an intervention is recommended if, according to the patient's testimony, other methods of removing the adenoma are not suitable for him.

Adenomectomy is prescribed in such cases:

the prostate has increased in volume above eighty millimeters,
Examination of the patient revealed complicating facts:
- the presence of stones in the bladder,
- if there is a need to remove a large diverticulum in the bladder cavity.

Prostate adenoma and other indications for the procedure

The described type of treatment, like any other therapeutic technique, is distinguished by the presence of indications, contraindications for its implementation.

So, the main indications of the doctor's procedure include:

the presence of a ban on endoscopic transurethral resection of the prostate;
diagnosis of benign prostatic hyperplasia with a tumor size of more than 80 cm3;
there is no positive dynamics in the treatment with standard methods;
the presence of an obstructive type of urination according to the uroflowmetric study;
diagnosing pathological disorders of the cardiovascular system;
nephrological ailments;
increased amount of sugar in the blood serum;
regenerative process of urinary functions in patients with cystoma;
the presence of expansion of varicose veins of the prostate gland with bleeding.

Despite such a significant list of indications for the described procedure, it also has contraindications, which it is desirable for every patient with prostate adenoma to know.

Laparoscopic removal

plentiful drink,
specialist supervision,
sudden movements should be avoided
antibiotic therapy may be prescribed,
nutrition should be balanced
exclude from the diet dishes:
- salty,
- fried,
- smoked;
one and a half months should refrain from sexual intercourse,
shown to follow a healthy lifestyle,
daily walks,
perform a special set of exercises.

Why is the treatment of prostate adenoma by traditional methods ineffective?

The operation is performed in a specialized X-ray operating room, which must be equipped with an angiographic complex, which makes it possible to obtain a high-quality picture during the entire procedure.

Embolization is performed not by urologists, but by X-ray endovascular surgeons.

This is explained by the fact that such a process involves precise action with vessels of small diameters using special equipment and tools. The described procedure belongs to the category of the least traumatic. There is no need for general anesthesia.

Prostatic hyperplasia, otherwise prostate adenoma, is the most common disease among the strong half of humanity, which has reached the milestone of 50 years. This disease is caused by the spontaneous growth of the prostate gland and the blockage of the lumen of the urethra.

At the same time, the output of urine worsens, the accumulation of pathogenic bacteria in the bladder begins, causing various complications. These phenomena can be eliminated by conservative treatment in the early stages of the disease and by surgical intervention (operation).

Consider the causes of the appearance and development of this disease and modern methods of dealing with it.

Prostate adenoma: how does the disease develop?

enucleation

This technique is often used instead of open surgery and intervention through the urethra. During enucleation, adenoma tissues are, as it were, “husked” under the influence of a laser. The advantages of removing prostate adenoma by this method include:

The possibility of subsequent examination of the removed prostate tissues for a malignant process.
Removal of a large adenoma (over 200 g).
A short recovery period.
Possibility of carrying out for patients with various pathologies:

In the presence of metal implants in the skeleton.
The presence of a pacemaker.
Violation of blood clotting.

The procedure involves the "husking" of tissues to be removed using a laser. The method successfully replaces transurethral resection and open surgery.

Positive aspects of the method:

the ability to test the extracted tissue for oncology,
the method can be used when the gland grows up to 200 g and even more,
the benefits obtained from tissue vaporization are retained:
- a short recovery period;
it is possible to carry out the procedure for patients with problems:
- having a pacemaker
- in the case of metal devices built into the skeleton,
- if violations associated with normal blood clotting are detected.

The cost of intervention on adenoma

Embolization of the prostate arteries in BPH can only be done on an outpatient basis without hospitalization. True, the patient may remain in the hospital until the next morning.

Since the procedure is quite effective and is performed by a highly qualified specialist, its cost for some can be very solid.

Do you want to cure prostate adenoma? Contact us!

What is prostate adenoma: operation and reviews

Having studied the reviews of patients who were faced with the need for an operation to remove an adenoma, it can be noted that they are all well tolerated. The consequences may depend on the type of surgery:

After transvesical adenomectomy, the rehabilitation period is the longest. There is also a risk of developing various complications (urinary incontinence, decreased potency, retrograde ejaculation, etc.).
Transurethral resection is accompanied by the possibility of the same complications as the traditional removal of the adenoma, but the time required for recovery is slightly shorter.
After enucleation, some men report a violation of sexual function. At the initial stage, there may be problems with holding urine. Sometimes it is possible to develop bleeding or ejaculation in the bladder.

Since this technique is minimally invasive and at the same time highly effective, the bulk of the feedback from both doctors and patients is positive.

According to statistics, the effectiveness of PEA reaches 80-100%, while the recurrence of the disease is extremely rare.

Studies have shown that after 4-6 months, the size of the tumor is reduced by 30-35% with the relief of the patient's condition.

In addition, EAP does not require abdominal surgery and general anesthesia. Patients note the fact of perfect painlessness of the procedure with a duration equal to 1-2 days.

This operation requires a thorough diagnostic examination of the patient. Without fail, a man is assigned to take general clinical tests (blood, feces, urine, blood for sugar), a study of the state of the cardiovascular system (ultrasound of the vessels of the lower extremities, ECG), as well as a rectal digital examination of the prostate gland and ultrasound of the prostate.

If a malignant disease of this organ is suspected, the level of the prostatic agent (PSA) is measured for the patient and a biopsy of the prostate tissue is performed. The patient must take a test for the sensitivity of the body to anesthetic drugs.

Doctors unanimously confirm the high therapeutic effect of arterial embolization of the prostate, based on their experience. Statistics show that the effectiveness is about 80-100%, and the risk of relapse is minimal. Approximately six months later, all patients confirmed a stable decrease in tumor tissues by about a third, and sometimes more.

Patients themselves are also satisfied with the results of the treatment, noting that the procedure is painless and does not require postoperative restrictions or long-term recovery. After about a couple of weeks, as men note, a gradual decrease in the symptoms of adenoma begins, which is manifested by an improvement in the condition. After a month, you can really evaluate the effectiveness of embolization.

Patients tolerate all types of operations to remove adenomas well.

It is noted that open intervention is fraught with a more difficult recovery period.

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