Surgery to remove prostate adenoma. Surgery to remove prostate adenoma: indications for surgical treatment and an overview of the techniques used

One of the most serious problems of modern urology is the surgical treatment of prostate adenoma. When prescribing treatment, doctors try to resolve the situation without the use of surgery, however, in some cases, it is not possible to do without surgery on the prostate. At least one third of all cases of prostatitis end with surgery in a specialized clinic.

Why surgery may be required for prostate problems

Treatment of prostatitis with medication does not always lead to the desired result. Complex cases can be dealt with by taking surgery. The operation acts as a harmless and effective means to combat the problems of the prostate gland in a disease that has developed to severe stages. If all actions are performed correctly, the timely intervention will help to avoid malignant tumors, the recovery period will pass quickly enough, there will be no metastases.

If a patient has a prostate adenoma, surgery may not necessarily be the only method to improve the condition.

The choice of the appropriate method will depend on several factors. The doctor decides on the methods of treatment. The need for an operation is considered only by a qualified urologist who is able to take into account the condition of a particular person.

When calculating whether it is worth performing an operation for prostate adenoma, the doctor takes into account the following factors:

• Patient status;
• Clinic opportunities;
• The presence of other diseases that can affect recovery;
• Consent of the patient himself to the operation of prostate adenoma;
• The patient's age;
• Stage of the disease;
• Is there oncology in humans.

What could be the reasons for removing adenoma

If a prostate gland adenoma is diagnosed, the operation, as well as its possibility, can cause concern for the patient. Fear often leads to late seeking medical attention. Patients get to the doctor with a very advanced course of the disease. This is the wrong approach - the longer you pull, the worse. It is easy to do without surgery on the prostate gland if the tumor is small. Operations are needed with such signs of the severity of the condition:

• Severe urinary retention or spotting;
• A lot of fluid remains in the bladder after going to the toilet;
• Renal failure;
• The deposition of stones in the bladder;
• Kidney problems.

Any medical assistance for prostatitis, including surgery, is performed with the aim of improving the condition during urination. First of all, it is necessary to help the patient to suffer less from pain, then the inability to lead a normal life will gradually come to naught.

The growing tissue of the prostate causes quite a lot of trouble - painful sensations when trying to go to the toilet, severe discomfort. If the disease worsens, renal failure comes, and other disorders and problems with sexual activity often begin.

Those who are afraid of such treatment should find out more precisely how the prostate operation is performed. It seems to most patients that surgical treatment of prostate adenoma ends with its complete removal. The main concern is that after such an intervention, male sexual health will be disrupted. But this is not so - modern developments used to help patients with adenoma work to eliminate part of the organ that presses on the urethra and makes it difficult for fluid to drain.

Adenoma treatment, TUR operation

Transurethral resection, or TUR, is a well-proven treatment of prostate adenoma to help remove unnecessary tissue. Those who do not know how an operation to remove a prostate adenoma is performed should ask the doctor who made the appointment. During the procedure, the grown benign tumor is removed. The patient is recovering quickly, prostate surgery is harmless and has a good effect.

If this disease is detected, the operation is recommended for patients with a state of moderate and mild severity. If the tumor is large, the operation will not work well.

The process requires spinal or general anesthesia.

How is the operation to remove prostate adenoma:

1. A special instrument, a resectoscope, is introduced into the urethra of a prepared patient. It is equipped with an accumulator for collecting liquid, a light source and a loop for manipulation.
2. The targeted areas of tissue are removed, then the vessels are coagulated.
3. After dissection, tissue elements are sent for microflora assessment to determine the presence or absence of malignant cells in them.
4. During surgery, a catheter is inserted into the bladder to draw fluid out. He will be there for several days.

How long does the operation take

The operation to remove the prostate adenoma will take about an hour and a half. The time it takes to remove the adenoma depends on the amount of overgrown tissue. Then the patient will remain in the clinic so that his condition can be monitored.

The operation to remove prostate adenoma can be accompanied by various complications. If a prostate adenomectomy has been performed, the patient's condition should be monitored. The most common consequences are:

• Outflow of blood, clots;
• Injured bladder
• Broken integrity of the prostate capsule.

After the removal of the prostate adenoma is completed, postoperative complications may occur. Among them are the following:

• Infectious lesions;
• Dysuria;
• Complications of urination;
• Traces of blood may remain in the urine for a long time.

If an intervention was carried out for a prostate adenoma, the consequences largely depend on the state of the patient before the intervention, on the accuracy of the doctor's advice, on how correctly it was performed. Sometimes there are short-term erectile dysfunctions, the urethra sometimes narrows (up to 3%), it is extremely rare to require repeated treatment.

Types of operations

Methods for removal of prostate adenoma can be chosen those that are most convenient in the case of a particular patient, from which the greatest effect is expected. Depending on how convenient access is, and on the amount of work expected, the following options are distinguished:

• Simple open removal of the affected tissue (adenomectomy);
• Transurental resection of prostate adenoma, incision;
• Endoscopic, minimally invasive manipulations (for example, cryodestruction).

