Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?
Indications and contraindications for surgery to remove prostate adenoma in men
Removal of prostate adenoma is indicated for a certain category of patients. The need for this surgical intervention is determined on an individual basis. Factors such as age can influence the doctor's decision regarding manipulation.
Often the procedure is carried out with such indications:
- chronic or acute urinary retention;
- . This disease occurs when serious. When a patient has prostate adenoma of the third or fourth degree, then the bladder is compressed by an enlarged organ. Together with this, weakness of the sphincters is caused. Because of this, men develop urinary incontinence - the involuntary release of portions of urine drop by drop throughout the day.
The last point is often the main indication for surgical intervention to remove an adenoma. This is due to the fact that urinary incontinence provokes not only physical discomfort, but also moral.
An indication for the procedure can also be pathological impurities found in general. In this case, we are talking about an increased amount of protein and leukocytes.
Pronounced signs are noted with a noticeable increase in the gland, and also if benign hyperplasia occurs simultaneously with it. When detected in the bladder, which appeared due to a deterioration in the outflow of urine in the second, third, fourth degree of prostate adenoma, surgical intervention is also indicated.
Problems with the functioning of the kidneys (in particular, renal failure) with benign hyperplasia are also a serious reason for the operation.
What are the modern surgical methods for the treatment of BPH: types of surgical interventions
IN last years has changed significantly. When used, the volume of the affected organ does not decrease. This is the reason for the surgery.
Types of surgical treatment of BPH:
- . This procedure is indicated for the removal of the prostate, its neoplasms. It is carried out by introducing a medical instrument into the patient's body through the urethra. The advantage of the procedure is the preservation of the organ and its performance. During the intervention, only the tumor is removed. At the moment, this is the main way to treat a disease such as BPH. The indications for the procedure are the following disorders: a feeling of incomplete emptying of the bladder, a person is forced to make efforts to carry out the process of urination, the stream is intermittent, the sick man often develops or returns the urinary ducts, during the diagnosis, stones are found in the structure of the bladder or, on against the background of complicated urination, the patient develops diseases of the excretory system, in particular renal failure;
- . With this type of surgical intervention, an incision up to 15 cm long is made. The area from the navel to the pubic bone is excised. Through an incision, the surgeon removes the affected organ. In most cases, this procedure leads to the series . She is not nerve-sparing. After the operation, the patient may experience the following symptoms:,;
- transvesical adenomectomy. It consists in the complete removal of the affected areas. The procedure is performed through a longitudinal incision of the anterior abdominal wall and bladder. Manipulation is prescribed at advanced stages of the disease. Especially when the adenoma is large;
- . This procedure is a minimally invasive surgical procedure. During it, the arteries that provide blood supply to the tumor neoplasm are blocked. As a result, its size is significantly reduced, and the function of emptying the bladder is slowly restored;
- . This is a method of treatment based on the removal of hyperplastic tissue using laser radiation formed by a holmium crystal;
- interstitial. During this procedure, the tissues of the affected organ are exposed to high temperatures. In this case, the laser is inserted into the prostate. Several sites undergo coagulation;
-
laser vaporization. The intervention is performed endoscopically, without a preliminary incision. The technology used in the procedure with the use of a laser is considered to be less traumatic and has a gentle character. This method allows you to quickly remove the overgrown prostate tissue by evaporation. For manipulation, laser systems are used that emit a powerful light beam of a certain length; - . This is a minimally invasive method of removing the prostate gland. It is carried out thanks to the use of an appropriate medical device - a laparoscope. The method of treatment is characterized by minimal trauma. The doctor makes several incisions to insert the device. The procedure is controlled by using a video camera;
- needle ablation. It is an outpatient treatment for BPH. Manipulation allows you to eliminate. The method consists in the use of radio frequencies to destroy a fragment of the affected organ that compresses the urethra and disrupts the outflow of urine.
How is prostate adenoma treated surgically?
The main methods of surgical intervention for the removal of BPH are the following:
- transurethral resection. It is performed under local or general anesthesia. During the procedure, a resetoscope is used. It is inserted through the urethra while visualizing the prostate gland with a video camera. After that, the affected tissue is excised using an electric loop. The procedure does not take more than one and a half hours;
- open adenomectomy. Most often, two types of surgical interventions are used: transvesical and retropubic. Both are performed under general anesthesia.
How long does the surgery take?
Each type of surgical treatment has its own duration. Transurethral resection lasts about half an hour. Treatment of BPH with a laser lasts from twenty minutes to one hour. Radical prostatectomy lasts two to three hours. Manual laparoscopy - approximately three hours.
When and how is the catheter removed after surgery?
The catheter is removed depending on the chosen method of surgical treatment. At the end of the TUR, it is taken out after two, three or four days.
After adenomectomy after one week, if bladder was sewn up.
When the surgeon decides to install an additional drainage tube during the procedure, the urethral catheter is removed two days later, and the cystostomy tube a few hours after the operation.
Possible complications in men during the rehabilitation period
The procedure for removing the prostate, its affected areas is accompanied by some complications.
The patient may experience such unpleasant symptoms as lack of erection, impaired urinary function, and a strong inflammatory process.
The consequences that appear in the late period after the performed surgical intervention may include other unpleasant symptoms. Often after surgery, a man may experience an imperative urge to urinate and pain during it.
Symptoms appear when urine comes into contact with open wound. The healing process lasts approximately thirty days. After that, all signs feeling unwell disappear, which is confirmed
Surgical treatment of prostate adenoma continues to be a very urgent problem of modern urology. Despite the fact that specialists are doing their best to reduce the percentage of surgical interventions, at least a third of patients still need them.
Surgery for prostate adenoma often becomes the only way out that can not only rid a man of the tumor, but also improve his quality of life, since problems with urination often cannot be eliminated by any other methods.
In terms of frequency, surgical interventions on the prostate gland occupy a strong second place in urology. For the time being, they are put off, fighting the disease with the help of medications, but conservative therapy gives only a temporary effect, so three out of ten patients are forced to go under the surgeon's knife.
The choice of a specific method of surgical treatment depends on the size of the tumor, the age of the patient, the presence of concomitant diseases, the technical capabilities of the clinic and staff. It is no secret that any invasive procedure carries the risk of a number of complications, and with age, their likelihood only increases, so urologists approach indications and contraindications very carefully.
Of course, every man would like to be treated in the most effective way, but the ideal way has not yet been invented. Considering possible complications and risks from open surgeries and resections, more and more surgeons are trying to save the patient from the problem of "little blood" by mastering minimally invasive and endoscopic procedures.
In order for the surgical intervention to go as smoothly as possible, it is important to seek help in time, but many patients do not rush to the doctor, starting the adenoma to the stage of complications. In this regard, it is worth once again reminding the strong half of humanity that a timely visit to a urologist is as necessary as the treatment itself.
