Adenoma creates trouble urinating, which in neglected form initiates other troubles and complications.
Currently, there is a large selection of surgical techniques, among which you can find a suitable method for each patient, taking into account its characteristics and accompanying problems.
Indications
Surgery refers to the most effective ways to treat prostate adenoma.
The choice of the method of care is done by the specialist and the patient together.
This is due to the fact that the consequences that accompany different types of operations cause some of the patients with adenoma to choose less effective methods, but which allow to preserve the erectile functions. This applies especially to young men.
Obligatory indications for surgical intervention are:
- cases when other methods do not give the desired result;
- severe voiding,
- detection in the bladder of stones,
- during urination in the urinary bladder a significant amount of urine is retained,
- if the pathway catheterization did not improve the condition of the patient with acute urinary retention, the
- disease triggered an infection in the urinary tract area,
- urinary retention,caused by the disease, led to disruption of the kidneys;
- hematuria.
Preliminary examination of
To select the method of treatment the patient is carefully examined.
For this, the following activities are carried out:
- the patient passes urine and blood tests to determine the general condition and possible other health problems;
- method of uroflowmetry observes the degree of disturbance of urine flow,
- the urologist performs rectal examination of the prostate,
- transrectal ultrasound of the gland is the main way of obtaining detailed information about the sizes of adenoma and other features of the pathology;
- PSA level determination is a method that clarifies the possibility of oncology presence.
Types of surgical treatment
Various methods of surgical intervention to remove prostatic adenoma are used:
- traditional method - open surgery( adenomectomy),
- transurethral resection,
- laser vaporization,
- transurethral incision,
- arterial embolization,
- laparoscopic operation,
- enucleation of prostatic adenoma.
Transurethral resection( TOUR)
This is one of the most commonly used methods of helping patients with prostate adenoma. For the purpose of conducting transurethral resection, the indications are:
- , the volume of the prostate is up to eighty milliliters, the
- surgeon predicts the duration of the operation for not more than an hour.
A resectoscope passes through the ureter to the site of the operation. The excision of tissues occurs with the use of diathermocoagulation.
The areas to be removed are exposed to high temperatures. In the place of work resectoscope make irrigation of tissues, with a view to their cooling.
Video about TOUR surgery for prostate adenoma:
An operation similar to this, but when tissue removal is not performed, but a dissection of the prostate is done at the site of narrowing of the ureter, a transurethral incision is called. This improves the possibility of urine output through the urethra. This procedure is performed in the case of:
- if the prostate has a small volume,
- when the probability of having an oncology is excluded.
Adenomectomy
Even recently, this was the main type of surgery to remove prostatic adenoma. Now such an intervention is recommended, if according to the patient's testimony other ways of removing adenoma are not suitable for him.
Adenomectomy is prescribed in such cases:
- prostate has increased in volume above eighty millimeters,
- in the examination of the patient revealed complicating facts:
- presence in the bladder of stones,
- if there is a need to remove a large diverticulum in the bladder cavity.
The procedure involves cutting the bottom of the abdomen. Depending on the choice of the method of penetration to the prostate, the bladder can also be dissected.
The operation requires high qualification of the surgeon. When the procedure is performed by an experienced professional, one can expect high results of getting rid of the symptoms of the disease.
Laparoscopic removal of
The operation is classified as a number of effective and gentle methods. The equipment gets to the site of adenoma removal through several small incisions in the abdominal region.
The removal of adenoma occurs under the detailed observation of video equipment. From the patient's body, the excised tissues are extracted using an ultrasonic knife adapted for this manipulation. A catheter inserted into the ureter at the end of the operation is displayed on the sixth day after the procedure.
Advantages of the method:
- , low-traumatic,
- minimal blood loss,
- effective.
The method has the advantage over other sparing surgical interventions in that it can be used in cases where the adenoma has reached a large size. Prostate can be increased in volume to more than one hundred cubic centimeters.
Prostatic artery embolization( EAP)
Manipulation of angiographic equipment is performed. The prostate decreases as a result of the overlap of the arterial vessels that it feeds.
Contraindications:
- flotation thrombi, defined in the veins of the legs,
- cases when there are vascular diseases.
When the operation is shown:
- if the patient has additional problems:
- disorders related to blood clotting,
- kidney disease,
- diabetes mellitus in severe form.
The method is used relatively recently. The method is a full-fledged alternative to open surgery, as well as transurethral resection of adenoma.
Laser vaporization
A modern method of helping patients with adenoma, which gives the least complications. It also covers patients who have problems with blood clotting disorders.
The equipment enters the area of the prostate through the ureter. Principle of operation of the method - the laser beam evaporates unwanted tissues. At the same time, blood vessels entering the area of the beam are brewed, preventing bleeding.
Photo-selective vaporization - exposure to a green laser. A laser with a certain wavelength, passed through the crystals of potassium-titanium-phosphate, acquires a green color and the ability to evaporate the tissue.
The progress of the operation is reflected on the monitor. The surgeon sees every action. The use of a green laser is advisable for prostate sizes ranging from sixty to eighty cubic centimeters.
Advantages of the method:
- is low-traumatic,
- effective,
- eliminates the complication accompanying other types of operations - bleeding, sexual disorders;
- the ability to perform manipulation in outpatient settings,
- a short postoperative period,
- can help patients who have diseases that worsen blood clotting.
The method with all the undeniable advantages has such disadvantages:
- the duration of the procedure is twice as long as the TOUR,
- not every clinic has such equipment.
Enucleation of
The procedure involves "vyluschivanie" tissues to be removed by laser. The method successfully replaces transurethral resection and surgical intervention by the open method.
