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Traditional surgical treatment of prostate adenoma is its excision - adenomectomy.
Surgical treatment can be both traditional and low invasive, that is paired with minimal surgical intervention.
Pain relief operations on the prostate gland depends on the general condition of the patient, concomitant diseases. Types of anesthesia:
* General anesthesia (endotracheal) - with this kind of pain the patient is in operation without consciousness. For this introduces an anesthesiologist in advance of the patient in anesthesia induction with intravenous drugs, and then on the background of the so-called relaxants he enters the patient''s trachea tube, which serves the general anesthesia: nitrous oxide mixed with oxygen.
* Epidural anesthesia - a safer method of anesthesia, it is the introduction of a local anesthetic (eg, ropivacaine, marcaine) in the epidural space with a needle. Thus, anesthetic nerve blocks all the way, going to and from the spinal cord responsible for innervation of the patient''s body below the navel. For this anesthesiologist makes an injection needle into a special place between 4 and 5 lumbar vertebrae. Please note that the needle is inserted not in the spinal cord, and on his coat - in the region of the epidural space. The patient is in operation in mind.
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The operation consists in the fact that the surgeon makes a longitudinal incision in the bladder. Previously in the patient''s bladder filled with sterile solution of liquid (eg, furacillin). The surgeon selects filled bladder and reveals it. This enlarged prostate is visible in the cavity of the bladder. Then after a small incision around the adenoma, the latter seemed to extirpate finger surgery. Next, the patient''s urethra installed a plastic catheter. Bladder sutured. At the skin sutures. The meaning of the establishment of the catheter is as follows. After husking prostate adenoma is, of course, the destruction of the prostatic urethra. When the catheter is formed around the urethra (in the part where it was destroyed).
The operation is one of the earliest and at the same time - the most traumatic.
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* Stricture of the urethra - that is, fusion of the urethra
* Urinary incontinence due to weakness of the sphincter of the bladder
Minimally invasive surgery
Here are the detailed methods of minimally invasive surgical procedures used in prostate cancer:
* Transurethral resection of prostate (TUR or Turpo) - the method lies in the fact that using a special endoscopic equipment, which is introduced into the urethra produce resection (excision) of prostate adenoma. It uses the method of electrocoagulation, ie excision of adenoma tissue using an alternating electric current. The advantages of this method is that it is not necessary to make a traumatic incision of the bladder, husking adenoma finger. Because the resection is performed with electrocautery, while coagulate and small blood vessels, ie the risk of bleeding is much lower than during normal operation.
* Transurethral elektrovaporizatsiya prostate - in this case is also used endoscopic equipment, but the principle method of disposal adenomy somewhat different. Elektrovaporizatsiya means a sort of "evaporation" of tissue adnomy the prostate using the same alternating electrical current.
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* Transurethral incision of the prostate - a section of the prostate urethra, which is performed in order to reduce urethral resistance and reduce the symptoms of disturbances of urination. This procedure is particularly effective in patients with small prostate glands, it causes fewer complications than transurethral resection.
Microwave therapy - in this method, use the ability of microwaves to penetrate into the tissue, causing them while warming up. And since the penetration depth depends on the frequency used by microwaves, then managing the power and duration of action of microwave radiation of certain frequency in the diseased tissue can be ruinous for them to create heat. Thus histoclastic prostatic adenoma.
* High Intensity Focused Ultrasound
* Transurethral needle ablation
Last 4 types of less invasive interventions have common principles of action and is to destroy the tissues of adenoma. There are two similar methods of less invasive interventions:
* Balloon dilatation
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This method of operation is similar to the method used in vascular surgery. Using a special catheter with a spray at the end of the lumen of the prostate enlargement is made of the urethra. In addition, this department can be installed stent - a tube of special material that supports a certain diameter, narrowed urethra.
Impaza for treatment of erectile dysfunction
Since 2001. put into practice a new domestic product for the treatment of erectile dysfunction - impaza. The theoretical premise for the creation impazy (active ingredient - antibodies to endothelial NO synthase in ultralow doses) was the discovery of modifying the properties of ultrasmall doses of antibodies.
On the mechanisms of action impazy as a new class of drugs based on micro-doses of antibodies, on the one hand and a fundamentally new means to restore erectile function - on the other, it is possible with sufficient certainty to judge on the basis of experimental studies.
In the experiment, at course oral administration of male rats in physiological conditions (seasonal) and age suppression of reproductive function impaza significantly stimulated sexual behavior and increased the copulative function of animals. The change of some indicators pointed to the presence of a drug effect on the central mechanisms of erection.
Against the backdrop of the introduction impazy for treatment of erectile dysfunction was found a significant increase in smooth muscle cells of the corpora cavernosa level of intracellular cGMP. As for single and at course introduction impazy in the tissue of the corpora cavernosa increased content of nitric oxide derivatives. The increase of nitric oxide in the tissues of the corpora cavernosa animals receiving impazu associated with twice the increased activity of the enzyme endothelial NO synthase.
Thus, experimentally confirmed the basic peripheral mechanism of action impazy for treatment of erectile dysfunction: increased activity of the enzyme endothelial NO-synthase - a key enzyme that determines the maintenance of erection.
The results of clinical studies suggest that efficiency impazy significantly exceeds the effect of "placebo" and ranges from 45% to 66%.
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Given these data, we found it necessary to assess the validity impazy in two clinical studies. At the beginning for the clinical assessment of the drug was followed by an open noncomparative study.