Indications for surgical removal of prostate adenoma are:
- Strong narrowing of the urethra with disruption of the bladder, when a large amount of urine is retained in the latter;
- stones in the bladder;
- Chronic kidney failure;
- Acute urinary retention, repeated many times;
- bleeding;
- Infections and inflammatory changes in the organs of the genitourinary system.
In case of large tumors, when the volume of the prostate exceeds 80-100 ml, the presence of many stones in the bladder, structural changes in the walls of the bladder (diverticula), the advantage will be given to the open and most radical operation - adenomectomy.
If the tumor with the gland does not exceed 80 ml in volume, then transurethral resection or dissection of the adenoma can be dispensed with. In the absence of a strong inflammatory process, stones, a small adenoma, endoscopic techniques using a laser, electric current are preferable.
Like any type of surgical treatment, the operation has its contraindications, including:
- Severe decompensated pathology of the heart and lungs (due to the need for general anesthesia, the risk of bleeding);
- Acute renal failure;
- Acute cystitis, pyelonephritis (operated after the elimination of acute inflammation);
- Acute general infectious diseases;
- Aortic aneurysm and severe atherosclerosis.
It is clear that many contraindications can become relative, because the adenoma needs to be removed one way or another, therefore, if they are present, the patient will be sent for a preliminary correction of existing disorders, which will make the upcoming operation the safest.
Depending on the volume of intervention and access, there are various ways to remove the tumor:
- Open adenomectomy;
- Transurethral resection and incision;
- Minimally invasive and endoscopic procedures - laser vaporization, cryodestruction, microwave therapy, etc.
Surgical treatment prostate adenoma through open surgery some three decades ago was almost the only way to remove the tumor. Today, many other methods of treatment have been invented, but this intervention does not lose its relevance. Indications for such an operation are large tumors (more than 80 ml), associated stones and diverticula of the bladder, the possibility of malignant transformation of the adenoma.
Open adenomectomy occurs through the opened bladder, so it is also called abdominal surgery. This intervention requires general anesthesia, and if it is contraindicated, spinal anesthesia is possible.
The course of the adenomectomy operation includes several stages:
- After treatment with an antiseptic solution and shaving off the hair, an incision is made in the skin and subcutaneous tissue of the abdomen in the longitudinal and transverse directions (does not play a fundamental role and is determined by the preferences of the doctor and the tactics adopted in a particular clinic);
- After reaching the anterior wall of the bladder, the latter is dissected, the surgeon examines the walls and contents of the organ for stones, protrusions, neoplasms;
- Digital isolation and removal of tumor tissue through the bladder.
The most important stage of the operation is the removal of the tumor itself, which compresses the urethra, which the surgeon performs with a finger. Manipulation requires skill and experience, because the doctor actually acts blindly, focusing only on his tactile sensations.
Upon reaching the inner opening of the urethra with the index finger, the urologist gently tears the mucous membrane and with a finger ejects the tissue of the tumor, which has already pushed the gland itself to the periphery. To help isolate the adenoma with a finger of the other hand inserted into the anus, the surgeon may move the prostate up and forward.
When the tumor is isolated, it is removed through the opened bladder, trying to act as carefully as possible so as not to damage other organs and structures. The resulting tumor mass is necessarily sent for histological examination.
In the early postoperative period, there is a high probability of bleeding, since none of the known methods is able to completely eliminate this consequence of the intervention. Its danger lies not so much in the amount of blood loss, but in the possibility of the formation of a blood clot in the bladder, which can close its outlet and block the exit of urine.
To prevent bleeding and obstruction of the bladder, constant washing with sterile saline is used using tubes placed in the lumen of the organ. The tubes remain in the bladder for about a week, during which the damaged tissues and vessel walls are gradually restored, the lavage fluid becomes clear, which indicates the end of bleeding.
For the first few days, the patient is recommended to empty the bladder at least once an hour in order to reduce the pressure of the fluid on the walls of the organ and the newly stitched sutures. Then you can do it less often - once every one and a half to two hours. Full recovery of the pelvic organs can take up to three months.
The undoubted advantage of abdominal adenomectomy is its radical nature, that is, the complete and irreversible removal of the tumor and its symptoms. Behind high efficiency the patient, in turn, “pays” with a long period of stay in the hospital (up to one and a half weeks with an uncomplicated course, and even longer in case of complications), the need to “survive” general anesthesia, the risk of complications from the surgical wound (suppuration, bleeding, fistulas ), the presence of a postoperative scar on the anterior wall of the abdomen.
Transurethral resection (TUR) is considered the "gold standard" in the treatment of prostate adenoma. This operation is performed most often, and, at the same time, it is very complex, it requires impeccable skill and jewelry technique of the surgeon. TUR is indicated for patients with adenoma, in which the volume of the gland does not exceed 80 ml, as well as when the planned duration of the intervention is not more than an hour. In large tumors or the likelihood of malignant transformation in the tumor, preference is given to open adenomectomy.
The advantages of TUR are the absence postoperative sutures and scars, a short rehabilitation period and a rapid improvement in the patient's well-being. Among the disadvantages are the impossibility of removing large adenomas, as well as the need for complex and expensive equipment in the clinic, which a trained and experienced surgeon can use.
The essence of transurethral removal of an adenoma is to excise the tumor with access through the urethra. The surgeon, using endoscopic instruments (resectoscope), penetrates through the urethra into the bladder, examines it, finds the location of the tumor and removes it with a special loop.
The most important condition for a successful TUR is good visibility during manipulations. This is ensured by the continuous introduction of fluid through the resectoscope with its simultaneous removal. Blood from damaged vessels can also reduce visibility, so it is important to stop bleeding in time and act very accurately and accurately.
The duration of the operation is limited to an hour. This is due to the peculiarities of the patient's posture - he lies on his back, his legs are divorced and raised, as well as with a long stay in the urethra of a rather large diameter instrument, which can subsequently provoke pain and bleeding.
transurethral removal of prostate adenoma
Adenoma is excised in parts, in the form of shavings, until the moment when the parenchyma of the gland itself appears in the field of view. By this time, a significant amount of fluid has accumulated in the bladder with the “shavings” of the tumor floating in it, which are removed with a special instrument.
After excision of the tumor and washing the cavity of the bladder, the surgeon is once again convinced that there are no bleeding vessels that can be coagulated by electric current. If everything is in order, then the resectoscope is removed outside, and a Foley catheter is inserted into the bladder.
Foley catheter
The installation of a Foley catheter is necessary to compress the place where the adenoma was (the catheter has an inflating balloon at the end). It also produces a constant washing of the bladder after the operation. This is necessary to prevent obstruction of the outlet section by blood clots and a constant diversion of urine, providing rest to the healing bladder. The catheter is removed after a few days, provided there is no bleeding or other complications.
After the catheter is removed, men notice significant relief, urine flows freely and in a good stream, but at the first urination it can be colored reddish. Don't worry, this is normal and shouldn't happen again. In the postoperative period, it is recommended to urinate frequently in order to prevent stretching of the walls of the bladder, allowing its mucosa to regenerate.
For small prostates with an adenoma that compresses the urethra, a transurethral incision can be performed. The operation is not aimed at excising the neoplasm itself, but at restoring the flow of urine, and consists in dissecting the tumor tissue. Considering the “non-radical” nature of the method, it is not necessary to count on a long-term improvement, and TUR may follow the incision after some time.
Among the sparing methods of treatment of prostate adenoma include laparoscopic removal. It is carried out with the help of equipment introduced into the pelvic cavity through punctures of the abdominal wall. Technically, such operations are complex, require penetration into the body, so TUR is still preferred.
Minimally invasive methods of treatment are successfully developed and implemented in various areas of surgery, including urology. They are carried out through transurethral access. These include:
- Microwave thermotherapy;
- Vaporization using electric current;
- Electrocoagulation of the tumor;
- cryodestruction;
- laser ablation.
The advantages of minimally invasive treatment are relative safety, fewer complications compared to open surgeries, a short rehabilitation period, no need for general anesthesia and the possibility of its use in men for whom surgery is contraindicated in principle for a number of concomitant diseases (severe heart and lung failure, coagulation pathology). blood, diabetes, hypertension).
Microwave thermotherapy consists in exposing the neoplasm tissue to high-frequency microwaves, which heat it and destroy it. The method can be applied both transurethral and by inserting a rectoscope into the rectum, the mucosa of which is not damaged during the procedure.
Vaporization leads to heating of the tissue, evaporation of fluid from the cells and their destruction. This effect can be achieved by acting with electric current, laser, ultrasound. The procedure is safe and effective.
At cryodestruction, on the contrary, the adenoma is destroyed by the action of cold. Liquid nitrogen is the standard medium. During the procedure, the wall of the urethra is warmed to prevent damage to it.
Laser treatment of prostate adenoma- quite effective and one of the most modern ways to get rid of the tumor. Its meaning lies in the action of laser radiation on the tumor tissue and simultaneous coagulation. pros laser treatment- bloodlessness, speed, safety, the possibility of use in severe and elderly patients. The effectiveness of laser removal of the prostate is comparable to that of TUR, while the likelihood of complications is several times lower.
Laser vaporization- this is, as they say, the "last peep" in the field of minimally invasive treatment of prostate adenoma. The impact is carried out by a laser emitting green rays, which leads to the boiling of water in the tumor cells, its evaporation and destruction of the adenoma parenchyma. Complications with this treatment practically do not occur, and patients notice a rapid improvement in well-being immediately after surgery.
Laser removal of adenomas is especially indicated for men with concomitant hemostasis disorders, when the risk of bleeding is extremely high. Under the action of a laser, the lumen of the vessels is sealed, as it were, which practically eliminates the possibility of bleeding. The procedure can be performed on an outpatient basis, which is also a definite advantage. In young men, after laser vaporization, sexual function is not disturbed.
No matter how hard the surgeons try, it is impossible to completely exclude the possible complications of radical treatment. The risk is especially high during abdominal surgery, it is with TUR, and in the case of endoscopic removal it is minimal.
The most common complications of the early postoperative period are:
- bleeding;
- Infectious and inflammatory changes;
- Thrombosis of the veins of the legs, pulmonary artery and its branches.
More distant consequences develop within the pelvic organs. These are strictures (narrowings) of the urethra against the background of growth connective tissue, sclerosis of the bladder wall at the site of the urethra, sexual dysfunction, urinary incontinence.
To prevent complications, it is important to follow the doctor's recommendations regarding behavior immediately after the intervention, as well as at a later date, until the tissues recover completely. In the postoperative period it is necessary:
- Limit physical activity for at least a month;
- Exclude sexual activity for a month at least;
- Ensure a good drinking regime and timely emptying of the bladder (better - more often);
- Refuse spicy, spicy, salty foods, alcohol, coffee;
- Perform gymnastics daily to activate blood flow and increase overall tone.
Reviews of men who have undergone surgery for prostate adenoma are ambiguous. On the one hand, patients note a significant relief of symptoms, improved urination, and reduced pain, on the other hand, with the most common types of treatment (abdominal and TUR), the majority are faced with urinary incontinence and impaired potency. This can not but affect the psychological state and quality of life.
Men themselves are also to blame for the high probability of some complications, because not everyone is used to visiting a urologist every year in adulthood and old age. An almost standard situation is when a patient comes to the appointment with a large adenoma that requires more active treatment than laser, coagulation, cryodestruction, and hence urinary incontinence, impotence, bleeding. To facilitate both the operation itself and recovery after it, you should immediately consult a doctor as soon as the first signs of trouble in the genitourinary system appear.
Adenoma treatment can be done free of charge in a public clinic, but many patients choose paid operations. Their cost varies greatly depending on the level of the clinic, equipment and locality.
Minimally invasive operations and TUR on average cost about 45-50 thousand rubles, in Moscow this figure can reach 100 thousand or more. Abdominal removal of the gland in the capital will cost from 130 thousand rubles on average and from 50-55 thousand in other cities. The most expensive is laparoscopic adenomectomy, which will have to spend about 150 thousand rubles.
Men's health is an important aspect not only for the physical condition, but also for the psyche. A change in the functioning of the genital organs is noted in urological diseases. The most common of them are prostate pathologies. The prostate ensures normal ejaculation in men and helps to block the exit from the bladder during ejaculation. Prostate diseases can be associated with inflammatory, hyperplastic and oncological processes. Often the treatment is to remove the prostate. Despite the radical nature of the method, in some cases, surgery is considered the only option.
Removal of the prostate is performed in cases where conservative therapy is powerless. In most cases, this is an oncological process. Sometimes a prostatectomy is performed for benign prostatic hyperplasia. An increase in the organ due to inflammation is not a reason for surgery. The following indications for removal of the prostate are distinguished:
- Early stages of prostate cancer.
- Calculous prostatitis - accompanied by impaired urination and hematuria.
- Benign hyperplasia of the organ - adenoma.
Cancer is considered the main indication for organ removal. Prostatectomy is performed only at stages 1 and 2 of the disease. In these cases, the oncological process is limited to prostate tissue. If the prostate is not removed in a timely manner, the cancer can spread throughout the body. The operation is performed on men under 70 years of age, since somatic pathologies are contraindications to its implementation.
Prostate adenoma leads to an increase in the organ. As a result of this disease, sexual weakness and impaired urination are noted. With the progression of benign hyperplasia and the lack of effectiveness of therapeutic methods of treatment, a prostatectomy is performed.
There are several ways to remove the prostate. The choice of method depends on the prevalence of pathology. Removal of an organ can be complete or partial. Surgical options include:
- Transurethral resection of the prostate. It is characterized by partial removal of tissues, which is performed through the urethra. Resection is performed laparoscopically. It is carried out with benign prostatic hyperplasia.
- Incision of the prostate. Such a surgical intervention involves the dissection of the tissues of the organ. It allows you to expand the lumen of the urethra and prevent compression of the urethra. An incision is made on the prostate gland, but the organ is not removed.
- radical prostatectomy. It is carried out with tumor formations and severe benign hyperplasia. The gland is removed along with lymph nodes. Access to the organ can be different - perineal, supra- and retropubic. Open surgery is dangerous for the development of complications.
- laser intervention. It is considered more preferable, as it reduces the risk of bleeding. Removal of the prostate with a laser is performed with benign gland hyperplasia. There are several methods for performing this manipulation. Among them are vaporization (evaporation), enucleation and laser resection of adenoma.
Currently, preference is given to less traumatic surgical procedures. These include laser removal of adenomas, transurethral resection. However, it is not possible in some cases to replace an open operation with other methods.
Removing the prostate gland is a radical treatment that comes with a number of health risks. These include complications of the early and late postoperative period. Among them - a violation of the process of urination and ejaculation. After removal of prostate adenoma with a laser and transurethral resection, the risk of these complications is reduced compared to open surgery.
This operation is stressful for the whole organism. Therefore, after it, there are violations of the functioning of the genitourinary system. Normally, they gradually disappear. In 2-10% of cases, violations remain. Side effects of a prostatectomy include:
- Urinary incontinence.
- Lack of ejaculate during sexual intercourse.
- Infertility.
- Erectile disfunction.
- Inflammatory processes in the small pelvis.
To prevent these complications from developing, in the first days after the removal of the prostate, the patient's condition is monitored. When discharged, you should follow the recommendations of the urologist. This will help reduce the risk of late complications.
During the first days after prostatectomy, the patient's condition is severe. This is due to blood loss and changes in the functioning of the urinary organs. At this time, there is a risk of developing the following complications:
- Infection of the wound and penetration of microbes. The patient's condition is severe, with fever, local inflammation, and signs of peritoneal irritation.
- Bleeding - occurs in 2.5% of cases.
- Obturation of the urethra with blood clots, the occurrence of strictures.
- Relaxation of the sphincter of the bladder. Normally, this symptom goes away on its own. Muscle relaxation leads to urinary incontinence.
Diagnostics early complications carried out by medical personnel in a hospital. In case of development of acute conditions, the help of a surgeon is required.
The early postoperative period is several days (5-7 days). During this time, the patient's condition is normalized, there is an independent urination. However, full recovery after removal of prostate cancer or adenoma may occur only after a few months. It depends on the age of the patient, the characteristics of his body and the technique of the operation. To speed up rehabilitation and reduce the risk of late complications, the following instructions must be observed:
- Do gymnastics to strengthen the pelvic muscles. Kegel exercises will help bring the process of urination back to normal. Gymnastics consists in alternating tension and relaxation of the pubic muscle.
- Vibrotherapy and massage.
- The use of an electrostimulator or a vacuum erector.
After a prostatectomy, heavy objects weighing more than 3 kg should not be lifted. It is also not recommended to sedentary work and drive a car. Nutrition should be fractional, with a predominance of easily digestible carbohydrates and proteins.
Removal of the prostate often leads to disruption of the urination process. In the first days after surgery, a catheter is inserted into the urethra. It is necessary for the evacuation of fluid from the bladder. The catheter is removed after a few days or weeks. Due to the weakness of the pelvic floor muscles, urination is difficult to control. But gradually the process is getting better. To speed up rehabilitation, it is necessary to do gymnastics, spa treatment is useful.
3 months after prostatectomy, the patient can begin sexual activity. By this time, the pelvic muscles should recover. In some cases, patients experience retrograde ejaculation. Seminal fluid is released, but it enters the lumen of the bladder. This phenomenon is not dangerous, but it prevents conception. To get rid of this symptom, vibromassage and vacuum erectors are used. For erectile dysfunction prescribed medications containing sildenafil. These include medicines "Cialis", "Viagra".
Doctors say that prostatectomy is a complex operation that should be performed only when necessary. With prostate adenoma, it is not recommended to completely remove the organ; it is better to perform resection or laser vaporization. Recovery after a prostatectomy is gradual, so you should follow the instructions of the urologist and be patient.
Depending on the stage of the disease and other features clinical picture the physician may suggest to the patient surgery one of the most appropriate ways. For example, the operation can be performed using endoscopic resection or contact laser vaporization. This modern ways, in which the consequences after the operation will not be so pronounced.
Since prostate adenoma is a serious disease in which proliferating gland tissue compresses the urethra, leading to inflammation of the urinary tract, as well as kidney failure, it not only worsens the quality of life, but also poses a threat to overall health.
The doctor decides on the method of treatment only after a thorough diagnosis and study of the test results. An operation to remove prostate adenoma is required when there are obvious violations in urodynamics, as evidenced by acute urinary retention, kidney disease, which include hydronephrosis, pyelonephritis, urethritis and other pathological processes that provoke the development of infection.
Despite the proven clinical efficacy surgical method, any man will have to face the consequences after the removal of prostate adenoma, and one must mentally prepare for this in advance. Most patients recover quickly enough and feel good, but, of course, not the next day after the operation, but after a couple of months.
The recovery period often becomes a real test for the stronger sex. But the main thing that every patient should remember is that the unpleasant consequences after the removal of prostate adenoma are an integral part of the treatment, so all the problems that arise are completely controllable and must be discussed with the attending physician. He, in turn, should monitor the well-being and general condition in the postoperative period, answering the patient's questions and helping to find a solution in each case.
As mentioned earlier, the consequences of the operation and their severity will directly depend on the method by which the removal of prostate adenoma was carried out, and whether it was complete or partial. In 80% of all cases, only partial excision of the prostate gland will be sufficient, which will make it much easier to endure the recovery period. But no matter how stuffed the surgeon's hand is, any operational methods treatments for prostate adenoma do not go completely without a trace, and what a man will encounter during the recovery period depends primarily on the individual characteristics of his body, the speed of the regenerative function and the experience of the doctor involved in his treatment.
Surgery for a prostate adenoma brings men a significant investment, but the first time after it, there may be problems with the implementation of urinary control. You should not be afraid of this, the consequence is temporary, and normalization of urination occurs in a short time.
More severe consequences of the removal of prostate adenoma relate to the late postoperative period, and some of them can be analyzed in more detail.
The main question of all men: if the prostate adenoma is removed, will the erection be restored and what quality will it be? According to statistics, violations associated with the consequences of surgical intervention range from 1 to 25%. However, these complications are usually temporary, and provided that there were no problems with sexual activity before, sexual function is completely restored on its own or with medical care selected by the attending physician.
If a man previously had problems with erection or she was completely absent, the operation will not be able to restore his sexual life, since it does not directly affect men's sexual capabilities in any way.
Despite the fact that a successful operation to remove prostate adenoma does not affect a man's erection, it can still lead to infertility. It is a consequence of retrograde ejaculation. This happens due to the fact that after removal of prostate adenoma, the lumen of the urethra expands somewhat and the sperm moves to where it meets the least resistance, thus entering the bladder.
These are the unpleasant consequences of the operation, which are sometimes amenable to drug treatment, but only a doctor should select it.
