Arterial embolization as a modern treatment for prostate adenoma and varicocele. Embolization of prostate arteries: procedure, rehabilitation Embolization of the prostate aorta

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Prostate adenoma has been replaced by the updated diagnostic name of benign prostatic hyperplasia (BPH).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 early stages of the disease, it is acceptable to use folk remedies treatment. 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 cardio-vascular 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?

1. 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.
2. 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.
3. 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.
4. 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:

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

1. Avoid strenuous exercise or sudden movements.
2. In order to prevent the development of an infectious process, the patient may be prescribed a course of antibiotic therapy.
3. Refuse sexual intimacy for 1.5-2 months.
4. Lead a healthy and active lifestyle. Take daily walks in the fresh air.
5. 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.

Today there are a great many various methods treatment of benign prostatic hyperplasia. In the event that the disease was diagnosed at an early stage of its development, the patient may be prescribed certain medicines.

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:

1. Medical treatment.
2. 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 medicines:

• 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.

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.

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

• 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).

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.

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;
• absence 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:

1. Lack of positive dynamics during drug therapy.
2. An impressive volume of the prostate (up to 60 cm3).
3. 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:

1. Anomalies in the development of the iliac vessels, their occlusive lesion.
2. 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:

1. A significant increase in the size of the prostate (exceeds 80 mm).
2. 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 comply healthy lifestyle life,
• 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.

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.

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:

1. The possibility of subsequent examination of the removed prostate tissues for a malignant process.
2. Removal of adenoma big size(over 200 g).
3. A short recovery period.
4. 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 sides 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.

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.

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. On the initial stage may have problems 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.

The prevalence of male diseases genitourinary system associated with changes in the prostate gland, makes doctors and scientists around the world look for effective treatments that allow patients to quickly return to normal life, get rid of problems with urination and weak erections. Until recently, the only reliable method for eliminating the consequences of adenoma and cancer caused by hyperplastic growths of prostate tissue was surgical removal of the tumor. A long recovery period and a high risk of postoperative complications, along with the likelihood of a return of the disease several years after surgery, reduces the effectiveness of treatment, and also has limited indications. One of the progressive techniques that allows to eliminate the consequences of tissue growth in a short period of time has become the embolization of the arteries of the prostate. The intravascular injection technique is characterized by low invasiveness and gives a high percentage of positive results with minimal risk.

The essence of the method

The prostate gland is a small organ located in men under the bladder and surrounding the urethral canal. The secretory and excretory function of the prostate is to produce specific enzymes and secrets that affect the hormonal level, reproductive and erectile abilities. Normally, the size of the prostate gland is comparable to the average walnut, but as a result of age-related changes or under the influence adverse factors the tissues of the organ begin to grow, with the formation of a tumor of a benign or malignant nature. Prostate hyperplasia causes impaired urination, which is caused by compression of the urethral canal up to its complete obstruction. In the tissues of the organ, changes occur that have a negative effect on the level of hormones, cause weak potency and infertility.

Our regular reader got rid of PROSTATITIS by an effective method. He tested it on himself - the result is 100% - complete elimination of prostatitis. This is a natural remedy based on honey. We tested the method and decided to recommend it to you. The result is fast. ACTIVE METHOD.

In the early stages of tumor formation, active cell growth can be controlled using conservative therapy methods that differ depending on morphological characteristics. Later, the only way out is the complete removal of the prostate gland or partial resection of hyperplastic tissues by surgery, which is accompanied by an increased risk to the health and life of a man.

In 2008, in one of the Brazilian clinics, the method of embolization of the prostatic arteries was first used, which made it possible to achieve a reduction in the symptoms of adenoma immediately after medical intervention. Later, a similar type of operation was performed in Portugal, using a different technique for blocking blood vessels, and also received positive results. The effectiveness of the technique is based on the characteristics of the blood supply to the prostate gland. A dense network of blood vessels that feed the organ also becomes the reason that pathologically active cellular structures receive a sufficient amount of building material for reproduction and growth. By limiting the flow of blood into the prostate, it was possible to stop cell division, which not only stopped the development of hyperplasia, but also reduced the size of the gland and significantly reduced the level of PSA.