According to protocol in the study included men with mild to moderate ED, aged 45 to 65 years. All patients received the drug every other day under the tongue, regardless of the timing of sexual intercourse within 3 months. Efficacy was assessed using the IIEF questionnaire. Before treatment the average score index "erectile function" ICEF amounted to 18.89? 5.25. After 3 months the average score index "erectile function" ICEF amounted to 22,50? 4.86. At the same time 11 patients (36.7%) treatment effectiveness was assessed as good (mainly due to the achievement of values of the "erectile function," 25 or more points), 4 patients (13,3%) - as well, 5 patients (16,7%) - as satisfactory, 10 patients (33,3%) - no effect, or deterioration in one patient were recorded.
Most excellent effect in the treatment of erectile dysfunction was observed in patients with psychogenic, neurogenic and mild arteriogenic ED. Therapy impazoy was ineffective in patients with severe arterial insufficiency, veno-occlusive and combined ED.
No reliable effect impazy depending on the weight of the patients were recorded. The effectiveness of therapy impazoy varied from 60% to 66.7% depending on the etiology and pathogenesis of ED.
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It has been observed that 7 patients (23.3%) improvement in IIEF occurred gradually, as we continue taking the drug impaza for 10-11 weeks, which might suggest that the therapeutic effect and the approach of a therapeutic effect. Furthermore, there are increasing number of sex acts with 5,3-1,32 to 7,8? 1.55 attempts per month. The total score of indicators of "satisfaction with sexual intercourse" and "overall satisfaction" questionnaire IIEF also increased from 7.15? 2.37 to 12.48? 3,54 and 4,58 "1,52 to 7,42" 2,69 respectively. Reliable change indices "orgasm" and "libido" IIEF questionnaire were recorded.
Tolerability and safety of care rated as excellent. Over time, research has not been any unwanted side effects, how to assess patients and doctors. Any negative impact on the course of concomitant diseases and the need to change therapy of these states are also not observed.
The aim of the next study was to evaluate the clinical efficacy and safety impazy compared with placebo in the treatment of ED. The study included 130 patients aged 18-75 years (mean 48,6 ± 11,9) with ED of various origins mild to moderate severity. After a comprehensive survey of andrological patients were randomized to a group impazy (n = 100) and placebo (n = 30). Patients taking the drug or placebo impaza 1 tablet under the tongue until complete resorption through the day. Treatment efficacy was evaluated after 12 weeks on increasing IIEF erectile function for 3 or more points, or achieve 26 points, security - by the presence of adverse events.
According to the survey overall performance impazy was 63%, which was significantly superior to placebo (23,3%). Impaza was effective both in isolated psychogenic (78,6%), and with organic ED (58,1%). Effectiveness impazy consistently decreases with age and with increasing severity of ED. Safety of the drug confirmed the absence of side effects.
Thus, impaza is effective in treating patients with organic and psychogenic ED. The advantages of this drug is effective, combination therapy with therapy related diseases, including coronary heart disease, hypertension and others, the almost complete absence of side effects and adverse systemic effects. Furthermore, the possibility of exchange rate with a gradual increase effectiveness in some patients, said on curative effect of the drug. The relatively low cost is also an undeniable advantage.
The different mechanism of action of inhibitors of PDE-5 and Impazy suggests the possibility of combining them in those patients who do not have the effect of monotherapy, or has a significant side effects. This combination has allowed us to improve the effectiveness of therapy, reduce side effects of inhibitors of PDE-5, thereby reducing their dose while maintaining the effectiveness of treatment at the same level.
In case of contraindications or lack of effectiveness of oral drugs, or intrakavernoznaya intrauretralnaya therapy are appropriate treatment option for erectile dysfunction.
Preparations for the introduction intrakavernoznogo and intrauretralnogo
Application intrakavernoznyh injections for artificial erection was proposed in 1982 Virag and became one of the pivotal events in the history of treatment of erectile dysfunction.
Intrakavernozno first introduced for treatment of erectile dysfunction medicine has papaverine. Papaverine has a direct effect on miorelaksiruyuschim smooth muscle, which is associated with nonselective inhibition of the enzyme phosphodiesterase.
Another drug that can cause an erection when intakavernoznom introduction, is prostaglandin E1 (PG-E1) (kaverdzhekt). PG-E1 stimulates specific e-prostanoidnye receptors associated with Gs proteins. But these receptors in turn stimulate adenylyl cyclase - the enzyme responsible for the formation of cAMP. It is a very effective mechanism for relaxation of smooth muscles of cavernous bodies. Effectiveness intrakavernoznyh injection of PG-E1 in the treatment of ED is 70-80%.
When intrakavernoznom indiscriminate introduction of alpha-antagonists, such as fentolamin, cause a significant increase in penile blood flow, often passing in an erection. For the first time such an ability fentolamina found English physician Brindley. Intrakavernoznye injection fentolamina as monotherapy ED in clinical practice do not apply. This drug is usually used in combination with papaverine or PG-E1.
There is also a combined drug papaverine-fentolamina-prostaglandin (trimix), which is the most successful for intrakavernoznogo introduction.
The first dose of the drug is introduced into the clinic. Parallel studies conducted by the individuals conducting the procedure. It should be explained to the patient that the injection should be done in the area of the lateral surface of the penis as an injection in the midline can result in damage to the neurovascular structures (on the dorsal surface), or the spongy urethra of the body (on the ventral surface). When the dose is set and the doctor was convinced that the patient is able to perform the procedure yourself, you can continue the injections at home, but not more than 2 times a week.