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Types of operations on prostate adenoma and patient rehabilitation

At the initial stage of prostate adenoma, as a rule, a man is offered medication and physiotherapy. But, at stage 2 of the adenoma, doctors often refer the patient to surgery, and at stage 3 - surgery is required. Not always the operation to remove the prostate adenoma involves the removal of the classic way. Fortunately, now surgery has advanced so far in its development that it offers many other, more gentle methods.

Types of prostate surgery

At the moment, several types of adenoma removal operations are practiced:

  • electrical incision
  • adenomectomy (classic method),
  • laser vaporization,
  • laparoscopy,
  • transurethral resection,
  • arterial embolization,
  • enucleation.

Each of their methods is used depending on the indications and contraindications, has its advantages and disadvantages.

Electrical incision

Electroinfection involves the dissection of prostate tissue using a laser through the urethra. With this method, the laser performs precise actions that minimize traumatic tissue.

Benefits:

The accuracy of the operation, the risk of bleeding is excluded.

Disadvantages:

Cost, impossibility of carrying out with a larger prostate mass.

Adenomectomy

Today, this method is considered classic, but applied when nothing else is accessible to the patient. This is an open operation manually.. Until recently, this was the only surgical procedure for prostate adenoma.
Before the procedure, the patient is injected into a state of drug sleep (general anesthesia). An incision is made in the lower abdominal cavity using a scalpel. In some cases, the bladder is dissected. The doctor examines the bladder and prostate, having perhaps directly visually examine the pathology. Then remove the adenoma.

Benefits:

  • the ability to remove large adenomas,
  • the ability to remove the prostate when there is no other way,
  • the method allows you to cure the patient in the last stage of the disease.

Disadvantages:

  • risk of complications
  • long rehabilitation period
  • there are contraindications
  • risk of bleeding after or during surgery,
  • negative effects of general anesthesia.

An adenomectomy should be performed by a highly qualified and experienced doctor with an excellent reputation. This method involves the human factor, the patient’s life is literally in the hands of the surgeon.

Laser vaporization

It is a gentle method of surgical intervention for prostate adenoma. The procedure is performed using a laser that vaporizes the adenoma through the ureter. There is no bleeding during the operation, since the laser, when the operation is performed, cauterizes blood vessels.

Benefits:

  • high efficiency with low morbidity,
  • no risk of bleeding,
  • lack of risk of impotence in the form of complications after surgery,
  • with prostate adenoma, surgery is indicated for patients with low blood coagulation,
  • short recovery period
  • there is no need for treatment in a hospital.

Disadvantages:

  • low availability of the method due to lack of equipment in many clinics,
  • long duration of the procedure (in comparison with TUR).

Laparoscopy

The procedure using an ultrasonic knife is considered one of the best. Several cuts are made on the abdomen. An ultrasonic knife surgically excises pathological tissues, removing them from the patient's body.

Benefits:

  • efficiency,
  • there are practically no complications after removal of prostate adenoma,
  • the ability to remove large adenomas.

Transurethral resection

In short, this method is called a prostate adenoma tour. It is one of the most popular methods of surgical treatment of the prostate.. Sometimes used in conjunction with laser vaporization, as the best methods of removal. A resestoscope is used, which is passed through the urethra.

Video: Surgery of TUR of prostate adenoma.

Benefits:

  • lack of scars
  • there is no need for general anesthesia,
  • few contraindications
  • can remove an adenoma of any size,
  • you can remove the entire prostate when necessary,
  • the operation does not last long.

Disadvantages:

  • stay in the hospital can take 3-5 days,
  • a long period of rehabilitation after surgery,
  • the results of the operation can be understood only after a year.

Enucleation

This is a surgical treatment using a laser that husks hyperplasia cells. Thus, prostate adenoma is removed.

Benefits:

  • the ability to biopsy with prostate adenoma,
  • can remove adenomas of the largest masses (200 g)
  • quick recovery, getting rid of unpleasant symptoms.

Indications and contraindications for operations on the prostate gland

Indications for the operation are:

  1. prostate adenoma, reaching a mass of 20 grams or more,
  2. symptoms of stages 2 and 3 of prostatic hyperplasia,
  3. symptom of urinary retention,
  4. accession of pathologies of nearby organs,
  5. kidney stones and / or bladder.

Surgery to remove prostate adenoma is carried out only as a last resort and only when other methods of treatment for adenoma do not work. Therefore, it is so important to start treatment on time, and for this you need to diagnose the disease on time. Removal of the prostate itself in men is extremely rarely done with adenoma.

Even when the doctor talks about indications for surgery for prostate adenoma, there are contraindications when it may be impossible.

  1. shriveled bladder (then some types of gentle methods are not available)
  2. pathological inflammation,
  3. problems with heart,
  4. poor health
  5. blood diseases.

Possible postoperative complications


It is because of the development of consequences after surgery for prostate adenoma that surgery is an extreme measure. Complications can be very different.. After TUR surgery, bleeding may occur requiring transfusion. Also, tour syndrome is possible, that is, hydrointoxication - the ingress of fluid into the bloodstream. After an adenomectomy, bleeding, clogging of the urethra with blood clots may also occur.

Other consequences of operations:

  • frequent urination (usually after a while)
  • a symptom of pain during urination by the type of cuts (after a recovery period they go away),
  • urinary incontinence,
  • problems with ejaculation, when the ejaculant enters the urethra, which creates a problem with conception,
  • male impotence (10% of cases),
  • bacterial inflammation
  • urinary fistulas
  • decreased sexual activity,
  • wound infections after open surgery.

Of course, the complications after surgery to remove prostate adenoma are alarming, and some men are scared. But, before being scared, you need to take a sober look at the consequences of prostate adenoma - in some cases, refusing an operation can cost your life.

Indications and contraindications for surgery

Surgical intervention on the prostate gland is performed according to such absolute medical indications:

  • Chronic urinary tract infections
  • Violation of the outflow of urine even after the insertion of a catheter,
  • The presence of blood in the urine,
  • Bladder stones are false or primary,
  • Pathological processes in the kidneys (hydronephrosis, pyelonephritis, etc.),
  • Kidney failure
  • Low daily urine volume (200 ml or slightly more.

It is also worth noting here that the removal of prostate adenoma is also carried out according to relative indications. These include:

  • The complete lack of therapeutic effect of drug therapy,
  • Patient age up to 45 years,
  • The proliferation of the middle part of the prostate gland.

In this case, it is worth knowing that there are contraindications to the operation to remove the prostate. They look like this:

  • Chronic heart failure
  • Acute infections
  • Atherosclerosis of the vessels of the brain of the head,
  • Aortic aneurysm.

Types of operations for prostate adenoma

The type of surgery for prostate adenoma is determined only by the attending physician, depending on several important factors:

  • General condition of the patient
  • Opportunities of the hospital the patient contacted
  • Parallel chronic pathologies in the patient’s history,
  • Stage of pathology and the possible presence of oncology,
  • Patient age
  • Consent of the patient to surgery.

Open adenomectomy (lane surgery)

This operation to remove prostate adenoma is the most traumatic and difficult in terms of invasiveness. Intervention is performed under general anesthesia or under spinal (epidural) anesthesia. During the operation, the patient is cut into the skin in the suprapubic area. Soft tissues (fiber, fat, muscles) and even possibly the bladder are dissected there. Thus, the surgeon opens access to the diseased prostate and has an overview of all nearby organs. After removal of the prostate by the cavity method, all tissues are sutured in the reverse order. A drainage tube is inserted into the bladder to divert urine with the inclusion of blood clots.

Band operation threatens the patient with such complications:

  • Severe blood loss,
  • Mixing the infectious process
  • Constipation on the background of digestive tract disorders,
  • Leakage of urine or urinary incontinence.

Important: today, band operation is extremely rare. Only if other types of surgical intervention are not suitable for the patient according to clinical indications.

Embolization of the prostate arteries (EAP)

This is a relatively new and expensive method of surgical intervention. It is not carried out everywhere, since embolization requires the use of special equipment and the presence of certain skills at the doctor. Most often, such an intervention is carried out in private urological clinics.

The principle of embolization of the prostate arteries is that the attending physician, through a puncture in the skin, determines the vessels that feed the prostate gland, and introduces a special substance into them. This substance clogs the blood vessels, and the nutrition of the prostate tissue stops. As a result, the swelling subsides, and the lumen of the urethra opens.

Important: the procedure is performed under local anesthesia, and the consequences of surgery on an adenoma of the prostate of this kind are minimal.

However, for the embolization procedure, there are a number of contraindications:

  • History of oncology,
  • Pathological processes of the patient’s internal organs (especially in the acute phase),
  • Disruptions in the endocrine system in a patient,
  • X-ray substance allergy.

Vaporization of prostate adenoma

Here, a special Greenlight laser is used to perform prostate surgery. Intervention is carried out without any incisions. All manipulations are performed exclusively transurethrally. That is, a camera and a laser are introduced into the patient urethra. The specialist burns the affected prostate tissue with a laser, tracking his actions on the monitor. It is worth noting that the laser removes the adenoma well and quickly (2 g / min of exposure) and does not touch healthy cells at all.

After vaporization, the patient wakes up and recovers as quickly as possible. And all the possible consequences inherent in other types of surgical intervention are absent.

Vaporization is one of the most minimally invasive and at the same time effective methods of treating prostate adenoma.

Postoperative patient rehabilitation

Regardless of the type of adenoma removal method, surgery is considered a serious intervention in the human body. Therefore, even if the patient feels great in the postoperative period, it is necessary to return gradually to the usual way of life in the recovery period. For at least two weeks, the patient must strictly follow all the recommendations of the surgeon. These include:

  • Restriction of motor activity and physical activity,
  • Organization of an adequate drinking regime (at least 1.5 liters of water per day),
  • Revision of the diet and the introduction of more plant and sour-milk food into it,
  • Refusal of alcohol, smoking, smoked meats and fatty foods during the rehabilitation period,
  • Abstinence from sexual activity for at least 1.5-2 months,
  • Regular monitoring by your doctor.

It should be understood that surgery to remove the prostate can improve the patient's condition for the next 13-15 years. The general prognosis is favorable and indicates that only one patient out of ten operated again returns to the doctor with relapse. Moreover, if the operation did not bring relief to the patient, the doctor prescribes the installation of a special prostatic stent, which will limit the narrowing of the urethra while in it.

The essence of the operation

The use of medications to combat adenoma does not always give the desired results. To cope with the pathology often only the operation helps. It is a safe and effective method to combat this disease.

The choice of a particular technique depends on a number of factors. Only a doctor can make a decision on the use of this or that type of operation, taking into account a number of features. These include:

  • patient condition
  • the presence of other pathologies,
  • facilities of a medical institution,
  • patient age
  • consent or disagreement of the patient,
  • the severity of the pathology,
  • the presence of malignant processes.

Indications and preparation

There can be many reasons for the operation. So, adenomectomy - the complete removal of overgrown tissues - is needed with an adenoma volume of more than 80-100 cubic centimeters. Also, the operation is indicated for the following diseases and conditions:

  • violation of urination - manifests itself in the form of urinary retention, bloody impurities in it, incontinence,
  • chronic urethritis,
  • genital swelling,
  • severe pain in the pelvic area,
  • chronic form of prostatitis.

Carrying out such an operation requires a number of preparatory procedures. So, you need to take urine and blood tests. Be sure to determine blood coagulation and do a biochemical study. Equally important is the definition of blood type. In addition, you need to evaluate the work of the kidneys and urodynamics.

12 hours before the operation, it is forbidden to eat any food. Also prohibited are liquids and medications.

Removal of prostate adenoma is necessary to prevent compression of the pelvic organs. This helps to improve the functioning of the bladder.

Contraindications

Resection of prostate adenoma may not always be performed. The main limitations to such an operation include:

  • pelvic inflammation
  • infectious pathologies
  • inflammation of the abdominal organs,
  • malignant tumors
  • adhesions in the pelvic area after operations,
  • leukemia,
  • complex forms of diabetes
  • allergic reactions
  • heart failure at the stage of decompensation,
  • complex forms of arrhythmia,
  • circulatory problems in the brain,
  • violation of the respiratory system at the stage of decompensation,
  • kidney failure.

If there are serious contraindications to the procedure, palliative interventions are performed. They help restore urine excretion. Embolization of the vessels of the prostate can also be carried out or conservative therapy is prescribed.

Transurethral RF Thermal Destruction

During the operation, the doctor inserts an active electrode into the urethra. In parallel, passive electrodes are attached to the lower back and a high-frequency current is applied to them.

After passing through the prostate, the current produces a large amount of thermal energy. This leads to thermal destruction of the damaged areas. The operation takes place within 1 hour. It is not accompanied by damage to the external sphincter, which helps minimize the likelihood of urinary incontinence.

Laser treatment

A more harmless and modern method of removing prostate adenoma is laser exposure. The most effective options include the HOLEP and HOLEPR methods. They provide a targeted effect on damaged areas, which helps minimize all risks and threats.

Another innovative treatment is the use of a green laser. With it, you can remove all overgrown prostate tissue and avoid blood loss. This is achieved by sealing vessels in the area of ​​damage.

The laser beam penetrates only a few tenths of a millimeter. Therefore, the removal of abnormal tissues consists in layerwise evaporation. The duration of the operation does not exceed 1 hour. The patient is discharged from the hospital after 3-4 days.

This technique of surgery helps to preserve nerve fibers and restore potency after the intervention. Any laser method is gentle, because it is used only in the initial stages of pathology.

If a malignant organ lesion is suspected, such an effect is contraindicated.

Abdominal surgery

Surgical treatment of prostate adenoma also includes abdominal surgery. In such a situation, the doctor selects anesthesia, which is not dangerous for the patient. When carrying out this type of operation, the specialist dissects the tissues that impede the full access to the operated areas.

After that, the doctor with the help of special tools removes the affected areas. After removal of the adenoma, a catheter is placed in the urethra.

Abdominal surgery on the prostate can lead to serious complications, which include:

  • infectious complications
  • stool disorders in the form of constipation,
  • serious blood loss
  • problems with urination.

An operation to remove the prostate should be performed by a qualified surgeon. This manipulation is planned, because the patient can prepare and undergo the necessary examinations in advance.

Rehabilitation

After the operation, an important stage of rehabilitation begins. The patient is gradually returning to a normal lifestyle. In the first 2 weeks after the intervention, you must strictly adhere to the advice of a doctor.

After surgery on the prostate gland, the following rules must be observed:

  • refuse sharp movements and serious physical exertion: they can cause damage to scar tissue,
  • other drink
  • eat right - eliminate pickles, smoked meats, fried foods,
  • take antibiotics if necessary,
  • constantly visit the attending physician,
  • adhere to the principles of a healthy lifestyle - give up alcohol, walk a lot in the fresh air,
  • refuse sex for 1-1.5 months.

To speed up the recovery process, you need to perform special exercises. An individual complex will be selected by the attending physician. To achieve good results, you must adhere to the following recommendations:

  • do morning exercises,
  • do exercises daily
  • increase loads gradually.

Complications

Any surgery can cause unpleasant health effects. Specific complications depend on the type of manipulation. Surgical treatment of adenoma leads to the following consequences:

  1. TUR syndrome - due to the penetration of the wash fluid into the vessels. This can happen when washing the bladder, when the vessels remain open. This complication is associated with the time taken to complete the procedure.
  2. Bleeding. When a prostate adenoma is removed, the surgeon can damage a large vessel. In severe blood loss, a blood transfusion may be necessary.
  3. Impaired urination. This complication is due to various pathologies of the bladder. It also depends on the age category. Errors during the operation often lead to complications. In the latter case, it may be necessary to repeat the procedure.
  4. Organ infection. This is due to the activation of the microflora of a man or the penetration of pathogens from the external environment.
  5. Inflammation of the bladder. Also, the operation is associated with a risk of damage to the bladder, intestines, urethra, etc.
  6. Urinary incontinence. The cause of this problem is neurogenic disorders, problems in the functioning of the urethra, which is responsible for the retention of urine.
  7. Sexual Issues. Many men after such an operation experience retrograde ejaculation. As a result, the seed does not go outside, but enters the bladder. There is also a risk of worsening sexual activity, poor erection. This is due to the age of the patient, the influence of medications or the effects of instruments.
  8. The narrowing of the urethra. This condition is often observed after transurethral resection. It can be associated with incomplete removal of prostate adenoma or exacerbation of pathology.

Surgery to remove prostate adenoma helps to cope with the pathology and improve the patient’s health. To achieve optimal results and avoid negative consequences, you need to adhere to all the advice of a doctor on preparing for the intervention and rehabilitation after it.

Watch the video: Bob's Prostate Surgery - St. Luke's Hospital Cedar Rapids (February 2020).

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