The essence of the embolization method is reduced to the mechanical blocking of the arteries with the help of intravascular injection of emboli - small synthetic balls that prevent blood flow. The accuracy of the actions of the vascular surgeon is monitored by angiography. As a result of blockage of the arteries, prostate tissue is no longer supplied with blood. nutrients, the volume of the organ decreases, the pressure on the urethra decreases and the outflow of urine resumes. Due to the normalization of cell division, secretory and excretory functions are restored, allowing you to maintain potency and reproductive abilities. Benign hyperplasia shrinks, and some morphological varieties of cancer cells are destroyed without additional influences. In this case, the entire operation takes from 30 minutes to 3 hours, depending on the qualifications of the specialist and the anatomical features of the location of the arteries in the man.

Indications

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 spectrum effective use methods have been 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.

Contraindications

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:

1. Individual intolerance to drugs that are used as a contrast agent to monitor the progress of the operation.
2. Acute infectious and inflammatory diseases that increase the risk of postoperative septic complications.
3. Chronic diseases of internal organs in the stage of decompensation.
4. Severe form of bronchial asthma.
5. Post-infarction or post-stroke condition.
6. Thrombosis of deep and superficial veins of the lower extremities.
7. 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.

Training

Despite the fact that the operation is considered minimally invasive and is performed in modern clinics on an outpatient basis, the preparatory stage is necessary measure precautions. Before arterial embolization, a man is prescribed a diagnostic set of procedures, which includes general examinations and techniques aimed at clarifying the current state of the prostate.

Approximate plan of preparatory diagnostics:

1. Urine and blood tests.
2. Manual examination.
3. Ultrasound examination of the prostate.
4. Blood test for PSA content.
5. Histology of prostate tissues.
6. Uroflowmetry.
7. Ultrasound of the arteries and veins of the lower extremities.
8. ECG and X-ray of the lungs.

Depending on age and the presence of concomitant pathology, the doctor may prescribe angiography and computer methods for examining the pelvic organs.

Before embolization, the patient is prescribed a course of antibacterial and sedative drugs 2-3 days in advance, as well as a test for sensitivity to a contrast agent and anesthesia drugs.

On the eve of the operation, a light dinner, a cleansing enema, and hygienic treatment of the groin area with shaving of vegetation are recommended. On the day of arterial embolization, the patient undergoes bladder catheterization and is taken to the operating room.

Operation progress

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:

1. The man is brought to the operating room, the necessary medical equipment is connected and local or epidural anesthesia is administered.
2. 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.
3. Equipment is installed for blood supply to the prostate during the operation and a device is launched that delivers emboli to the nearest artery.
4. After the introduction of the drug, angiography is repeated to monitor the effectiveness of the embolization of the prostate arteries.
5. 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.

Recovery period

Embolization of the prostate arteries is a low-traumatic surgical technique and there is no rehabilitation period after the intervention in the classical sense. A man does not need to be in a hospital, go for dressings and re-learn self-care skills. After getting out of anesthesia and receiving recommendations from the doctor on taking the necessary medications, the patient is discharged home, and the recovery period proceeds without interruption from the usual life.

Possible Complications

The occurrence of hematoma and pain at the insertion site of the arterial catheter is the most common consequence of embolization of the prostate arteries. Men are recommended to treat the injured area with absorbable ointments to get rid of discomfort and external signs.

At first, there may be problems associated with urination, which manifest themselves in the form of false urges and the appearance of cramps. Such complications are caused by the installation of a catheter, go away on their own or with the help of medical correction.

Allergic reactions to the contrast agent used during embolization of the prostate arteries are rare and can be treated with antihistamines.

Expected effect

According to studies of the effectiveness of embolization of the prostate arteries in men aged 45 to 90 years, a decrease in the severity of symptoms of urinary disorders is observed already in the first few hours after surgery. In the first week, the urination process is almost completely restored, the pain syndrome disappears, and the patient's general condition improves. For 3 months, the size of hyperplastic growths, and with it the volume of the prostate, is halved.

A pronounced decrease in PSA levels in the first month is noted in the group of men who underwent embolization with the installation of a urinary catheter, and in those who undergo the procedure for blocking the arteries of the prostate using a lightweight technique, the change in the content of prostatic antigen in the blood takes a longer time.

Restoration of erectile function occurs against the background of taking auxiliary medications in older patients, and the potency and reproductive abilities of younger men normalize on their own.

In general, the method of intravascular embolization of arteries is considered today one of the best options for the treatment of prostate diseases that occur according to the hyperplastic type. The operation is carried out quickly, gives a low percentage of complications, but due to the high cost and low prevalence of the technique, it is available to a limited number of patients.

Modern surgical methods for curing prostate adenoma are being improved every day. Embolization of prostate arteries has been widely used in Russia for about 10 years. This procedure is classified as a minimally invasive procedure and should be performed by a highly qualified physician experienced in intravascular surgery. The operation allows you to achieve remission of the adenoma, but for this you must strictly adhere to the rules during the rehabilitation period.

Prostate adenoma is a benign tumor in the prostate gland. The reasons for its appearance in most cases lie in a change in the balance of hormones. This process is typical for men aged 50-55.

It is at this age that the concentration of sex hormones begins to gradually fall, and estrogen and estradiol increase. These hormones contribute to the growth of adenoma.

Doctors distinguish 3 stages of the disease. Conservative treatment is indicated in the first stage, the next two require the intervention of a surgeon. In advanced cases, the prostate has to be removed.

Symptoms of prostate adenoma:

• Constant urge to urinate. Even immediately after going to the toilet, the patient again feels the urge. Sensation worse at night;
• Sluggish stream. In order to urinate, a man has to keep the abdominal muscles in a strong tension. Despite increased efforts, there is a feeling of a full bladder;
• Burning and itching in the urinary tract;
• Potency problems. Sexual desire is greatly reduced, up to complete impotence;
• Presence of blood in urine and semen. This sign indicates that the pathology is aggravated;
• Pain in the groin area that occur during intercourse and the process of urination.

If the treatment of adenoma is not started in time, the patient's condition will quickly begin to deteriorate. Urinary retention accumulates, the patient's sensations are characteristic of a state of severe poisoning.

Indications for embolization

Embolization of the arteries of the prostate gland is designed to restore the function of the prostate. Operation is indicated when the formation is benign, and the total size of the prostate and tumor does not exceed 80 cm 3 .

Embolization has also been successfully used in prostate cancer, dealing with the effects of mechanical gland injuries, with varicose veins.

The operation is shown rupture of blood vessels feeding the prostate.

Embolization is not a panacea and in some cases cannot be used. So, with anomalies of adenoma and in violation of vascular patency, it is strictly contraindicated. If there is a risk of thrombus separation, embolization is also strictly prohibited.

Training

Embolization of prostate adenoma is always preceded by a set of diagnostic measures. Tests to be done before the procedure:

• general urine and blood tests;
• blood sugar test;

The urologist must digital examination of the prostate and does blood test for tumor markers.

Having all the results of the examination in hand, the doctor decides whether it is advisable to do embolization or other methods of treatment are indicated to the patient.

Special preparation for the procedure is not required. It is enough to cleanly shave the hair in the groin and not eat 4 hours before the operation. Drinking water is allowed, but in small quantities.

Carrying out the procedure

If necessary, the patient before embolization takes prescribed antibiotics. Immediately prior to embolization, the surgeon injects a sedative intramuscularly for anesthesia and then inserts a catheter.

Embolization of the prostate is carried out as follows:

1. The patient is placed on the operating table. Sensors are attached to his chest to take ECG data. Wrist cuff helps track pressure fluctuations. A blood oxygen sensor is attached to the patient's finger.
2. A few centimeters from the groin on the right thigh, a puncture is made and the surgeon proceeds to arteriography.
3. The doctor then locates the arteries leading to the prostate gland and inserts a microcatheter less than 1 millimeter in diameter into them.
4. The surgeon localizes the location of the catheter in the artery, then delivers a special drug through it. It is a microscopic piece of medical plastic rounded shape.
5. After the introduction of the embolization preparation, a control study of the vessels is done. It confirms that the arteries supplying the prostate are well blocked.

After the operation, the doctor in a special way squeezes the puncture site in the thigh to avoid the formation of a hematoma. The whole procedure takes from half an hour to an hour, depending on its course.

X-ray endovascular embolization of the prostate arteries leads to a decrease in the size of the adenoma by 60-80%. The prostate gland itself is also reduced in size by 50% or more. Thanks to this effect, the process of urination returns to normal.

The positive effect of the procedure makes itself felt after 3-4 days. Frequent painful urge to urinate stops, a person gets rid of constant pain in the groin and other unpleasant sensations.

The vast majority of patients note the fact that the embolization procedure has significantly improved their quality of life. A person not only gets rid of constant discomfort, but also regains confidence in his own potency quickly enough.

You need to spend 2-3 days in the hospital for a full recovery.

Prevention

In order to exclude further recurrences of prostate adenoma, it is enough to follow simple rules:

• Go to the urologist regularly for checkups. Be sure to take all the tests prescribed by the doctor to control the prostate. Do not think that after the operation, the adenoma will not be able to return again;
• Eat properly. In addition to the basic rules of a healthy diet, patients after embolization should avoid foods high in fat and simple carbohydrates;
• Eliminate alcohol from your diet. This recommendation applies especially to beer containing phytoestrogens. These hormones can provoke the growth of adenoma;
• Quit smoking since this habit has a bad effect on the vascular system as a whole;
• Take drugs containing hormones only as prescribed by a doctor and very carefully. Any change in hormonal balance can cause re-adenoma;
• Exercise and try to maintain an active lifestyle. This is especially true for patients with sedentary work. They definitely need walks, which not only remove the stagnation of blood in the pelvic region, but also positively affect the emotional sphere.

Are any drugs needed after adenoma embolization to prevent its possible growth? Usually not needed unless there is a special indication. These medications have a negative effect on potency and sperm quality, so taking them for prevention is not justified.

In the postoperative period, the doctor may prescribe supplements for rapid healing and in order to avoid recurrence of adenoma in the future.

As a rule, general recommendations about changing your lifestyle to a healthier one are enough to ensure that prostate adenoma does not return.

2018 – 2019, . All rights reserved.

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.

REFERENCE! It is believed that BPH occurs in more than 50% of men over 60 years of age. The increase in age leads to an increase in the risk of this disease. According to statistics, BPH is becoming one of the most common urological diseases in older men.

Traditional methods of treatment. Briefly tell us about the treatment options, on which they can be used, folk, drug options, operations - what are there, what complications are possible.

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

To achieve this goal, apply:

• invasive and laser procedures;
• with partial removal of the prostate.

IMPORTANT! However, all these methods of treating BPH have limitations associated with the age of the patient, the presence of other diseases (cardiovascular), and the size of the adenoma. The need to find a modern technique (the least traumatic and the most effective) led to the introduction of embolization.

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 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.

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?

1. 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.
2. 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.
3. 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.

   REFERENCE! The main task is to find the endings of the blood supply to the prostate. A microcatheter (0.6–0.8 mm in diameter) is inserted into these sources, and an embolus (intravascular substrate) is inserted through it. Then it is checked whether all the selected vessels of the prostate are securely blocked.

4. 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).

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.