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Ιατρείο Δρ. Πούλιας Ηρακλής

Το ιατρείο του Χειρουργού – Ουρολόγου Δρ. Πούλια Ηρακλή βρίσκεται στην Αθήνα. Συγκεκριμένα είναι έναντι του Ξενοδοχείου President. 

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Πότε θέλει εγχείρηση ο προστάτης

Πότε θέλει εγχείρηση ο προστάτης

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Πότε θέλει εγχείρηση ο προστάτης

Όταν ένας άντρας λέει «έχω προστάτη», αναφέρεται στην καλοήθη υπερπλασία (διόγκωση) του προστατικού αδένα, που σχετίζεται άμεσα με την ηλικία: όσο μεγαλύτερος είναι κάποιος, τόσο πιθανότερο είναι να την παρουσιάσει.

Η καλοήθης υπερπλασία του προστάτη συνήθως εμφανίζεται μετά την ηλικία των 40 ετών. Υπολογίζεται ότι προσβάλλει το 20% των 40άρηδων, το 60% των ανδρών ηλικίας 60-69 ετών και έως το 90% των 70άρηδων και των 80άρηδων.

«Αν και σχεδόν όλοι οι άνδρες θα έχουν ιστολογικές ή μικροσκοπικές ενδείξεις καλοήθους υπερπλασίας του προστάτη μέχρι να μπουν στην όγδοη δεκαετία της ζωής τους, η κατάσταση δεν θα χρειασθεί θεραπεία πριν αρχίσει να προκαλεί συμπτώματα», διευκρινίζει ο πρόεδρος της Ελληνικής Εταιρείας Ουρολογικής δρ Ηρακλής Πούλιας, τ. Διευθυντής στην Ουρολογική Κλινική του Κοργιαλένειου Μπενάκειου Νοσοκομείου ΕΕΣ.

Όπως εξηγεί, ο προστάτης έχει φυσιολογικό όγκο 20-25 κυβικά εκατοστά, ενώ στην περίπτωση της καλοήθους υπερπλασίας του αδένα ο όγκος υπερβαίνει τα 30 κυβικά εκατοστά. Ωστόσο αυτό δεν σημαίνει πως αμέσως θα αρχίσουν και τα συμπτώματα, διότι η εμφάνισή τους δεν εξαρτάται μόνο από το μέγεθος του προστάτη. «Υπάρχουν ασθενείς των οποίων ο προστάτης φθάνει στα 60 ή τα 70 κυβικά εκατοστά χωρίς να παρουσιάσουν ιδιαίτερα προβλήματα, ενώ άλλοι με μέγεθος προστάτη 30 κυβικά έχουν συμπτώματα», λέει ο Δρ. Πούλιας. «Αυτό σχετίζεται με το πόσο πιέζεται η ουρήθρα, δηλαδή το “σωληνάκι” αποβολής των ούρων που διέρχεται από το μέσον του προστάτη».

Η συμπίεση της ουρήθρας είναι ο λόγος για τον οποίο τα συμπτώματα της καλοήθους υπερπλασίας του προστάτη εντοπίζονται στην ούρηση: αναπτύσσονται δυσκολίες στην έναρξή της, αδυναμία αποβολής των ούρων, μειωμένη ροή και διακοπτόμενη ούρηση. Τα συμπτώματα αυτά αποκαλούνται αποφρακτικά, διότι ο διογκωμένος προστάτης αποφράσσει την ουρήθρα. Άλλα, δευτερεύοντα όμως συμπτώματα είναι η συχνουρία, η νυκτερινή ούρηση και η επιτακτική ούρηση.

Εάν ο ασθενής έχει μεν συμπτώματα, αλλά αυτά δεν επηρεάζουν την ποιότητα της ζωής του, δεν συνιστάται περαιτέρω θεραπεία, σύμφωνα με τις αναθεωρημένες οδηγίες της Ευρωπαϊκής  Ουρολογικής Εταιρείας (EAU). Και αυτό, διότι στόχος της θεραπείας είναι να καταπραϋνθούν τα ουρολογικά συμπτώματα, να επιβραδυνθεί η εξέλιξη της υπερτροφίας και ταυτοχρόνως να βελτιωθεί η ποιότητα ζωής του ασθενούς.

Πρακτικά αυτό σημαίνει ότι «η υπερτροφία του προστάτη στα αρχικά στάδια χρειάζεται μόνο παρακολούθηση, η οποία συνίσταται σε ψηλάφηση από τον γιατρό και μέτρηση του PSA τουλάχιστον μία φορά τον χρόνο», λέει ο Δρ. Πούλιας. «Θεραπεία με φάρμακα ή χειρουργική επέμβαση συνιστάται μόνο όταν τα συμπτώματα καθιστούν τη ζωή του ασθενούς βασανιστική» παρά τη λαμβανόμενη φαρμακευτική αγωγή

Όταν τα συμπτώματα του ασθενούς είναι ήπια, εξακολουθεί να υποβάλλεται σε τακτική παρακολούθηση αλλά συζητά με τον γιατρό του τις πιθανές θεραπευτικές επιλογές και ενημερώνεται για τα δυνητικά οφέλη έναντι των δυνητικών κινδύνων.

Όταν τα συμπτώματα γίνουν μέτρια και αρχίσουν να επηρεάζουν, ακόμα ανεκτά,  την ποιότητα ζωής, ο γιατρός συνιστά πρώτα τροποποιήσεις του τρόπου ζωής (π.χ. αποφυγή της κατανάλωσης υγρών τη νύχτα, καλή κένωση της ουροδόχου κύστεως, συστηματική άσκηση), διότι μπορεί να βοηθήσουν έως ένα βαθμό.

Αργότερα, μπορεί να προσθέσει φαρμακευτική αγωγή, η οποία κατά κανόνα λαμβάνεται από το στόμα και μπορεί να συμπεριλάβει διάφορες ομάδες φαρμάκων, άλλες εκ των οποίων αυξάνουν την ροή των ούρων και ανακουφίζουν τα συμπτώματα της συχνουρίας και της νυκτουρίας και άλλες εμποδίζουν την περαιτέρω διόγκωση του προστάτη.

Οι ενδείξεις

Όταν τα συμπτώματα του ασθενούς είναι μέτρια έως σοβαρά, αποτύχουν οι φαρμακευτικές θεραπείες ή/και ο ασθενής παρουσιάσει επιπλοκές της καλοήθους υπερπλασίας του προστάτη, τότε εξετάζεται το ενδεχόμενο χειρουργικής θεραπείας.

Ειδικότερα, η χειρουργική θεραπεία συνιστάται όταν υπάρχουν:

* Ανυπόφορα συμπτώματα

* Αποτυχία των συντηρητικών (μη χειρουργικών) θεραπειών

* Οξεία, υποτροπιάζουσα ή χρόνια επίσχεση ούρων, δηλαδή παντελής αδυναμία αποβολής των ούρων

* Πολύ ελαττωμένη αποβολή ούρων που έχει ως επακόλουθο να «λιμνάζουν» τα ούρα μέσα στην ουροδόχο κύστη (σε τέτοια περίπτωση υπάρχει αυξημένος κίνδυνος λοίμωξης ή ακόμα και καταστροφής των νεφρών)

* Υποτροπιάζουσες ουρολοιμώξεις ή/και αιματουρία

* Προστάτης ασυνήθιστου μεγέθους ή σχήματος

* Αζωθαιμία ή νεφρική ανεπάρκεια λόγω προστατικής απόφραξης (η αζωθαιμία είναι η παθολογική αύξηση των επιπέδων της ουρίας στο αίμα, χωρίς όμως να προκαλούνται συμπτώματα στον ασθενή).

Χειρουργική θεραπεία συνιστάται επίσης όταν ο ασθενής εκτός από την καλοήθη υπερπλασία του προστάτη έχει και λίθο (πέτρα) ή εκκολπώματα (εξογκώματα) στην ουροδόχο κύστη.

Οι τεχνικές

Από τις χειρουργικές μεθόδους, η διουρηθρική εκτομή του προστάτη (TURP) ή η εκτομη και εξάχνωση ( TURIS )αποτελεί – σύμφωνα με τις οδηγίες της EAU – την επέμβαση επιλογής. Αυτή γίνεται από το πέος, μέσω της ουρήθρας και συνίσταται σε εξαίρεση του αδενώματος με μορφή   τεμαχίδίων   ξεκινώντας από το κεντρο του προστάτη, απ’ όπου διέρχεται ανεμπόδιστα η ουρήθρα, με αποτέλεσμα να απελευθερώνεται η ουρήθρα και να αποκαθίσταται η ακώλυτη ροή των ούρων.

Σήμερα ολο και λιγότερο χρησιμοποιούνται  οι ίνες  Laser  για την εκτομή ,εξάχνωση και εκπυρήνηση του  προστάτη αδένα

Εναλλακτική λύση στην διουρηθρική προστατεκτομή αποτελεί η διουρηθρική σχάση του προστάτη (TUIP). Κατ’ αυτήν, δεν αφαιρείται προστατικός ιστός, αλλά γίνονται μερικές μικρές τομές πάνω του, για να μειωθεί η πίεση που ασκεί στην ουρήθρα και να διευκολυνθεί η ούρηση. Η επέμβαση αυτή κατά κανόνα είναι κατάλληλη για τους άνδρες με σχετικά μικρή υπερπλασία και σε ηλικίες μικρότερες των 55 ετών

Αντιθέτως, στους άνδρες με πολύ μεγάλη υπερπλασία (όγκος προστάτη πάνω από 80-100 κυβικά εκατοστά), σε όσους έχουν εκκολώματα κύστης και σε όσους έχουν λίθους κύστης, συνιστάται ανοικτή προστατεκτομή, δηλαδή με διάνοιξη τομής στο τοίχωμα της κοιλιάς.

Οι εγχειρήσεις στον προστάτη μπορεί να γίνουν με γενική, επισκληρίδιο ή ραχιαία αναισθησία και η βελτίωση στην ούρηση είναι εμφανής αμέσως μετά την ολοκλήρωσή τους.

 

 

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