After removal of prostate adenoma, the possibility of developing infectious diseases genitourinary system, which is characterized by the following symptoms:
- chills;
- elevated temperature;
- lower back pain;
- discomfort in the lower abdomen;
- turbidity of urine due to the appearance of various impurities in its composition (mucus or blood).
Most often, the infection is introduced into the genitourinary system after the operation through the fault of the patient himself due to non-compliance with simple hygiene rules. To avoid such situations, after removal of prostate adenoma, the patient is prescribed a specific type of antibiotics, which should be taken regularly. In the case when the infection is already there, refusal to take antibiotics can lead to the penetration of bacteria into the blood, which is why there is a possibility of developing sepsis.
During surgery on prostate adenoma, the consequences make themselves felt in the first place, when a man makes his first attempts to urinate. This is an inevitable and fortunately temporary complication. But sometimes the problem lies not only in the difficulty of controlling urination, but also in the fact that blood clots or removed fragments of the excised prostate, detached from it during removal from the body, enter the urethra and clog it. To prevent such pathological processes, after the operation for prostate adenoma has been completed, the patient does not remove the catheter during the day.
Severe bleeding can occur during the operation when removing prostate adenoma or a little later, in the initial recovery period. According to statistics, this happens infrequently, but still about 2.5% of patients deal with such severe consequences of the operation on prostate adenoma, which can lead to serious blood loss, requiring urgent blood transfusion.
Prostate adenoma is a very common disease among men 40-50 years old, but more often men at a more respectable age turn to the doctor. Therefore, this disease is still classified as an age-related disease. As a rule, a man can live with prostate adenoma for a long time and not be aware of its existence, although the changes in the prostate gland have already begun.
The disease in the advanced stage is always treated only by surgery, so it is best to try to have time to diagnose the adenoma at an early stage. This can be facilitated by such symptoms as: urine leakage, the need to strain the muscles of the abdominal wall during urination, a feeling of fullness of the bladder even after going to the toilet, and frequent nighttime awakenings. A timely visit to the doctor will help to avoid serious complications, and the operation itself will be faster and easier.
If the medical method of treatment for prostate adenoma did not bring any effect, then in order to quickly return to the usual way of life, it is necessary to undergo a whole range of rehabilitation measures, follow all the doctor's instructions, and take the prescribed medications on time. The time required for a full recovery after an operation to remove prostate adenoma largely depends on the actions of the patient himself, the psychological mood and the general state of his health. Age also plays an important role in this matter. The rehabilitation period may take several months.
Fortunately, a second operation is required no more than in 5% of cases. This largely depends on the chosen method of treatment, the method of surgical intervention and, of course, the experience of the surgeon. If during the operation the prostate adenoma was completely removed, then its re-growth is excluded. If a technique was applied in which a certain part of the adenoma is destroyed, then the risk of recurrence of the growth of the prostate gland is quite high. Therefore, repeated surgery may be needed in five or ten years.. In general, the removal of prostate adenoma is a very common operation, which belongs to the category of fairly simple ones, because the disease is getting younger, but it occurs mainly in men at least forty years old with rare exceptions.
To date, there are a huge number of techniques and special medical devices, so the treatment of prostate adenoma is successful in most cases and the effect lasts for about 15 years, allowing a man to live a full life.
Found an error? Select it and press Ctrl + Enter
In what cases is surgical treatment necessary?
The most effective method of treatment is surgical intervention - transurethral resection of the prostate (tour), laser resection, adenomectomy, electrovaporization. Each of these methods is unique, so the consequences, the rehabilitation process and possible complications are very different.
Surgical treatment of prostate adenoma - surgical intervention, which is necessary in cases where:
- it becomes impossible to urinate independently;
- there is blood in the urine;
- this disease is the cause of infectious diseases;
- stones have formed in the kidneys and / or bladder;
- The patient suffers from involuntary urination.
IN modern medicine there are many surgical methods for the treatment of benign prostatic hyperplasia, which are based on a variety of approaches: a scalpel, laser, microwaves, electricity, etc. The doctor selects the method of treatment, due to the individual characteristics of the human body, the stage of the disease, as well as the personal preferences of the patient .
The most popular way to deal with prostate adenoma is transurethral resection - partial or complete removal of the prostate gland.
This method of treatment is used in cases where:
- the volume of the prostate is not more than 60-80 cm3;
- there is a suspicion of a malignant tumor of the prostate;
- there are severe diseases associated with the respiratory, endocrine and cardiovascular systems, as well as obesity;
- the patient is relatively young and has a need for procreation;
- operations were performed in the area of the bladder;
- chronic prostatitis is a companion of prostate adenoma.
This operation takes place according to a simple algorithm:
- First, the patient receives general or spinal anesthesia.
- After that, an endoscope is inserted (through the urethral canal) to extract small parts of the prostate.
- Blood and urine are removed through a catheter.
The operation lasts no more than an hour, and the time that you need to stay in the hospital is from two to three days.
IMPORTANT! TUR should only be performed by an experienced doctor who has excellent vision.
The result of this event in 90% of cases is more than excellent. Patients state a significant reduction or complete disappearance of the symptoms of prostate adenoma.
The scheme of transurethral resection is also present in electrovaporization.
The main difference between these two methods is the strength of the current used.
As a result of the installation of the endoscope, the doctor "evaporates" the painful matter.
Another topical treatment for benign prostatic hyperplasia is laser resection.
Differs in universality (suitable for people of any age categories), speed of recovery, as well as the absence of the need for hospitalization.
The disadvantages of this procedure are the high cost and isolated cases of urinary incontinence after surgery to remove prostate adenoma or difficult urine output.
In cases where there are blood clots in the urine, the genitourinary system often becomes infected, the bladder expands (manifested by bloating in the lower abdomen), and problems with the kidneys or ureters appear, it is worth resorting to adenomectomy.
This is a rather lengthy process (about 10 days in the hospital and three months of rehabilitation), and is most effective. This procedure occurs with the help of an incision, while the doctor opens the bladder for a detailed examination.
The main goal of the operation is the complete removal of the adenoma and its further laboratory research. In the postoperative period, it will be necessary to flush the urinary tract, in order to avoid the appearance of blood clots after prostate surgery.
All the consequences of a strip operation and the course of the operation itself depend on the qualifications and experience of the doctor who performs it.
With microwave therapy, the destruction of prostate tissue occurs by means of the heat of high-frequency microwave pulses.
The procedure is as follows:
- A special probe is fed through the urethra to the prostate, which is located in the tube (for the safety of the mucosa).
- After that, powerful impulses destroy the prostate tissue.
The duration of the procedure is from 30 minutes to two hours, after which the patient is allowed to go home.
These procedures should be carried out if all contraindications, consequences of prostate surgery have been studied.
The individual characteristics of the body, the doctor's mistake or the patient's violation of the instructions proposed by the doctor can cause various complications after the operation to remove prostate adenoma.
During the operation, the patient is at risk (very insignificant - less than 1-2%):
- damage to a nearby organ or wall of the bladder;
- the occurrence of severe bleeding;
- introduction of various infections;
- TUR syndrome (excess water in the body, an extremely rare phenomenon, which is treated with diuretics).
To remove prostate adenoma, the consequences of the operation: it is worth considering the fact that during the day after the operation, the urinary discharge will have a reddish color, but we must not forget: if the color of the urine turns bright red - this is a signal for an urgent blood transfusion. If this procedure is ineffective, a second operation will be necessary.
After removal of prostate adenoma complications, consequences: another natural side effect in the early days, doctors highlight bladder spasms as a result of the presence of a catheter. The peculiarity of this process is rapid self-destruction.
Removal of an adenoma on the prostate - the consequences of the operation: after the operation, even if it was successful, there may be a recurrence of adenoma growth, retrograde ejaculation (ejection of sperm in the opposite direction: into the bladder, which makes the man infertile) and / or a decrease in the diameter of the urethra.
Prostate adenoma - operation, consequences of removal:
- urinary incontinence in men after prostate surgery or its delay (the appearance and duration of this dysfunction depends on the stage of the disease);
- sexual problems (occur in 30% of those operated on, last for about a year).
For the treatment of urinary incontinence after removal of prostate adenoma, medications are used.
Restoration of potency after removal of prostate adenoma is a rather lengthy and complex process. The key to its successful outcome, that is, recovery, depends entirely on physiological characteristics patient, his age, and also because of whether the patient complies with medical recommendations.
IMPORTANT! healthy image life and following the instructions prescribed by the doctor minimizes the chances of complications.
What to do if there is no urine flow after prostate adenoma surgery? What needs to be done for proper rehabilitation?
In the first days after the operation, bed rest is necessary, this helps to avoid any complications.
Also, it will be very helpful:
- breathing exercises and simple limb exercises;
- a large amount (from 2 liters) of high-quality non-carbonated water;
- frequent urination (every half an hour);
- special diet (restriction in sweets, smoked meats and alcoholic products);
- taking antibiotics (to protect yourself from infection).
It is necessary to inform the doctor if, nevertheless, there are problems with urine after rehabilitation.
As the popular philosophy says, The best way cured - it does not get sick. But if trouble has already happened, do not be upset. Compliance with all doctor's instructions, proper nutrition, a set of exercises, as well as progressive methods of treatment eliminate the problem. Prostate adenoma is easily and quickly treated, and excessive self-hypnosis about all sorts of negative consequences will only aggravate the situation.
is a benign disease that, to one degree or another, begins to manifest itself with age in almost every man. At first, problems with urination caused by adenoma are well removed by drug therapy. But over time, the effectiveness of therapy decreases, and surgery may be necessary.
Previously performed only open surgery for prostate adenoma- adenomectomy, through a vertical incision in the lower abdomen. Currently, this operation is used only in rare cases: with a very large volume of the gland or the presence of large stones in the bladder, formed due to prolonged stagnation of urine.
Now the main operation of prostate adenoma in the world is resection (or transurethral resection of prostate adenoma TUR). It refers to endourological benefits and is performed through the urethra. With the help of an instrument ending in an arc-shaped electrode (“loop”), the prostate tissue is sequentially cut up to the gland capsule. With the same instrument, the surgeon coagulates the bleeding areas. During the operation of prostate adenoma, the removed tissue is transferred to the bladder. At the end, it is removed with Janet's syringe. This operation compares favorably with the open one: blood loss is less, rehabilitation is faster, functional results are better.
The cost of prostate adenoma surgery
In the clinic of urology of the First Moscow State Medical University. THEM. Sechenov TUR of prostate adenoma is performed under the compulsory medical insurance policy (excluding consumables). In the presence of quotas allocated by the Department of Health, a quota will be required before admission. This is not a complicated procedure, and it takes a little time. Quotas are issued in the Department of Health of the subject of the Russian Federation in which you are registered (registered). Find out about the need to obtain a quota in advance, during a consultation in our clinic.
Prostate adenoma - laser surgery
The main limitation in transurethral resection of prostate adenoma is the volume of the prostate. TUR of the prostate is performed in layers. Thus, with an increase in the volume of the prostate, the time of resection and blood loss increase proportionally. Technically, it is still possible to perform TUR, but such an operation becomes irrational when the volume of the gland is on average more than 100 cm 3 . And then there are 2 ways: traditional open adenomectomy or laser enucleation of prostate hyperplasia.
Features of the operation of prostate adenoma with a laser is that it is not produced in layers. The surgeon immediately passes through the entire thickness of the gland tissue to the capsule and then moves the instrument along the capsule, successively highlighting the lobes of the gland. Thus, with a large volume of the prostate, the treatment of prostate adenoma with a laser is faster than resection with an electric loop, and there is practically no blood loss with it.
Another type of laser surgery - vaporization of prostate adenoma (evaporation), is used with a small volume of the gland. This operation consists in a slow layer-by-layer evaporation of the gland tissue by a laser and also occurs without bloodshed.
Operation of prostate adenoma in Moscow
In the clinic of urology of the First Moscow State Medical University. THEM. Sechenov, all surgical aids for prostate adenoma are performed: transurethral electroresection, laser enucleation and laser vaporization, as well as, sometimes, traditional open operations for prostate adenoma. All surgeons have many years of their own experience, in addition, they have repeatedly undergone advanced training in Russia and abroad.
Similar diseases
Prostate adenoma is a disease that affects the majority of the male population over the age of 50 years. The incidence rate directly depends on age - the older, the more likely the detection of this pathology. This disease is associated with growth in the tissues of the prostate gland benign tumor in the form of a knot that gradually increases within the urethra.
Treatment of this disease includes not only medical methods, but also surgical removal of the gland. However, in recent years there has been a trend towards a decrease in the number of operations performed on the prostate gland. This is due to the emergence of effective conservative methods of treatment.
Nevertheless, it is too early to write off radical ways to combat this disease - at present, prostate surgery in elderly men is in second place among all surgical interventions. According to statistics, almost every third elderly man has undergone such a method of treatment.
Surgery for prostate adenoma is usually performed in cases where a quick correction of the patient's condition is required. For example, if due to the blockage of the urethra, there is an acute urinary retention and, as a result, renal failure.
However, it is possible to use radical methods of treatment in cases where the mass of the tumor is insignificant, there are no signs of impaired renal function. Modern methods of surgical treatment can minimize the risks of complications, so they are used even in the early stages of the disease. This article will tell you how an operation is performed to remove prostate adenoma, how hyperplastic tissues are removed, what recommendations can be given to patients with such a pathology.
Causes and symptoms of adenoma
The development of the disease is associated with many factors, but leading role plays violation hormonal background men, when the level of the sex hormone testosterone in the blood decreases. This condition in most cases occurs in older people.