Laparoscopy of adenoma, recovery

One of the types of operations for prostate adenoma, in cases where it reaches large volumes, all the necessary procedures can be performed laparoscopically. Before a prostate adenoma operation is performed, the patient must be prepared for it. It is carried out only with the help of special equipment in a clinic.

The doctor with the use of trocars - special hollow tubes - gets the necessary access to the organ. They are injected through small incisions made in the skin. For manipulations, instruments are used that can penetrate the diseased organ through the internal cavities of the trocars. With the help of a camera inserted into one of them, the course of the operation for prostate adenoma is projected onto a screen. Three to five trocars can be used.

During the operation to remove the prostate adenoma, general anesthesia is used. In time, it can last up to two and a half hours. After the completion of the prostate adenoma surgery, a catheter is inserted into the patient's urethra.

Laparoscopy, as an operation to remove a prostate adenoma, in comparison with an open one, has many advantages:

• There are no complications or they are minor;
• No bleeding occurs;
• Catheter placement is only required for a short time;
• The patient's recovery is fast.

Abdominal prostate surgery

The methods of removing adenoma of the prostate gland include such as the cavity. The work is carried out using anesthesia that is safe for the patient. Surgical treatment of prostate adenoma consists in dissection of tissues and organs, due to which access to the operated organ is difficult. The surgeon, after gaining access, removes problem tissues with his hands, using special instruments for this. When the adenoma is removed, a catheter is placed in the urethra.

After abdominal surgery, the following complications may occur:

• Infection;
• Urinary incontinence;
• Constipation;
• Large blood loss.

Methods for working with the prostate gland include embolization of the arteries of the affected organ.

Surgical treatment of prostate adenoma in this way can only be carried out using a properly equipped operating room and trained personnel.

This type of intervention is performed as planned, the patient receives all the necessary examinations in advance.

For prostate surgery, the technique will be as follows. With the help of special preparations, the vessels are blocked, which feed the problem area with blood. The tissues are narrowed, as a result of which a lumen appears in the urethra. An operation on prostate adenoma is performed without unnecessary incisions, under local anesthesia.

The blood supply to the adenoma is blocked with a catheter - an embolization agent is injected into it to block the vessels. Then the adenoma is removed through the urethra. The procedure may have contraindications:

• Endocrine system problems;
• Faults in the work of the heart;
• Pathological diseases of internal organs;
• Allergy to the radiopaque component;
• Malignant tumors, acute diseases, and so on.

How to operate with a laser prostate adenoma

When a prostate adenoma is found in men, surgery may be performed using a laser. This is a convenient and safe method for the patient.

The necessary manipulations are carried out through the urethra. In the process, valorization of the affected area is carried out with a surgical laser.

After this procedure, the patient's condition quickly improves, recovery is better than after removing the problem tissue by surgery. With this method, healthy tissues are not injured, as sometimes happens with other options. Whatever the indications for prostate adenoma surgery, complications, unlike other methods, do not appear.

When is surgery for adenoma of the prostate using a laser indicated? The appointment will follow the same criteria as the TOUR. When choosing which operation is safe for prostate adenoma, the attending physician will most likely stop at this method.

Conclusion

Not necessarily every case of prostate problems ends with an operation.

Timely treatment of prostatitis is very important, while most patients go to the doctor when the disease has gone far and the prostate gland is not in the best condition.

It is not uncommon when a patient, who has no idea at what volume of the glandular organ the operation is performed, is admitted for examination with a large adenoma. Sparing methods such as cryodestruction, laser and others can no longer help here. Active treatment can lead to additional problems.

To facilitate the work of surgeons and for a calm postoperative recovery, it is better to consult a doctor right away when you notice an unfavorable work of the genitourinary system.

Creates urination problems, which, when neglected, initiate other troubles and complications.

Currently, there is a large selection of surgical intervention methods, among which you can find a suitable method for each patient, taking into account his characteristics and related problems.

Indications

Surgical intervention is one of the most effective methods.

The choice of the method of care is made by the specialist and the patient together.

This is due to the fact that the consequences that accompany different types of operations force some of the patients with adenoma to choose less effective methods, but which allow to preserve erectile functions. This is especially true for young men.

Mandatory indications for surgery are:

• cases when other methods do not give the desired result;
• severe difficulty urinating,
• detection of stones in the bladder,
• during urination, a significant amount of urine is retained in the bladder,
• if the catheterization of the ways did not improve the condition of the patient with acute urinary retention,
• the disease provoked an infection in the urinary tract,
• retention of urine caused by the disease has led to impaired renal function;
• hematuria.

Exploratory survey

To select a method of treatment, the patient is carefully examined.

For this, activities are carried out:

• the patient undergoes urine and blood tests to determine the general condition and possible other health problems;
• uroflowmetry monitors the degree of urine flow disturbance,
• a urologist conducts a rectal examination of the prostate,
• transrectal ultrasound examination of the gland is the main way to obtain detailed information about the size of the adenoma and other features of the pathology;
• - a method that clarifies the possibility of the presence of oncology.

Types of surgical treatment

Various methods of surgical intervention are used to remove prostate adenoma:

• the traditional method is open operation (),
• transurethral resection,
• laser vaporization,
• transurethral incision,
• laparoscopic surgery,
• prostate adenoma.

Transurethral Resection (TUR)

This is one of the most used methods of helping patients with prostate adenoma. For the appointment of transurethral resection, the indications are:

• the volume of the prostate is up to eighty milliliters,
• the surgeon predicts the duration of the operation no more than an hour.

The procedure is performed using endoscopic techniques. The instrument that removes tissue is located at the end of a thin tube.

Through the ureter, the resectoscope enters the site of the operation. Excision of tissues occurs with the use of diathermocoagulation.

The areas to be removed are exposed to high temperatures. At the place of operation of the resectoscope, tissues are irrigated in order to cool them.

Video about TURP surgery for prostate adenoma:

An operation similar to this, but when the tissue is not removed, but the prostate is dissected at the site of the narrowing of the ureter, is called transurethral incision. This improves the ability of urine to pass through the urethra. This procedure is performed in the case of:

• if the prostate has a small volume,
• when the likelihood of oncology is excluded.

Adenomectomy

More recently, it was the main type of surgery to remove prostate adenoma. Now such an intervention is recommended if, according to the patient's indications, other methods of removing the adenoma are not suitable for him.

Adenomectomy is prescribed in such cases:

• the prostate has increased in volume above eighty millimeters,
• when examining the patient, complicating facts were revealed:
  • the presence of stones in the bladder,
  • if there is a need to remove a large diverticulum in the bladder cavity.

The procedure involves making an incision in the lower abdomen. Depending on the choice of the method of penetration to the prostate, the bladder may also be dissected.

The operation requires a highly qualified surgeon. When the procedure is performed by an experienced professional, you can expect good results in getting rid of the symptoms of the disease.

Laparoscopic removal

The operation is classified as an effective and gentle method. The equipment is delivered to the site of adenoma removal through several small incisions in the abdomen.

Removal of adenoma occurs under the detailed supervision of video equipment. The excised tissues are removed from the patient's body using an ultrasonic knife adapted for this manipulation. The catheter inserted into the ureter at the end of the operation is removed on the sixth day after the procedure.

The advantages of the method:

• less traumatic,
• minimal blood loss,
• effective.

The method has an advantage over other sparing surgical interventions in that it can be used in cases when the adenoma has reached a large size. The prostate can be enlarged to more than one hundred cubic centimeters.

Embolization of the arteries of the prostate (EAP)

The manipulation is carried out with the participation of angiographic equipment. The prostate shrinks as a result of the occlusion of the arterial vessels that feed it.

Contraindications:

• floating blood clots found in the veins of the legs,
• cases when there are vascular diseases.

When surgery is indicated:

• if the patient has additional problems:
  • disorders associated with blood clotting,
  • kidney disease
  • diabetes mellitus in severe form.

The method is used relatively recently. The method is a complete alternative to open surgery, as well as transurethral resection of adenoma.

Laser vaporization

A modern way to help patients with adenoma, giving the least complications. Also covers patients with blood clotting problems.

The equipment enters the prostate area through the ureter. The principle of operation of the method is that unwanted tissues are evaporated with a laser beam. In this case, the blood vessels falling into the area of \u200b\u200bthe beam are welded, preventing bleeding.

Photoselective vaporization - exposure to a green laser. A laser with a certain wavelength, passed through the crystals of potassium-titinal-phosphate, acquires a green color and the ability to evaporate tissue.

The progress of the operation is reflected on the monitor. The surgeon sees his every action. The use of a green laser is advisable for prostate sizes from sixty to eighty cubic centimeters.

The clinics practice a combination of two methods: laser vaporization and transurethral resection for prostate sizes of more than one hundred cubic centimeters.

Method advantages:

• less traumatic,
• effective,
• relieves from complications accompanying other types of operations - bleeding, sexual disorders;
• the ability to perform manipulation on an outpatient basis,
• short postoperative period,
• you can help patients who have diseases that worsen blood clotting.

The method, with all the indisputable advantages, has the following disadvantages:

• the duration of the procedure is twice as long as the TUR,
• not every clinic has such equipment.

Enucleation

The procedure involves "peeling" the tissue to be removed using a laser. The method successfully replaces transurethral resection and open surgery.

Positive aspects of the method:

• the ability to check the extracted tissue for oncology,
• the method can be used when the gland grows up to 200 g and even more,
• the advantages obtained during tissue vaporization remain:
  • a short recovery period;
• it is possible to carry out the procedure for patients with problems:
  • having a pacemaker,
  • in the case of metal devices built into the skeleton,
  • if violations associated with normal blood coagulation are found.

The video shows laser enucleation of prostate adenoma:

Contraindications:

• if the patient's bladder is shrunken,
• severe general condition,
• the presence of inflammatory processes,
• inability to pass a resectoscope through the ureter.

For the most part, contraindications apply to all types of operations. The impossibility of inserting a resectoscope and a shrunken bladder are obstacles for surgical interventions that occur with the instrument passing through the ureter.

Complications

The negative consequences of transurethral resection include:

• bleeding from tissues wounded during surgery,
• the ingress of fluid, which is used to wash the bladder during manipulation, into the patient's vascular bed.

The risk of complications increases with the duration of the procedure. The operation time directly depends on the volume of the prostate.

In the future, the patient may have the consequences of surgery:

• formation of cicatricial narrowing in the urethra,
• the development of a symptom of urinary incontinence,
• disorder of sexual function.

Two percent of patients seek re-treatment for complications. Five percent of patients who underwent removal of adenoma by this method come for a second resection.

In open surgery, the complications are similar to those of transurethral resection.

After adenomectomy, problems related to the features of the method are added:

• complications due to the violation of the integrity of the skin and walls of the bladder:
  • formation of urinary fistulas,
  • infection of wound surfaces,
  • urinary leakage
• long postoperative period - up to ten days.

Rehabilitation after surgery to remove prostate adenoma

In order for the patient to recover after surgery, the specialist indicates the rules of behavior that must be followed:

• plentiful drink
• supervision of a specialist,
• sharp movements should be excluded,
• antibiotic therapy may be prescribed,
• nutrition should be balanced,
• exclude dishes from the diet:
  • salty,
  • fried,
  • smoked;
• for a month and a half, you should refrain from sexual intercourse,
• shown to follow a healthy lifestyle,
• daily walks,
• perform a special complex.

Price

The name of the procedure for the removal of prostate adenoma	Cost, rub
Transurethral resection	20900 ÷ 21000
Adenomectomy	16000 ÷ 30600
Arterial embolization	180000
Laparoscopic surgery	125000 ÷ 165000
Laser vaporization	from 55000
Enucleation of adenoma	66000 ÷ 80000

Preparing for surgical treatment

Preparatory activities include:

• communication with the anesthesiologist so that he can decide on the drug for anesthesia;
• identification of possible contraindications for the selected method of surgical intervention,
• analysis of chronic diseases,
• determination of blood counts for coagulation,
• blood chemistry,
• in some types of operations, a specialist may prescribe antibiotics on the eve of the procedure for the purpose of prevention,
• on the day of the operation, food is not taken.

Postoperative period

Most of the methods of surgical intervention have the following postoperative actions after removal of the prostate adenoma:

• the patient is washed with the bladder,
• appointment is scheduled:
  • antibiotics,
  • pain relievers;
• if the operation involved making incisions in the abdominal wall, then after it, procedures for the care of the seams are performed.

All materials on the site have been prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and inapplicable without consulting your doctor.

Surgical treatment of prostate adenoma continues to be a very urgent problem in modern urology. Despite the fact that specialists are doing their best to reduce the percentage of surgical interventions, at least one third of patients still need them.

Surgery for prostate adenoma often becomes the only way out that can not only save a man from a tumor, but also improve his quality of life, since problems with urination are often impossible to eliminate 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 postponed, fighting the ailment 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 patient's age, 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 their likelihood only increases with age, therefore urologists approach indications and contraindications very carefully.

Of course, every man would like to undergo treatment in the most effective way, but the ideal way has not yet been invented. Taking into account the possible complications and risks of open operations and resections, more and more surgeons are trying to save the patient from the problem of "little blood", 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 are in no hurry to see a doctor, starting the adenoma to the stage of complications. In this regard, it is worth reminding the strong half of humanity once again that a timely visit to a urologist is as necessary as the treatment itself.

Indications and contraindications for surgery

Indications for surgical removal of prostate adenoma are:

• Severe narrowing of the urethra with disruption of the bladder, when a large volume of urine is retained in the latter;
• Bladder stones;
• 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 surgery - 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 and electric current are preferable.

Like any type of surgical treatment, the operation has its own contraindications, including:

1. Severe decompensated pathology of the heart and lungs (due to the need for general anesthesia, the risk of bleeding);
2. Acute renal failure
3. Acute cystitis, pyelonephritis (operated after the elimination of acute inflammation);
4. Acute general infectious diseases;
5. Aortic aneurysm and severe atherosclerosis.

It is clear that many contraindications can become relative, because the adenoma must be removed in one way or another, therefore, if they are available, the patient will be sent for preliminary correction of existing violations, which will make the upcoming operation the safest.

Types of surgery for prostate adenoma

Depending on the volume of intervention and access, various methods of tumor removal are distinguished:

• Open adenomectomy;
• Transurethral resection and incision;
• Minimally invasive and endoscopic procedures - laser vaporization, cryodestruction, microwave therapy, etc.

Open adenomectomy

Surgical treatment of prostate adenoma by means of 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 80ml), accompanying stones and diverticula of the bladder, the possibility of malignant transformation of the adenoma.

Open adenomectomy occurs through the opened bladder, therefore it is also called abdominal surgery. This intervention requires general anesthesia, and if it is contraindicated, spinal anesthesia is possible.

The course of adenomectomy operation includes several stages:

1. 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 (it does not play a fundamental role and is determined by the doctor's preferences and the tactics adopted in a particular clinic);
2. 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;
3. Finger extraction and removal of tumor tissue through the bladder.

The most important stage of the operation is the removal of the tumor itself, which squeezes the lumen of 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.

When the index finger reaches the inner opening of the urethra, the urologist gently tears the mucous membrane and with his finger exfoliates the tumor tissue, which has already pushed the gland itself to the periphery. To facilitate isolation of the adenoma with a finger of the other hand inserted into the anus, the surgeon can 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 must be sent for histological examination.

In the early postoperative period, the probability of bleeding is high, 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 as in the possibility of the formation of a clot of blood in the bladder, which can close its outlet and block the exit of urine.

For the prevention of bleeding and obstruction of the bladder, constant washing with sterile saline solution 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 walls of blood vessels are gradually restored, the lavage fluid becomes clear, which indicates the completion of bleeding.

For the first few days, the patient is advised 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 sutures that have just been applied. Then you can do it less often - once every one and a half to two hours. It can take up to three months for the pelvic organs to fully recover.

Undoubted advantage abdominal adenomectomy is considered to be radical, that is, complete and irreversible removal of the tumor and its symptoms. For high efficiency, the patient, in turn, "pays" for a long period of stay in the hospital (up to one and a half weeks with an uncomplicated course, and in case of complications - even longer), 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 abdominal wall.

Transurethral resection

Considered the "gold standard" in the treatment of prostate adenoma. This operation is performed most often, and, at the same time, it is very difficult, requires the surgeon's impeccable skill and jewelry technique. 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 no more than an hour. For large tumors or the likelihood of malignant transformation into a tumor, open adenomectomy is preferred.

The advantages of TUR are the absence of postoperative sutures and scars, a short rehabilitation period and a quick improvement in the patient's well-being. Among the disadvantages are the inability to remove 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 adenoma consists in excision of the tumor by access through the urethra. The surgeon, with the help of endoscopic instruments (resectoscope), penetrates the urethra into the bladder, examines it, finds the site of the tumor and extracts it with a special loop.

The most important condition for a successful TUR is good visibility during manipulations. This is achieved by continuously injecting fluid through the resectoscope while simultaneously removing it. 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, legs are divorced and raised, as well as with a long stay in the urethra of a rather large instrument in diameter, which can subsequently provoke pain and bleeding.

transurethral removal of prostate adenoma

The adenoma is excised in parts, in the form of shavings, until the parenchyma of the gland itself appears in the field of view. By this time, a significant amount of fluid accumulates in the bladder with tumor "chips" floating in it, which are removed with a special instrument.

After excision of the tumor and washing the bladder cavity, the surgeon once again makes sure that there are no bleeding vessels that can be coagulated with electric current. If everything is in order, the resectoscope is pulled out and a Foley catheter is inserted into the bladder.

foley catheter

Foley catheter placement is necessary to compress the site where the adenoma was (the catheter has an inflatable balloon at the end). It is also used for constant washing of the bladder after the operation. This is necessary to prevent obstruction of the outlet section by blood clots and to constantly drain urine, providing peace to the healing bladder. The catheter is removed after a few days, provided that there is no bleeding or other complications.

After removing the catheter, men notice significant relief, urine flows freely and in a good stream, but at the first urination it can be colored reddish. Do not be afraid, this is normal and should not happen again. In the postoperative period, it is recommended to urinate frequently in order to prevent distension of the bladder walls, allowing its mucous membrane to regenerate.

For small prostates with an adenoma that compresses the urethra, transurethral incision can be performed. The operation is aimed not at excising the neoplasm itself, but at restoring the flow of urine, and consists in dissecting the tumor tissue. Considering the "non-radical" method, it is not necessary to count on long-term improvement, and after a while, incision may be followed by TUR.

Laparoscopic removal is one of the sparing methods of treating prostate adenoma. It is carried out using equipment inserted into the pelvic cavity through punctures in the abdominal wall. Technically, such operations are difficult, require penetration into the body, so TUR is still preferred.

Video: transurethral resection of prostate adenoma

Minimally invasive prostate surgery

Minimally invasive methods of treatment are being successfully developed and implemented in various fields of surgery, including urology. They are performed through a transurethral access. These include:

• Microwave thermotherapy;
• Vaporization with electric current;
• Electrocoagulation of the tumor;
• Cryodestruction;
• Laser ablation.

The advantages of minimally invasive treatment are relative safety, fewer complications compared to open surgery, 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, clotting pathology blood, diabetes, hypertension).

Microwave thermotherapy consists in the impact on the tissue of the neoplasm with high-frequency microwaves, which heats and destroys it. The method can be applied both transurethrally and by introducing a rectoscope into the rectum, the mucous membrane of which is not damaged during the procedure.

Vaporization leads to heating of tissue, evaporation of fluid from cells and their destruction. This effect can be achieved by acting with electric current, laser, ultrasound. The procedure is safe and effective.

When cryodestruction, on the contrary, the adenoma is destroyed by the action of cold. The standard medium is liquid nitrogen. The wall of the urethra is warmed up during the procedure to prevent damage.

Laser treatment of prostate adenoma - quite effective and one of the most modern ways to get rid of a tumor. Its meaning lies in the action of laser radiation on the tumor tissue and simultaneous coagulation. Pros of laser treatment - bloodlessness, speed, safety, the possibility of using 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, as they say, is the “last peep” in the field of minimally invasive treatment of prostate adenoma. The exposure is carried out with a laser emitting green rays, which leads to water boiling in tumor cells, its evaporation and destruction of the adenoma parenchyma. Complications with such treatment practically do not happen, and patients notice a rapid improvement in well-being immediately after the operation.

Laser removal of adenoma is especially indicated for men with concomitant hemostatic disorders, when the risk of bleeding is extremely high. Under the action of the laser, the lumens of the vessels are sealed, as it were, which practically excludes the possibility of bleeding. The procedure can be performed on an outpatient basis, which is also an undoubted advantage. In young men, after laser vaporization, sexual function is not impaired.

Video: laser vaporization of prostate adenoma

Potential consequences of BPH surgery and rehabilitation

No matter how hard the surgeons try, it is impossible to completely exclude the probable complications of radical treatment. The risk is especially high with abdominal surgery, it is with TUR, and in the case of endoscopic removal, it is minimal.

The most frequent complications early postoperative period can be considered:

1. Bleeding;
2. Infectious and inflammatory changes;
3. Thrombosis of the veins of the legs, pulmonary artery and its branches.

More distant consequences develop within the pelvic organs. These are strictures (narrowing) of the urethra against the background of proliferation of connective tissue, sclerosis of the bladder wall at the site of urethral discharge, 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 are fully restored. 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);
• Give up spicy, spicy, salty foods, alcohol, coffee;
• Perform daily gymnastics to activate blood flow and improve overall tone.

Prostate adenoma is a medical diagnosis... The disease is said to be when the tissues of the inflamed prostate begin to increase in size, resulting in the formation of nodes (benign neoplasms). As a rule, this disease befalls men in adulthood and old age. In this case, an operation is prescribed to remove the prostate adenoma. All of them exist.

The prostate gland is a small, purely male organ that resembles a walnut in shape. This organ is located just below the bladder. The urethra passes through it, as well as the ejaculatory ducts.

The organ located in the small pelvis acts as a valve that closes the passage during erection and allows sperm to be thrown out and not enter the bladder. The prostate gland, among other things, produces a special special secret that is part of the sperm and makes it more fluid.

Symptoms of prostate adenoma

Symptoms and sensations from this pathological condition in men are initially similar to female symptoms with cystitis, and in a later, advanced stage, there is a complete cessation of the ability to urinate independently.

Symptoms of the early stage of adenoma:

• occasional difficulty urinating;
• the need to wake up at night to visit the toilet;
• longer time required to urinate;
• when you feel the urge to urinate, you need to visit the toilet immediately. No delay is possible;
• the stream of urine during a visit to the toilet is no longer clear, sometimes it reaches the point that a man empties with drops.

Symptoms of the late stage of adenoma:

• constant discomfort in the groin area;
• the inability to postpone the act of urination even for a few minutes, the inability to "endure" before the toilet;
• violation of sexual desire or its complete absence;
• the inability to go to the toilet - at this stage, medical intervention is extremely necessary.

Types of operations to remove a benign tumor

Removal of prostate adenoma is not a complete removal of this organ, as many think, especially if the disease is not completely started. Removal of adenoma of the prostate is the excision of excess flesh, which has led to a pathological enlargement of the organ.

There are two popular types of surgery to remove adenoma:

• Transvesical adenomectomy

Operation of adenoma TUR

This type is considered a relatively light surgical intervention, after which the man recovers within two days.

1. The essence of the operation is as follows: a special instrument is inserted into the man's urinary canal, which cuts off with the help of a high-frequency current the excess flesh of the prostate, which interferes with the normal functioning of the genitourinary system.
2. Vessels that are damaged during this procedure are arrested using the same high frequency current, which prevents bleeding and reduces the rehabilitation period. The whole process is regulated by the surgeon using a cytoscope visualizer.

IMPORTANT!

As for statistics, up to 90 percent of men note an improvement in well-being after the TUR manipulations.

Prostatectomy

The next type of surgery, more difficult and unpleasant for a man, is open prostatectomy surgery. Unlike (TUR), this manipulation involves the complete removal of the prostate, and it is carried out only if the gland grows to a size of 80 grams. Such cases are rare if you go to urologists at the time. With open prostatectomy, the testicles are not removed! Surgeons only work on the prostate!

The prostatectomy operation is carried out as follows: the prostate tissue is removed through the bladder with an incision in the lower abdomen or in the area between the anus and the scrotum. The type of incision is determined by the doctor after consultation with the patient.

ON A NOTE!

The recovery period after the prostatectomy operation reaches seven days - during this entire period the man is in the hospital with a catheter in the urethra.

In any case, the prostate tissue is removed through the bladder. The catheter in the urethra after abdominal surgery for prostate adenoma remains inside for 7 days, and the patient must stay in the hospital all this time, even if the state of health is normal.

There are no age restrictions for the removal of prostate adenoma. It is possible to cancel or correct the type of intervention only for indications such as the presence of cancer, heart disease and other critical conditions.

Laparoscopy

• Laparoscopyis carried out using laser technology, and the amount of biomaterial removed is adjusted by the surgeon using a camera. The recovery period is six days.
• The next kind of operation is prostatectomy of the prostate - the only practical type of removal of prostate adenoma, which does not imply any future difficulties with the erectile function of the male body.
• Transurethral resection to remove prostate adenoma becomes more and more popular due to the specifics of a relatively easy recovery period after this very intervention.
• And another important factor is the ultra-short recovery period. A drain and a catheter are only needed here for one day. This type is beneficial for those who cannot agree with the need to stay in the hospital for more than five days.

Benefits

1) local anesthesia, the resolution of which does not depend or practically does not depend on the state of the CVS.
2) no bleeding implies a short recovery period.
3) there is no immediate need to use a catheter.
4) being in a hospital ward for no more than 24 hours.

How is preparation for surgery going?

The operation involves staying in a hospital for a period of five to twenty days. For this period tests for:

• syphilis;
• hepatitis;
• chest x-ray;
• Ultrasound of the urinary system;
• PSA (blood test);
• determination of the blood group and Rh factor in the event that such data are not available.

Immediately before the manipulation, there is a meeting with a therapist, as well as with an anesthesiologist, who determines the type of anesthesia acceptable for a given case.

Prostate adenoma: on the eve of surgery - one evening before surgery

On the last evening before the intervention, the patient is not recommended to eat heavy food, in addition, the patient is prescribed a prophylactic enema to cleanse the intestines. After these manipulations, the man, either on his own or with the help of medical personnel, shaves off the hair growing on the pubis and below.

At the onset of 12 at night, all patients who are preparing for any type of surgery of the indicated type are prohibited from taking any liquid, even water. Immediately before the operation, the man is injected with special antibiotics.

Postoperative period

1. Any type of surgical intervention, even minimally invasive, and, as well as the complexity and duration of the operation, depend not only on the severity of the initial pathological condition and the type of intervention, but also on the age, state of human immunity and other nuances.
2. One of the not very pleasant postoperative procedures looks like a lavage, with continuous flushing of the bladder with furacilin. This procedure can last from several hours to several days.
3. Adenoma of the prostate implies a ban on taking any liquid for at least seven hours before the procedure itself, and about an hour and a half immediately after the operation. But in the future, in order for the negative consequences to be reduced to a minimum, a man should drink more than three liters of liquid per day.
4. At the same time, it is not necessary to be limited only to mineral water, juices, and teas, and fruit drinks are quite suitable. Perhaps, fruit drinks will be even healthier than ordinary water, because in addition to the main function of washing the bladder, such drinks saturate the body with vitamins and nutrients.

NEED TO KNOW!

During the rehabilitation period, you should not get carried away with drinks containing a high concentration of sugars. Preference should be given to natural freshly squeezed juices, weak green tea and natural mineral water with an average and low concentration of minerals and salts.

Removing the catheter

Adenoma of the prostate (surgery) is not complete without the postoperative period, in particular - without drainage and installation of a catheter. Removal of the catheter depends on the success and severity of the manipulation, on the general health of the person, as well as on what type of manipulation was carried out.

For example, after the catheter is removed at least one and a half to two days, and a maximum of four. The drain tube, if installed, is removed after about two and a half weeks.

Rehabilitation after surgery

Any type of BPH surgery involves a complete and complete recovery in a period from several days to several weeks. In any case, after removal of the catheter, normal urination is not immediately restored. For several more weeks there is a problem of blood clots in the urine and a change in its color.

ON A NOTE!

Full recovery of health occurs within one and a half to two months. In this case, after removal of the catheter, clots or blood elements are present in the man's urine.

If the discharge of blood together with urine in the postoperative period changes from the format of fragments and partial presence to the format of bleeding, even without pain symptoms or with mild pain symptoms, you should immediately and urgently seek help.

What not to do after surgery

• after surgery, it is unacceptable to take any alcoholic beverages, especially if antibiotic therapy has been prescribed;
• return to sexual activity in the absence of additional recommendations occurs in a period from one month to one and a half months. Prostate adenoma surgery is not a reason to give up sex.

CAUTION!

If a man plans to have children after the operation, then this issue should be discussed before the manipulation, since the side effects after it may include the absence of ejaculation. That is, after the onset of orgasm, sperm will enter the bladder, which will make conception impossible.

Potential consequences of prostate removal surgery

In extremely rare cases, when contacting non-professional specialists after surgery, the following complications are possible:

• bleeding;
• damage to the bladder;
• infection;
• relapse of enlargement;
• retrograde ejaculation (described above).

Operation price in Russia, Ukraine, Belarus

Adenoma of the prostate (namely, the cost of an operation to remove it) in all central cities of Russia costs about 150 thousand rubles. The cost may vary depending on the type of manipulation, prices for tests and the cost of consulting doctors.

• A TOUR in Russia will cost about 50 thousand rubles, an abdominal prostatectomy - from 55. Laser surgery is 10,000 rubles less.

As for the price of an operation to remove the prostate in Ukraine, in particular in Kiev and Kharkov, then

• laser surgery will cost no less than UAH 74,744.
• TOUR: from approximately 15 thousand hryvnia.
• laser vaporization: about 30 thousand hryvnia.
• prostatectomy: from about 27 thousand or more.

The cost for the removal of prostate adenoma in Minsk will be:

• Laparoscopic prostatectomy costs approximately 40,587,710 Belarusian rubles.
• TOUR approximately 13 529 236 rubles (Belarusian).
• Radical prostatectomy approximately 14 882 160 rubles (Belarusian).
• Laser vaporization approximately 10 823 389 rubles (Belarusian).

Any operation performed to remove prostate adenoma has a number of indications for its performance. In addition, the type of surgical intervention performed is recommended to the patient on an individual basis and agreed with him. Before the operation, the patient is also familiarized with possible complications. After removal of the tumor, the person who underwent the operation receives a number of recommendations.

Indications for surgery

The operation to remove the developed prostate adenoma can be carried out both according to planned indications and in emergency cases.

Planned surgery is prescribed for those patients who have the following symptoms:

• violation of the outflow of urine;
• inflammation of the bladder and kidneys;
• stones in the ureter;
• renal failure;
• the appearance of erythrocytes in the urine.

Emergency surgical interventions are carried out for the following indications:

• an increase in prostate tissue and developed against this background urinary retention with severe cutting pains in the groin area;
• heavy bleeding.

Adenomectomy

Refers to the most traumatic surgical methods. It can be performed by the transvesical, transurethral (TUR) or retropubic method.

In the groin area above the bosom, an incision is made through which one gains access to the anterior wall of the bladder. With the help of catgut threads, adenomatous nodes are removed through the walls of the bladder, while the prostate itself is not affected.

After the manipulations, the bleeding incision is fixed with a tampon, which is removed for 3 days. The patient may experience urinary incontinence for 2 to 4 months.

To stop bleeding in this method, a volumetric hemostatic catgut ligature is often used. For this, a good view of the adenoma bed and the ureteral passage is created. A catheter is inserted into the bladder transurethrally, which supplies the diseased organ with drugs and removes hemorrhagic clots.

The bladder enters the cystoma for 9 to 11 days. During this time, a healthy urination process is fully restored.

A possible complication after surgery may be a decrease in potency.

Transurethral resection

The operation is most effective with small volumes of adenoma, and it is also indicated for the development of middle lobe syndrome. Transurethral resection is performed without external incisions using a 7.6 mm resectoscope. With this tool, the urologist gains access to the bladder through the urethra. The entire diseased area is examined using the displayed screen and the procedure for removing prostate adenoma is performed using a special loop.

Good visibility of the urinary tract is ensured by the continuous flow of fluid through one channel of the resectoscope and its outflow through the other channel. Transurethral resection is performed within 1 hour. The indications for the operation are the size of the tumor up to 80 ml.

After removing the resectoscope, a Foley catheter is inserted into the bladder, which is equipped with an inflatable balloon. This balloon is filled with a special fluid that takes the place of the removed adenoma. In the postoperative period, the Faley catheter makes regular irrigation, preventing blood clots from blocking the channel for the outflow of fluid. In addition, this device provides peace of mind in the surgical area. On day 4, the catheter is removed.

Urination is restored, but for some time there may be cramps during emptying and a pale pink color of urine.

Laser removal method

Laser ablation

It is carried out by burning the tumor. The urethra is relieved of pressure and urinary function is restored. Laser ablation is divided into the following types:

1. Photosensitive laser vaporization. The tumor is evaporated from the body using endoscopic equipment. Indications for surgery: the size of the gland should be no more than 30 cc. This surgery is recommended for younger men.
2. Holmiyevo - laser ablation. The holmium laser is used, which performs contact laser resection.

Laser enucleation

The tumor is removed with minimal risk of postoperative complications. It can be used to extract large neoplasms. There are 2 types of laser enucleation:

1. Holmiyevo - laser resection. The laser is inserted into the penis and the tumor is removed in small pieces. The procedure is rarely carried out as it is outdated.
2. Holmiyevo - laser enucleation. Shreds tumors of all sizes. It is performed by highly qualified specialists in the largest clinics.

Interstitial laser coagulation

A laser is inserted through the punctures of the bladder mucosa. Atrophy of the infected tissue occurs.

The use of a laser stops the development of the disease, reduces pain symptoms, and regulates the urge to urinate. The laser method is the most gentle in comparison with other types of surgical intervention. In addition, after it is carried out, men retain their sexual function, and a return to their usual life is possible within 2 days after the procedure.

The only drawback of laser intervention is the expensive equipment for its implementation.

Any type of surgical intervention to remove prostate adenoma is aimed at restoring the outflow of urine and preventing various complications. The method of the operation is chosen strictly according to the recommendations of the attending physician after completing the full course of examination. Modern methods of operative actions have a minimal effect on the body. The patient returns to normal quickly enough, and the functions of the genitourinary system are fully restored in a short period of time.