Surgical treatment of BPH and prostate cancer

The monograph presents new data about the anatomy of the prostate, neurophysiology urination and the pathogenesis of its changes. Reflected the urgent issues of early diagnosis of prostatic hyperplasia and prostate cancer; with modern positions outlined their tactics of surgical treatment. Designed for urologists, surgeons, oncologists.

One of the most serious problems of modern Uro-Oncology remain diagnosis and treatment of BPH and prostate cancer, the frequency of which is greatly increased in men, elderly and senile age. The treatment of hormone-dependent tumors of the prostate gland (adenoma and cancer) cannot be solved unequivocally due to significant changes in the patient's organism in these diseases. This raises the need for a comprehensive approach to the problems of diagnostics and treatment of BPH and prostate cancer, which contain a number of controversial issues. The monograph by doctor of medical Sciences A. S. Tailor reflects the multifaceted aspects of the problem of treatment of patients with adenoma and cancer of the prostate and is based on years of clinical experience of the author. The present (third) edition is substantially revised and expanded in comparison with the previous. In the monograph includes new data on pathological anatomy of the prostate, which is a prerequisite for the solution of important practical problems related to histological diagnosis of adenoma and cancer, topography of various forms of adenoma, peculiarities of cancer growth, the possibility of using new hormonal preparations: gonadotropin-liberidou, inhibitors of prolactin, antiestrogens - in the treatment of prostate cancer. In the monograph widely covered assessment of urodynamics lower urinary tract in patients with prostate cancer according to uroflowmetry, cytomegalie, sphincter electromyography, defining the profile of urethral pressure. This information is essential when planning adenomektomii and postoperative treatment with the expected functional results. Urodynamic evaluation indicators supplemented with data computed tomography and ultrasound, opening wide opportunities to obtain accurate information about the size of adenoma, volume of residual urine without the introduction of tools of the cavity bladder. Emphasizes the need for early detection of changes in the kidneys and urinary tract nuclide and x-ray diagnostic methods, using all modern modifications excretory urographine. Having vast clinical experience of surgical treatment of patients with prostate adenoma cancer, the author considers in detail the important practical issues associated with various indications for urgent emergency, urgent and planned adenomektomii. Underlines the idea that the results of surgical treatment of adenoma is determined not only by the choice of the method of operation, but also largely correct indications to adenomektomii on the basis of thorough examination of the patient, rational preoperative preparation and postoperative treatment. Very valuable that the author comprehensively, at the level of modern knowledge and taking into account their own experience sets out some Central issues of preoperative preparation and postoperative treatment, including remedial measures, aimed at combating infectious-inflammatory process in the kidneys and urinary tract, chronic renal-hepatic insufficiency, the correction of hormonal and metabolic and immune disorders, prevention of thrombohemorrhagic syndrome. The monograph is significantly complemented by a presentation of modern methods of early diagnosis of prostate cancer - ultrasound, computed tomography, nuclear magnetic resonance - allows to set the stage of the cancer and to differentiate different pathological processes in the prostate gland. The monograph is supplemented by the results of multifactor analysis of the hormonal profile of a large group of patients with prostate cancer (determination in blood testosterone, estradiol, cortisol, adrenocorticotropic hormone, gonadotropin, prolactin, growth hormone, thyroid-stimulating hormone, progesterone in then we switched to dexamethasone test) and its changes under the influence of endocrinotherapy. This extensive information about the hormonal shifts at different stages in the development of prostate cancer are presented in the literature for the first time. The specific scheme of combined therapy of prostate cancer (operative treatment, endocrine-, chemo - and radiation therapy), and highlights their advantage over monotherapy cancer.
Monograph on the level of modern knowledge summarizes various aspects of the treatment of BPH and prostate cancer, gives the necessary information, practitioners, without knowledge of which it is impossible to correctly assess the clinic of these diseases, the results of diagnostic tests and choose the best method of treatment. This section will be useful to a wide range of doctors: urologists, surgeons, oncologists.

Table of contents

Chapter 1. Modern problems of anatomy and histology of the prostate
Chapter 2. Pathologic anatomy
Chapter 3. Clinical picture and diagnosis of prostate adenoma
Chapter 4. Surgical treatment of prostate adenoma
Chapter 5. Diagnosis of prostate cancer
Chapter 6. The prostate cancer treatment
List of literature



The problem of treatment of BPH and prostate cancer continues to draw the attention of urologists in all countries of the world in connection with a significant incidence of these diseases in men, elderly and senile age. Over the past decade have greatly improved technique of surgical treatment of these diseases. Undoubted achievements of biochemical, immunological, x-ray and radionuclide, ultrasonic diagnostics dishormonal tumors of the prostate gland (adenoma of prostate cancer). At the same time, the issue of their treatment contains a number of issues requiring further study. In recent years, improved functional outcomes of adenomektomii, reduced the period of hospital treatment and decreased postoperative mortality. However, timely diagnosis and surgical treatment of patients with prostate adenoma are still current issues. These patients often unreasonably long are at pre-hospital stage of treatment are frequent catheterization of the bladder and endourethral manipulation; not always satisfactory results of adenomektomii in early and late periods after surgery. This is largely determined more often of late diagnostics of prostate adenoma. In this regard, we felt it important to include in the monograph new chapters on the neurophysiological mechanisms of urination, linking the stated information by urodynamics of the lower urinary tract dysfunction which is the basis of early signs of obstruction in cervico-urethral segment due to increasing adenomatous nodes. A special section is devoted to the functional studies of lower urinary tract according to uroflowmetry, sphincter electromyography, the definition of the profile of urethral pressure (PUD). Much info about x-ray, nuclide, ultrasonic diagnosis of prostatic hyperplasia and prostate cancer. In the appropriate section discusses the role of the modified excretory urography (nefro - and pielografii) to identify the initial kidney function changes in patients with prostate adenoma cancer, and intravenous excretory uroginekologii in the assessment of evacuation function of the bladder and determination of residual urine, pneumocystography in the differential diagnosis of prostatic hyperplasia and prostate cancer. Re-written sections on ultrasound, CT, MRI.
We believe that the results of surgical treatment of prostate adenoma are determined primarily not by the choice of a particular technology operations, and a differentiated approach to the indications for adenomektomii with changes not only in the urogenital system, but in the vital organs. This issue in the monograph is given a significant place. Discusses the indications and contraindications for adenomektomii in conditions of rendering of the urgent emergency and urgent care, and in order deferred and planned operations. We thought it was important to highlight the Central issues of pre - and postoperative treatment with regard to possible complications and related intercurrent diseases. Special attention is paid to the question of the treatment of hospital infections new antibacterial drugs, prevention and treatment tromboamboliy, and acute renal failure. In accordance with the development of new methods of diagnosis of prostate cancer include data about tumor markers, immunological diagnosis of cancer, NMR. Amendments are introduced in the scheme of treatment of patients with cancer of the prostate. In separate chapters summed up the experience of prostate cancer and a number of new hormonal preparations (antiandrogens, antiestrogens, antiproductive drugs), drugs that changed the previous regimen. Along with this are considered indications and contraindications to the methods of surgical treatment of prostate cancer - radical and palliative, combined hormone, chemotherapy and radiation therapy. The fourth edition of the monograph revised significantly compared with the third (1979). The main chapters (pathologic anatomy, neurophysiological principles of urination, most of the sections, devoted to the clinic, diagnosis and treatment of benign prostatic hyperplasia and prostate cancer) written again. We hope that this monograph, which is based on the long experience of the author tried to cover the most important questions of clinic, diagnostics and treatment of benign prostatic hyperplasia and prostate cancer, will prove useful to a wide range of practical doctors - urologists, oncologists, surgeons - in their daily practice.