Changes in the prostate with adenoma
The symptoms that occur with prostate adenoma are primarily determined by the degree of narrowing of the urethra and the violation of the outflow of urine. These include:
- frequent urge to urinate at any time of the day;
- feeling of incomplete emptying of the bladder;
- decreased strength and speed of urine flow;
- difficulty urinating, the need for muscle tension to improve bladder emptying.
The severity of symptoms depends on the size of the tumor and the degree of compression of the urethra in its prostatic part. It is important to differentiate this disease from other pathologies of the urogenital area, since some urological diseases can manifest themselves in a similar way. For this reason, it is important to pay sufficient attention comprehensive examination patient and disease diagnosis.
According to the clinical study, the doctor can judge the degree of development of the tumor process, determine the most suitable variant of the operation to remove the gland in this case.
Examination of the patient before surgery
Diagnostic procedures aimed at identifying prostate adenoma in men include laboratory and instrumental research methods. The first group includes general and biochemical analysis blood, a test to determine the level of prostate-specific antigen in the blood (a marker of tumor processes in the prostate gland).
Also carry out the following set of diagnostic procedures:
- uroflowmetry - determination of the nature of urination;
- digital rectal examination to determine the size of the prostate gland, its consistency;
- x-ray examination of the pelvic organs, including the use of contrast - to determine the degree of narrowing of the prostatic lumen;
- ultrasound is the most effective method detection of prostate adenoma;
- biopsy of prostate tissue.
The last method is to take a small piece of gland tissue from a patient with further examination under a microscope. The biopsy is designed to assess the cellular composition of the tissues of the gland and the differential diagnosis of benign and malignant tumors of the organ. Based on the results of this procedure, the need and the most appropriate method of surgical treatment of prostate adenoma is determined.
Removal of an adenoma with a laser
In some cases, appoint conservative therapy, which is aimed at eliminating the manifestations of the disease in the early stages, when there is no significant amount of residual urine.
Currently, there are several directions of conservative treatment of this pathology:
- drug therapy based on the use of drugs that relieve spasm of the smooth muscles of the urinary tract and improve the outflow of urine;
- physiotherapeutic methods, the purpose of which is to remove the manifestations of inflammation in the diseased organ;
- bladder catheterization - used in extreme cases to remove all residual urine and prevent the development of kidney failure.
With more pronounced manifestations of the disease, it is necessary to use radical methods of treatment. There should be no doubt whether surgery is needed for prostate adenoma of grade 2 or higher, since the later the tumor is removed, the higher the likelihood of complications, and the more difficult the patient's rehabilitation is.
Contraindications to surgery
The operation to remove prostate adenoma has a number of contraindications:
- malignant nature of tumor growth;
- heavy general state the patient, the presence of severe somatic diseases, a significant increase in body temperature, etc.;
- decompensation of diseases of cardio-vascular system when there is a threat to the life of the patient;
- the presence of postoperative complications.
If there are contraindications to surgical treatment of the tumor, conservative treatment is prescribed, including the methods described above, therapeutic exercises.
Surgical treatment
Surgical treatment of prostate adenoma includes several methods. The most common types of operations are:
- Adenomectomy - removal of the gland. This is one of the most commonly used types of surgical treatment, as it has a minimum number of contraindications and restrictions. Adenomectomy is indicated in cases where the mass of the tumor is at least 40 grams, there is residual urine in the amount of 150 ml, and in the presence of complications caused by enlargement of the gland.
- Transurethral resection of the gland (TUR) - belongs to the category of "bloodless" interventions, since it is carried out without an incision, through the urethra. The operation of TUR of prostate adenoma is indicated in cases where the mass of the tumor does not exceed 60 grams, residual urine in the amount of not more than 150 ml, there are no complications (kidney function is not impaired).
- More modern options for TUR are vaporization of the prostate gland, ablation and laser destruction. These methods have a minimal damaging effect on the surrounding tissues, which contributes to the speedy recovery and recovery of patients.
Transurethral resection of the gland - a variant of surgical intervention
The tumor is removed in the department of urology or surgery. The choice of the method of surgical treatment of adenoma depends on many factors. Nevertheless, in recent years, sparing methods of treatment, for example, with the help of a laser, are most often used.
This method has several advantages over other benign prostate surgery:
- all surgical manipulations are carried out through the urethra, due to which no incisions are made on the skin;
- minimal bleeding during the intervention;
- after surgery to remove prostate adenoma by this method, patients recover quite quickly, which is possible due to epidural anesthesia, in which consciousness is not depressed.
Laser vaporization
A newer version of the radical removal of benign prostatic hyperplasia, which received good feedback from practitioners - laser vaporization.
It consists in the evaporation of prostate tissue by means of laser radiation and further coagulation of damaged areas. The consequences of the operation to remove prostate adenoma by this method are almost always favorable.
Laser vaporization can also be performed in cases where complications of the disease develop, in the presence of severe somatic diseases, for example, pathologies of the cardiovascular system, diabetes, neurological pathologies, etc.
Plasma vaporization
A more effective method of surgical treatment of a benign tumor, which has a number of advantages over laser vaporization:
- according to the European Association of Urology, this is a more effective and safe way to treat prostate adenoma;
- unlike laser vaporization, during plasma vaporization there is less blood loss, a minimal chance of developing pathologies such as urinary incontinence and urethral stricture;
- like the laser-based method, plasma vaporization can be used to treat patients with severe comorbidities.
Laparoscopic surgery for prostate adenoma requires high qualification from the surgeon
The consequences after the operation of prostate adenoma using plasma vaporization are most favorable for the patient, in whom the urinary catheter can be removed in two days, and after another 24 hours he is discharged. Plasma destroys all foci of tumor growth, so there are practically no relapses during this treatment method.
Surgery for large tumors
If a patient is diagnosed with prostate adenoma weighing more than 200 grams and the benign nature of its growth is confirmed, then it is recommended to perform an operation using laparoscopic access. In this case, it is also not required to make incisions, three or four punctures are enough.
The recovery period of the patient is from three to four days, after which he is discharged. He can return to work within a week after the intervention.
Rehabilitation
Postoperative period after removal of prostate adenoma plays an important role in preventing the occurrence of complications, such as urinary incontinence. The patient should be under the supervision of a urologist for several days. Even in the absence of complaints, it is important to strictly follow all the recommendations of the attending physician within two to three weeks after the operation.
In most cases, patients need to follow the following rules:
- limitation physical activity, the exclusion of sudden tension and movements - this can contribute to the formation of a scar in the wall of the urethra;
- sufficient amount of fluid to drink;
- limiting the use of salty, fried and smoked foods, maintaining a balanced diet;
- it is possible to prescribe antibiotic therapy to prevent the development of infectious complications;
- refusal of alcohol;
- regular walks in the fresh air;
- abstinence from sexual activity for 1 month after surgery.
The specialist paints an individual recovery scheme for the patient
Patients are prescribed a set of therapeutic exercises that significantly improve the condition of patients. It is recommended to follow some rules when doing exercises:
- the gymnastic complex must be performed in the morning;
- exercises should be repeated daily;
- gradually increase the load;
- a set of exercises should be performed in the absence of serious diseases from other organs and systems.
If the postoperative period is not managed correctly, the patient may need to install a prostatic stent - a device that expands the lumen of the narrowed urethra. Surgical treatment of prostate adenoma, according to statistics, saves the patient from the manifestations of the disease for at least 15 years. Only 10% of patients who underwent radical removal of the gland, during this period of time, again turn to the urologist with similar complaints.
Prostate adenoma is characterized by tissue proliferation, which as a result leads to the appearance of unpleasant symptoms: pain syndrome, erectile dysfunction, dysuric manifestations, up to acute urinary retention. On initial stages disease, the patient is undergoing a course of drug therapy.
If the prescribed medications are ineffective and there is accelerated growth volume of tissues, an operation is performed to remove prostate adenoma. Modern surgical techniques are minimally invasive and in 80-90% of cases guarantee a complete recovery of the patient after surgery.
When is surgery for prostate adenoma indicated?
The need for complete or partial removal of the gland is determined on an individual basis. Several factors influence the decision:- Pain syndrome - in the early stages, analgesics and antispasmodics are used to reduce symptoms, in some cases novocaine injections will be required. At an advanced stage, even after taking medication, the pain remains.
- Ineffective course of drug therapy. Hyperplasia can develop regardless of adequate treatment. The drugs included in the course of therapy are conservative in nature. If drug treatment, carried out within six months, is ineffective, an operation is prescribed.
- Patient's age- for men older than 65-70 years, surgery is not performed due to high risks to the patient's life. Before deciding on the need for surgical treatment, the general well-being of the patient is taken into account - conditions in which surgery is contraindicated.
- Accelerated proliferation of gland tissues- rapid progression of hyperplasia is a direct indication for surgical treatment.
Ways to remove prostate adenoma
Traditional prostatectomy is performed by the abdominal method. A large incision is made at the bottom of the abdominal region, through which surgical manipulations are performed. Abdominal surgery has many contraindications and is fraught with complications, so it is performed extremely rarely.Another method of removal, which is characterized by low invasiveness, is transurethral resection. The methodology is constantly being improved. The essence of the method is to conduct surgery through an endoscope inserted into the urethral canal.
The first experiments on TUR surgery occurred in 1926. Since then, the method has been constantly improved. Thus, transurethral incision appeared - a method of intervention, when the tissues of the gland are not removed, but dissected, which leads to a decrease in the volume of the prostate and alleviation of symptoms.
TUR and cavitary prostatectomy are considered classics of prostate surgery. Transurethral resection remains one of the most popular surgical techniques.
Long recovery after abdominal surgery, the likelihood of complications (erectile dysfunction, urinary incontinence), have led to the fact that prostatectomy is used extremely rarely and only in cases where it is impossible to perform minimally invasive surgery.
The latest methods for removing BPH
Classical prostatectomy is characterized by invasiveness and a large number of side effects. Minimally invasive methods are designed to minimize the harm from the operation. In modern surgery, sparing methods of treating the gland are preferred:
All modern methods of removing prostate adenoma have two goals:
- Reduce the load experienced by the body during surgery.
- Reduce the number of side effects in the postoperative period.
The cost of removing prostate adenoma depends on the location and the chosen technique, and is the main disadvantage of modern methods of therapy. The price for treatment in one of the Israeli clinics varies from $15-40,000. In the Russian Federation, a minimally invasive operation is cheaper and will cost $5-15,000.
Consequences after removal of prostate adenoma
In the preoperative period, the attending physician is required to inform the patient about the advantages and disadvantages of the chosen method of surgical therapy. The patient is warned about the dangers that a man can face after removal of prostate adenoma. A document is signed on the patient's consent to the operation.Any surgical treatment carries a potential danger. There is a risk of infection, blood loss. The anesthesia administered puts a heavy strain on the cardiovascular system.
The recovery period after removal of prostate adenoma lasts from 4 days to 2 weeks, depending on the chosen method of operation. During this time, the patient is hospitalized. The postoperative period after removal of prostate adenoma proceeds under the supervision of a doctor and other medical personnel.
The greatest danger lies in the likelihood of the following complications:
- Re-bleeding.
- General sepsis of the body.
The results of surgical therapy depend not only on the competent conduct of the operation itself, but also on compliance with the recommendations during the patient's recovery period.
What complications can you face
There are general consequences of the operation to remove prostate adenoma, independent of the technique, as well as negative effects inherent in certain types of surgery. The patient after prostatectomy should be prepared for the following symptoms:- Bleeding - a small amount of blood coming out in the form of clots or inclusions in the urine, is quite normal. Problems begin if hematuria occurs 2-3 weeks after surgery. The appearance of blood in the urine is an alarming sign that requires seeking professional medical help.
- Urinary incontinence - after partial removal, laser ablation or enucleation, swelling of the prostate is observed. With complete excision of the gland, tissues swell due to injury.
The most common complication after surgery is the inability to urinate normally, characterized by acute urinary retention or spontaneous leakage. The patient is temporarily catheterized.
During the rehabilitation period, a man learns to control the muscles of the bladder and over time, the process of urination is fully restored. - Dry orgasm - the prostate gland, in addition to participating in the production of ejaculate, plays the role of a natural barrier that prevents sperm from entering the bladder. After prostatectomy, the obstruction is removed.
Lack of sperm or dry orgasm, a frequent consequence of traditional abdominal surgery and TUR. For a couple planning a child, if possible, an alternative method of removing the prostate should be found. - Infection of the body- removal of the prostate is dangerous because even if sterility is observed in the operating room, a certain amount of pathogenic bacteria still gets into the wounds made. With some techniques, there is a high probability that excised tissues will remain inside the capsule.
Sepsis of low intensity, passing in 1-2 days is normal. Inflammation that lasts longer requires immediate intervention. To prevent infection, it is necessary to properly treat wounds after removal of the gland. Special attention pay competent catheterization of the patient and replacement of drainage.
Minimally invasive techniques are popular due to the fact that the rehabilitation period is much shorter than after abdominal surgery. Reproductive functions are restored in full in a relatively short period of time.
How does the removal of prostatic hyperplasia affect potency
The prostate gland is located in a capsule to which nerve endings are attached. The plexuses directly affect the erectile function of a man.Complications after removal of prostate adenoma associated with a deterioration in potency are mainly observed in patients with damaged during the intervention nerve endings. Erectile function in this case either does not recover at all, or worsens significantly.
The prognosis after removal regarding the restoration of potency largely depends on the chosen technique. Men have the greatest chance of maintaining normal erectile function after invasive and nerve-sparing techniques. So, with classical prostatectomy performed by a robotic method using the Da Vinci installation, the number of patients with complete recovery after surgery to remove prostate adenoma is 75-80%.
Preservation of reproductive function depends on two more criteria:
- Absence of a normal erection before surgery.
- The presence of a malignant neoplasm that has passed to the nerve fibers.