Positive aspects of the method:
- the ability of the extracted tissues to test for oncology, the
- method can be used when the gland grows to 200 g and even more, the
- retains the advantages obtained with tissue vaporization:
- a small recovery period;
- it is possible to carry out the procedure for patients with problems:
- having a pacemaker,
- in case of built-in skeleton of metal devices,
- if violations due to normal blood clotting are detected.
The video shows the laser enucleation of the prostate adenoma:
Contraindications:
- if the patient's bladder is wrinkled,
- severe general condition,
- presence of inflammatory processes,
- inability to pass a resectoscope through the ureter.
Most of the contraindications apply to all types of operations. Impossibility of injecting a resectoscope and a wrinkled bladder are obstacles for surgical interventions that occur with the instrument through the ureter.
Complications of
The negative consequences of transurethral resection include:
- bleeding from injured tissues during surgery,
- getting a fluid that rinses the bladder during manipulation, into the vascular bed of the patient.
The risk of complications increases with the duration of the procedure. Time of operation directly depends on the volume of the prostate.
In the future, the patient may have the consequences of surgery:
- formation in the urethra of the cicatricial narrowing,
- development of the incontinence symptom,
- is a disorder of sexual function.
Two percent of patients seek re-treatment associated with complications. Five percent of patients who have made adenoma removal by this method come for resection.
With open surgery, complications are similar to those of transurethral resection.
After adenomectomy, problems associated with the method are added:
- complications due to the disruption of the integrity of the skin and the walls of the bladder:
- formation of the urinary fistula,
- infection of the wound surfaces,
- urinary leakage,
- prolonged postoperative period - up to ten days.
Rehabilitation after an operation to remove prostatic adenoma
In order to restore the patient after surgery, the specialist specifies the rules of behavior that must be observed:
- salted,
- fried,
- smoked;
Price
| BPH name removal procedure | Cost, rub |
| Transurethral resection | 20900 ÷ 21000 |
| prostatectomy | 16000 ÷ 30600 |
| Embolization of arteries | 180000 |
| Laparoscopic | 125000 ÷ 165000 |
| Laser vaporization | from 55000 |
| enucleation of the adenoma | 66000 ÷ 80000 |
Preparation foroperative treatment
The preparatory measures include:
- communication with an anesthesiologist so that he can decide on the drug for anesthesia;
- reveals possible contraindications for the selected surgical procedure,
- analyzes chronic diseases,
- blood clotting determination,
- biochemical blood test,
- for certain types of operations, a specialist can prescribe antibiotics for prevention on the eve of the procedure,
- on the day of surgeryfood is not accepted.
Postoperative period
Most surgical procedures have such postoperative actions after removal of the prostate adenoma:
- the patient is washed with a bladder,
- is assigned to receive:
- antibiotics,
- analgesics;
- if the operation provided for making incisions on the abdominal wall, then after it the procedures for caring for the sutures are performed.
Reviews
Patients well tolerate all types of operations to remove adenoma.
Note that open interventions are fraught with a more difficult recovery period.
Reviews of the consequences associated with a decrease in sexual function, retrograde ejaculation, urinary incontinence occur both with the open method and with transurethral resection.
Laparoscopic surgery has a small number of consequences. Patients respond that the function to hold urine settles in about six months.
Laser vaporization does not leave unpleasant consequences. Patients talk about improving the functions of urination, while erectile functions seem to have become higher.
Laser enucleation has some consequences. Patients describe a violation in the sexual sphere, bleeding, at first it does not work to hold the function to hold urine, complain that there is ejaculation in the bladder.
How to cure prostate adenoma without surgery?
There are ways that can stop the growth of gland adenoma in the early stages of the disease. The state of health and age of the patient also matters.
- Two types of drugs affect all the mechanisms that worsen the outflow of urine. If the patient's body responds to the effects of drugs, then their use can be effective. Drugs of this action:
- Alpha-blockers help the muscles that are involved in the process of urination to relax. Thus, this function is being adjusted to some extent.
- 5-alpha reductase inhibitors lower the level of a hormone that helps the prostate to increase in size. On some patients, this has a marked effect, and the growth of the adenoma stops.
The action of the tools manifests itself at a low speed. A good result is observed with their integrated application.
- The way to bring your behavior to a healthy lifestyle, including dieting, also finds its admirers.
- Traditional medicine offers a large selection of prescriptions that can improve the condition of a patient with prostate adenoma:
- application of decoctions and herbal infusions,
- eating of raw pumpkin seeds,
- juice therapy,
- treatment of chestnuts,
- application of bee products
- and other methods.
There are several methods of influencing adenoma in order to reduce its volume, which use different types of thermal energy.
Apply minimally invasive methods of treatment:
- Microwave thermotherapy is performed by fixing for an hour in the vicinity of the prostate electrode. Affects cells that need to be removed. The ureter wall is protected from overheating. The intensity of the radiation is controlled by a computer. Applied with a small size of the gland. It is possible in this way to reduce the number of urination.
- Focused ultrasound treatment. It is used more often for patients of a young age. When this method is applied, sexual functions remain.
- Radiofrequency waves are also used to influence prostate adenoma. Among the thermal effects, the microwave method is often used.
- Cryotherapy - the tissues are exposed to low temperatures. Possible application of the method with a small adenoma.
- Stenting of the urethra is a way to expand the narrowed urethra. A special polymer cylinder is inserted into the lumen, the walls of which have a framework for rigidity. The method due to mechanical action improves urination. Applied together with other methods of assistance.
- Balloon dilatation - a method similar to the previous method, solves without therapeutic effect the problem of difficult urination associated with constriction of the ureter. The dilatation of the lumen provides a canister, which is opened in a fixed place. Enter the device with a catheter.
Video about what prostate adenoma and types of operations to remove it: