Radical methods of surgical interventions for removal of prostatic adenoma recede into the background, and they are replaced by new types of operations with different methods of conducting them.
Types of operation
There are three modifications of surgical procedures for prostatic adenoma, which differ between the initial access and the technique of conducting the operation:
- Overdose adenomectomy. When carrying out an overbearing adenomectomy, access to the gland is made through the lower-median incision from the navel to the pubic joint with the gradual dilution of the muscle layers, the removal of the vessels, penetration into the bladder, and then the prostate gland that is excised is excreted.
- Pelvic adenomectomy. Access is also done by cutting the skin below the navel, in this case the wall of the bladder does not dissect.
- Prostate removal through the urethral canal ( transurethral adenomectomy) is performed under visual control using a diathermic coagulant and endoscope. The endoscope is inserted into the urethra, the excision of the hyperplastic prostate gland is performed. This type of operation is considered the least traumatic.
Indications for adenomectomy
Constant progression in the growth and development of atypical prostate cells can lead to adverse and life-threatening consequences.
There are a number of conditions and symptoms that indicate that adenomectomy is necessary:
- The degree of enlargement of the prostate gland;
- Disorders in the function of accumulation and excretion of urine by the urinary bladder( parameters of urodynamics);
- Frequent difficulties in the process of urination;
- Appearance of residual urine( large amount) due to dysfunction of the muscle-derzor( pushes urine out of the bladder);
- Pathological enlargement of the cavities of the upper parts of the urinary system;
- Involuntary entry of urine from the bladder back into the ureters( reflux);
- Urinary retention( acute or often recurrent);
- Frequent inflammatory diseases of the urinary system( urethritis, cystitis, pyelonephritis);
- Development of deficiency of kidney function( more often there is a chronic form of renal failure).
Contraindications
Surgery for complete resection of the prostate is contraindicated in such cases:
- If any inflammatory process progresses in the body( to be verified through laboratory tests and anamnesis);
- It is impossible to perform an operation in case of decompensation of diabetes mellitus;
- Cardiac pathology( decompensated) is also a direct contraindication for surgery;
- Acute myocardial infarction, thromboembolism and other acute conditions;
- Adenomectomy in history;
- Pathology of the respiratory system( decompensated states);
- Detection of malignancy of the process in the prostate( cancer).
Preparation of
Preparation before operation is performed depending on the presence of concomitant pathology of other organ systems.
In case of malfunctions in the respiratory system, as well as the heart and vascular system, appropriate medications are prescribed to correct the condition.
Progress of the operation
- Overdose adenomectomy. The patient should lie on the operating table with a slightly raised pelvis. Access is made by means of a lower-median incision( longitudinal or transverse).The bladder is first filled with a warm saline solution through the urinary catheter. The wall of the bubble is fixed between the two holders and makes a cut through all the layers. Then examine the cavity of the bladder, find the ureteral anus, the urethral canal. In order to remove the adenoma it is necessary to cut the wall of the bladder in the place passing it into the urethra, this is done with an electric knife. Sometimes it is necessary to insert a finger into the rectum in order to better visualize the prostate. After removal of the prostate gland, her bed is carefully examined, hemostasis is performed, the wound is sutured layer by layer.
- The posterior adenomectomy is performed through the incision below the umbilical area without dissection of the bladder, the prostatic capsule is pierced above and below the intended site of dissection. Then the tissue of the gland is removed by means of scissors or by hand. Excise the prostate neatly without damaging the urethra and bladder, then carry out hemostasis and layer-by-layer wound suturing.
- Transurethral resection of the prostate is to perform resection of hyperplastic gland tissue using diathermic coagulation under the control of an endoscope. Previously, the patient is in the lithotomy position( legs bent at the knees and raised the pelvis).During resection, the prostate tissues are constantly irrigated with physiological saline to cool them. There are several types of transurethral resections of the prostate gland: total, partial, radical. The choice of the type of operation depends on the stage of development of the process and the nature of the cellular composition of the tumor.
Reviews
Michael, 55 years:
After carrying out transurethral removal of adenoma felt improvement, complications and pain disappeared after urination. After the operation, the pain as such was not, very pleased with the result.
Denis, 59 years:
After diagnosing prostate adenoma, I was treated for a long time at home with the help of folk remedies, I did not want to go to surgery. Treatment lasted until the moment when the outflow of urine completely stopped and severe violent pains appeared in the abdomen and genital organ. In an emergency procedure, I underwent surgery and at the moment I feel great!
Postoperative period
After adenomectomy, the patient may experience pain in the area of the operating wound, injecting painkillers are used to ease the condition.
In the urine, the first 3 days there will be blood. A man must be in the hospital for 6-7 days to monitor the condition of the body, the function of the kidneys and bladder, the consistency of the joints.
The next day after the operation, it is recommended to get up on your feet at least several times a day, this is necessary to prevent the formation of adhesions in the pelvic cavity.
Severe physical activity is allowed only after 4-5 weeks.
The video is dedicated to the retarded new adenomectomy: