Surgery for prostate cancer: indications, type of intervention, as a result of

Surgical treatment of BPH is still very actual problem of modern urology. Despite the fact that experts are struggling to reduce the percentage of surgical measures, they still need at least one-third of the patients.

Surgery for BPH is often the only solution that is capable not only gave man a tumor and improve his quality of life, problems with urination, it is often impossible to solve in any other way.

Action

Frequency surgery of the prostate gland is a solid second in urology. At times they lay, struggling with an illness with medication, but conservative treatment gives only a temporary effect, so three out of ten patients are forced to go under the surgeon's knife.

The choice of a particular method of surgical treatment depends on tumor size, patient age, presence of comorbidities, the technical capabilities of the clinic and staff. It is no secret that any invasive procedure is associated with risk of several complications, and their likelihood is only growing, so the indications and contraindications for urology very carefully.

Indications and contraindications for surgery

Indications for surgical removal of the prostate are:

  • A strong narrowing of the urethra, with disruption of the bladder, when the past lingers large amount of urine;
  • Stones in the bladder;
  • Chronic renal failure;
  • Acute urinary retention, repeated several times;
  • Bleeding;
  • Infection and inflammatory changes in the organs of the urogenital system.

In large tumors, when the prostate volume is more than 80 to 100 ml, the presence of multiple bladder stones, structural changes of the bladder wall (diverticula), preference is given to open and the most radical operation – adenomectomy.

If the tumor glands does not exceed 80 ml volume, then you can make a transurethral resection of the adenoma. Because of the strong inflammatory process, the stones, the small adenoma primary endoscopic technique using a laser, electrical current.

Like any surgical treatment, the operation has its contraindications, which include:

Indications and contraindications for surgery
  1. Severe decompensated pathology of the heart and lungs (because of the need for general anesthesia, risk of bleeding);
  2. Acute renal failure;
  3. Acute cystitis, pyelonephritis (after removal of the acute inflammatory effect);
  4. Acute General infectious diseases;
  5. Aneurysm of the aorta and severe atherosclerosis.

It is clear that many of you only can move into the category of relative, because the adenoma which case you need to remove, if available, the patient is called a pre-correction of current violations, which will make future operations safer.

Types of operations for BPH

Depending on the scope and uses are different methods of tumor removal:

  • Open adenomectomy;
  • Transurethral resection;
  • Minimally invasive and endoscopic procedures – laser vaporization, cryosurgery, microwave therapy, etc.

Open adenomectomy

Surgical treatment of the prostate through open surgery, about three decades ago, it was almost the only way to remove the tumor. Today invented many other methods of treatment, but this intervention does not lose its relevance. Indications for surgery include large tumors (more than 80 ml.), related to stones and bladder diverticula, the possibility of malignant transformation of adenoma.

Open adenomectomy occurs through exposure to the bladder, so it is also called abdominal surgery. This intervention requires general anaesthesia, and its possible contraindications to spinal anesthesia.

Action adenomectomy involves several steps:

  1. After treatment with antiseptic solution and shaving the hair, making an incision in the skin and subcutaneous tissue of the abdominal longitudinal and transverse directions (not important and is determined by the doctor's preferences and tactics, adopted in a certain clinic);
  2. After reaching the front wall of the bladder, the latter is dissected, the surgeon to inspect the walls and contents of the subject of rocks, protrusions, tumours;
  3. Finger separation and removal of tumor tissue through the bladder.

The critical step in this operation is the removal of the tumor, compressing the opening of the urethra, which the surgeon performed a finger. Manipulation requires some skill and experience, because the doctor works really blind, focusing only on their tactile sensations.

Upon reaching the index finger to the internal opening of the urethra, the urologist gently tear the mucous membranes and the finger to remove the tumor tissue, which has already pushed himself to the edge of the gland. In order to facilitate the choice of adenoma of the fingers of the other hand introduced, and the anus, the surgeon may move the prostate upward and forward.

Types of operations for BPH

When the tumor is selected, it is removed through the opened bladder, trying to act carefully, not to damage other organs and structures. Got the tumor mass is mandatory to be sent for histological examination.

After surgery early in the season, high probability of bleeding, than any of the known methods can not remove the effect of the intervention. Danger it is not so much the amount of blood loss, such as the formation as a convolution of the blood in the bladder, which can close the outlet and block the urinary secretion.

Prevention of bleeding and obstruction of the bladder to apply continuous irrigation with sterile saline through a tube placed in the cavity of the body. The tube stays in the bladder for about a week, during which it gradually regenerates the damaged tissue and blood vessels, the washing liquid becomes clear, that indicates the end of the bleeding.

The first few days, the patient should empty the bladder at least once an hour to reduce the liquid pressure against the walls of the body and sewn. You can then do it less often – time in half to two hours. The full restoration of the pelvic organs can take up to three months.

The undoubted advantage of the abdominal adenomectomy is considered to be its radical, that is, the complete and irreversible removal of the tumor and its symptoms. High efficiency the patient, in turn, "pay" a long stay in the hospital (up to six weeks in uncomplicated and in case of complications – even longer), is the "experience" of the general anesthesia, the risk of complications in the surgery wound (abscess, bleeding, fistula), the presence of postoperative scar on the anterior wall of the stomach.

Transurethral resection of the

Transurethral resection (TUR) is considered the "gold standard" treatment of benign prostatic hyperplasia. This operation is performed more often, and, however, it is very complicated and also requires many facilities, the skills and jewelry techniques surgeon. TOUR indicated in patients with adenoma, in which the volume of the breast does not exceed 80 ml., and the proposed duration of intervention less than an hour. Large tumors or risk of malignant transformation of the tumor rather open adenomectomy.

The advantages of the TOUR is the lack of stitches and scars, short recovery time and quick improvement in the health of the patient. Among the disadvantages is the impossibility of the removal of large adenomas, and also the need for the clinic complex and expensive equipment, which is able to use a trained and experienced surgeon.

Transurethral resection of the

Nuclear TRANS-urethral removal of the adenoma is the removal of the tumor through the urethra. Surgeon using endoscopic tools (resectoscope) penetrates through the urethra into the bladder, to check it, find the location of the tumor and remove it in a loop.

Surgery duration is limited to hours. This is due to the posture of the patient, that he is lying on his back, legs raised and divorced, as well as the long-term presence of the urethra is fairly large diameter tool, which can later cause pain and bleeding.

The tumor was removed piece by piece, in the form of shavings, until, as shown in the visual field of the parenchyma of the gland. Bladder to date, accumulated a significant amount of liquid floating in his "chips" tumors, which are removed with a special tool.

After removal of the tumor and irrigating the cavity of the bladder, the surgeon again to strengthen without blood vessels that can be coagulated by the electric current. If everything is in order, the resectoscope is removed outside, and into the bladder catheter Foley.

After removal of the catheter, the men reported significant relief, urine moves freely and with a good jet, but the first urination it can be painted a dark color. Don't worry, this is normal and must never happen again. After surgery it is often recommended to urinate, prevent the stretching of the bladder walls, so that it can regenerate the mucous membrane.

Among the gentle methods of treatment of BPH includes laparoscopic removal. It is performed using equipment, introduced into the pelvic cavity through a puncture in the abdomen. Technically, such operations are complex and require penetration into the body, so preference will be given to the TOUR.

Minimally invasive prostate surgery

Minimally invasive methods of treatment successfully developed and implemented in various fields of surgery, including and urology. These are:

  • Microwave thermo therapy;
  • Vaporization via electric current;
  • Electrocoagulation of the tumor;
  • Cryotherapy;
  • Laser ablationem.
Laser vaporization of the prostate

The advantages of mini-invasive treatment is relative safety, fewer complications compared to open surgery, a short rehabilitation period, no need for general anesthesia and the possibility of its application to men, the use of which is contraindicated, in principle, several concomitant diseases (severe heart failure and lung pathology blood clotting, diabetes, hypertension).

In general, these methods can be regarded as common through the urethra without incision of the skin and the possibility of local anesthesia. The only difference is that physical energy, which destroys the tumor, laser, ultrasound, electricity, etc.

Microwave heat treatment has been exposed to tissue-tumors with high-frequency microwaves, which heat up, and destroy. The method can be applied to both transurethral and the introduction of interest-osprey in the rectal mucosa, where the procedure is not damaged.

Vaporization leads to a heating of the fabric, evaporating the liquid from the cells and their destruction. This effect can be achieved by electric current, laser, ultrasound. The procedure is safe and effective.

During cryoablation, on the contrary, the adenoma is destroyed by the action of cold. The standard method is liquid nitrogen. The wall of the urethra during the procedure, warmed, to prevent its damage.

Treatment of BPH by laser is extremely effective and one of the modern ways to get rid of the tumor. The Idea is to provide the tumor tissue with the laser radiation and simultaneous coagulation. Advantages of laser treatment – the speed, security, possibility to use in difficult and elderly patients. Efficiency of laser removal of the prostate comparable to the TOUR, the probability of complications is significantly lower.

Laser vaporization is, as they say, "the last peep" in the field of minimally invasive treatment of BPH. Exposure is performed with the laser emitting green rays, which leads to boiling of water of the cells of the tumor, its evaporation and destruction of the parenchyma of the prostate. Complications of such treatment practically does not occur, and the patient reported rapid improvement in health after the surgery.

Possible effects of surgery for BPH and rehabilitation

No matter how hard the surgeons completely remove the likely complications of radical treatment impossible. Particularly high risk abdominal surgery, it is, after the TOUR, and if endoscopic removal is minimal.

The most common complications after surgery early in the season can be considered:

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

Longer-term effects are developing within the organs of small pelvis. This narrowing (stenosis) of the urethra against the background of a proliferation of connective tissue, disease of the bladder wall at the site of origin of the urethra, sexual dysfunction, urinary incontinence.

To prevent complications, it is important to follow the doctor's recommendations concerning the behavior of immediately after the procedure and later, until the tissue is fully recovered. After surgery you should:

  • Limited physical activity for at least a month;
  • Leave sexual activity for at least one month;
  • To ensure a good drinking regime and timely emptying of the bladder (preferably more often);
  • Give up spicy, spicy, salty foods, alcohol, coffee;
  • Perform daily exercises to improve blood circulation and improve overall tone.

Treatment of adenoma can be expressed in a public hospital, but many patients are opting for paid events. The price really varies depending on the level of the clinic, the equipment and solution.