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Blood in urine after prostate adenoma tour


Blood In Urine After Prostate Adenoma Tour

Blood in urine after prostate adenoma tour



Transurethral resection of the prostate: what is it?


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The most effective and popular operation for increasing the size of the prostate, during which its complete or partial removal is performed, is transurethral resection of the prostate (TURP). The main indication for this operation is benign prostatic hyperplasia (adenoma), in the case when the volume of the prostate does not exceed 60-80 cm3.


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Indications and contraindications for this procedure


The most common TUR of the prostate is performed for benign neoplasms, cancer and chronic inflammatory processes.


The main indications for this operation:



  • signs of significant or moderate bladder obstruction preventing normal urine flow;
  • renal failure developing against the background of obstruction of the outflow of urine;
  • persistent hematuria (blood in the urine);
  • constant, aching pain;
  • heaviness in the perineum and a feeling of fullness of the bladder with false urge to urinate.

Contraindications to this operation can be any general contraindications to surgical interventions (cardiovascular diseases in the stage of decompensation, the patient's serious condition, disorders in the blood coagulation system).


Transurethral resection of the prostate is not performed in case of acute diseases of the genitourinary system, as well as in the absence of access to the surgical field (diseases of the hip joints, limitation of the possibility of inserting instruments into the bladder).



Operation progress


The preparation for this operation is no different from the preparation for any other surgical intervention. A week before it, you should stop taking all drugs that affect the properties of the blood. On the day of the operation, the patient must refrain from eating. Medication preparation consists in prescribing sedatives to the patient on the evening before the operation.


Depending on the age, health status and wishes of the patient, surgery can be performed under general or spinal anesthesia. The patient is on the operating table in the supine position, with legs raised and spread apart.


TURP of the prostate is an endoscopic operation performed with a special instrument called a resectoscope under visual control. The doctor inserts it into the bladder through the urethra. After examining the area in which the prostate gland is located, the doctor gradually removes the prostate tissue using a loop.


When performing TUR of prostate adenoma, its tissues are removed until the gland tissue itself becomes visible. With prostate cancer, the gland can be removed almost completely.


Since this surgical procedure is performed solely under visual control, it is necessary to ensure good visibility of the surgical area. To do this, one of the channels of the resectoscope provides a constant flow of fluid, and the other - its outflow, thus there is a continuous washing of the bladder.


When performing TURP, bleeding from the vessels surrounding the prostate may occur. The stop of which is carried out by electrocoagulation of damaged vessels. After the prostate gland is partially or completely removed, it is necessary to evacuate its resected parts from the bladder.


After cleaning the cavity, a thorough control examination of the surgical field is performed. If necessary, bleeding from the vessels additionally stops.


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Given that there is a rather thick instrument in the urethra, as well as constant washing of the bladder and electric current, they try to limit the duration of the operation. It is desirable that the manipulation last no more than 1 hour.


After all the manipulations are completed, the resectoscope is removed, and a special catheter is inserted into the bladder through the urethra, which is fixed in the bladder, thanks to the inflating balloon at its end.



Early postoperative period


After the TUR of Prostate adenoma, the catheter is left in the urethra for several days.Due to the fact that it has 3 channels, it is possible to provide constant washing of the bladder according to the "inflow-outflow" principle. This allows for constant irrigation of the bladder cavity, which prevents the formation of blood clots, which can prevent the outflow of fluid through the canal.


Since a constant outflow of urine and flushing fluid passes through the catheter, the bladder is in a collapsed state, which ensures peace in the area where the operation was performed.


The duration and intensity of washing the bladder cavity can be different. The doctor determines the time the catheter is in the bladder based on the intensity of blood staining of the flowing fluid. Usually the catheter is removed from the urethra 2-4 days after the operation.


After the catheter is removed, patients urinate on their own, but may experience discomfort during urination. It is also possible to retain an admixture of blood in the urine. These phenomena are not complications after surgery and quickly disappear. It is impossible to delay urination for a long time, since an overflow of the bladder can provoke bleeding due to overstretching of the surgical area.



Late postoperative period


After removing the catheter from the urethra, the patient is discharged from the hospital. Be sure to prescribe a course of antibiotic therapy and anti-inflammatory drugs. Within a month after the operation, it is recommended to exclude sexual activity and limit heavy physical activity.


The rhythm of urination is usually restored within 3 months. Almost all men who underwent transurethral resection of prostate adenoma develop retrograde ejaculation, in which during ejaculation, seminal fluid is thrown into the cavity of the bladder, and not thrown out. Retrograde ejaculation is a natural result of the operation, and not a complication.



Possible complications


Unfortunately, in 10% of cases, complications may develop, both during the operation and in the postoperative period. One of the most serious complications is the development of massive bleeding. Its cause may be damage to one of the large vessels that could not be seen in the prostate tissue. In severe cases, a blood transfusion may be needed.


During surgery, as well as in the postoperative period, the syndrome of "water intoxication" may occur, the development of which is associated with the ingress of washing fluid through the opened lumen of the vessel into the bloodstream.


Within a few days after the operation, bleeding from the surgical wound may develop as a result of the discharge of a blood clot from the coagulated vessel. Usually, this complication does not require additional surgical interventions, conservative treatment with hemostatic drugs and intensive bladder lavage is sufficient.


It is very rare that infectious and inflammatory processes develop, such as acute prostatitis, acute inflammatory process in the testicles and appendages, acute pyelonephritis. To treat such complications, intensive antibiotic therapy is prescribed.


One of the most common complications of the late postoperative period after TURP is the occurrence of narrowing of the urethra and sclerosis of the bladder neck. To treat such complications, a second endoscopic operation is necessary.


In case of oncological diseases of the prostate gland, transurethral resection is performed quite often, however, in this case, the operation is symptomatic and does not cure the underlying disease. TUR for prostate cancer is aimed at restoring urination, but it should be remembered that this surgical intervention can cause tumor metastasis.


Despite the possible risk of complications, transurethral resection of the prostate is the "gold standard" in the treatment of patients diagnosed with BPH. Thanks to modern technologies used for this operation, the patient can return to a full life within a week after it.


Prostate adenoma is a benign neoplasm caused by hyperplasia of prostate tissue. Conservative treatment usually does not work, and the symptoms continue to increase. Against this background, doctors prescribe a radical method of treatment - removal of a prostate tumor. The choice of method for removing prostate adenoma depends on the patient's age, clinical and life history, the presence of concomitant infectious diseases of the prostate and pelvic organs.


To prevent complications in the postoperative period, patients must strictly follow all the doctor's recommendations. After surgery, a rehabilitation period follows, which differs in duration depending on the type of surgical treatment.



The main types of operations for prostate adenoma


There are three main surgical methods that underlie the radical treatment of prostate adenoma:


Transurethral resection (abbreviation TUR). Surgery involves the introduction of an optical device to the tumor through the urethral canal. The intervention is performed under general anesthesia. Next, the tumor is excised and scraped out, while the remains are abundantly washed out with saline solutions. Among the disadvantages are the risks of internal bleeding, the formation of blood clots along the Foley catheter. Adenomectomy. The type of intervention refers to abdominal surgery. Surgical access is carried out through a transverse incision in the lower abdomen or perineum. After manipulation, the functionality of the glandular structures of the prostate is preserved. The main advantage is good visualization, which allows you to reliably assess the degree of damage to neighboring organs. There are several more disadvantages of the operation: a long recovery, the risk of infection and the development of long-term postoperative complications. Laser resection. A gentle method of removing prostate adenoma, carried out under local or epidural anesthesia. Under the influence of a laser needle, the tumor is burned out, and the blood vessels are sealed. After the operation, the risks of complications are reduced, rapid recovery. The main disadvantage is the high cost of the operation. The golden mean in the removal of prostate adenoma is transurethral resection.



Possible complications


After each type of surgical intervention, early postoperative complications are more likely to occur. Only 1-2% of men are diagnosed with long-term consequences of the operation. The main complications are:


Difficulty emptying the bladder. In the first days, patients feel pain during urination, which disappears on its own, 3-5 days after the operation. urinary incontinence. Occurs with weakened muscle tone. Discomfort when urinating. If the condition is not resolved a few days after the operation, then there may be a technical error of the surgeon. Retrograde ejaculation. Ejaculation does not occur outside, but into the bladder. Pathology is eliminated by a second operation. Surgery to remove an enlarged prostate can impair erectile function. In this case, type 5 phosphodiesterase inhibitors (vardenafil, tadalafil, etc.) are prescribed, it is not worth spending time and money on treatment with various dietary supplements. Prognostic criteria completely depend on the severity of the pathological tumor in the prostate gland, the patient's age, urological history.



Rehabilitation period


The main objective of the rehabilitation program, regardless of the type of surgical method chosen, is aimed at preventing early and late complications. The duration of recovery depends on the duration of preparation for the intervention, on the type of operation chosen. With abdominal operations, recovery is always long and difficult. Laparoscopic methods imply a much shorter rehabilitation period. There are 3 main periods.



Early postoperative period


After any type of surgery, including TUR, a catheterization procedure (insertion of a Foley catheter into the bladder) is performed. The measure is necessary to create compression and disinfection of the bladder, as well as to remove urine


Drugs are administered intravenously to normalize the functioning of the heart and lungs. A ventilator and inhalers may be used. After surgery, patients experience severe discomfort in the lower abdomen. The drainage system is acutely felt, the urge to urinate, any movement causes pain, so painkillers are prescribed for the first 2 days after the operation.


After 2-3 hours after the intervention, drinking is allowed. On the first day, it is allowed to drink 1.5 liters of water. In the next 3-4 days, the volume of drinking is adjusted to 2 liters (in the absence of renal failure). If the first day passed easily for the patient, then on the 2nd day you can eat, you are allowed to get up. Depending on the general condition of the patient, the duration of the first stage of recovery lasts from 2 to 10 days.



Inpatient recovery


In the best case, after the operation, the catheter is removed for 2-3 days and the patient is transferred to the general ward. For special indications (old age, aggravated clinical history), patients can be catheterized for up to 7 days and stay in the intensive care unit until their condition stabilizes.


Patients are prescribed antibiotics and uroseptic preparations for the sanitation of urine and urinary tract. Daily urine tests, blood tests every other day. It is important to determine the degree of recovery of the body. Normally, the appearance of blood clots in the urine is considered, which characterizes the normal healing of the wound. Usually the blood in the urine stops for 5-7 days of the patient's stay in the hospital. On average, an extract from the urological department of the hospital occurs on the 14th day.



Late rehabilitation period


Patients are discharged from the hospital with the doctor's recommendations. The main instructions of the specialist is the correct behavior in the following aspects of everyday life:


Physical effort. It is unacceptable to lift weights, run, play sports. It is enough to walk with acceleration through the park, forest, street. Sex life. Sex remains banned for 4-8 weeks. Excitation can lead to internal bleeding and increase the risk of wound infection (important for TUR surgery, abdominal resection). Ration and diet. It is important to consume as much fiber as possible to lighten the stool, remove toxins and toxins from the body. Stool disorders may cause suture separation after complete adenomectomy or after TUR. hygiene procedures. It is unacceptable to visit the bath, sauna, hot bath. The best option is a daily visit to a warm shower. Any recovery involves maintaining a healthy lifestyle. So, you should limit smoking or reduce the number of cigarettes smoked per day. Alcohol is prohibited.


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After the operation, the patient is given a sick leave. A man should recover at home, without much physical strain. Throughout the recovery period, it is important to carry out adequate physical activity (preferably therapeutic exercises). A month after the treatment, you can visit the pool, excluding open water.


An operation to remove prostate adenoma, performed by any method, is a serious surgical intervention. Non-compliance with the doctor's medical recommendations can lead to serious consequences: bleeding, secondary infections, suture divergence, the need for re-intervention. In severe cases, a significant decrease in erectile function is possible.



Complications after prostate adenoma surgery


Prostate adenoma is a common "male" disease, usually requiring surgical treatment. The operation consists in removing one or more seals (nodes) that form in the prostate gland. This is an age-related disease, most often diagnosed in men aged 55 and older.


The main goal of surgery is to restore the normal process of urination, reproductive function, as well as the patient's immune system.


Currently, there are several types of surgical intervention used to remove a benign tumor:



Possible consequences of the operation to eliminate prostate adenoma


The choice of a specific method for the treatment of prostate adenoma depends on the general condition of the patient, the stage of development of the disease, etc. At the same time, like any surgical intervention, an operation to remove a benign tumor, despite its obvious effectiveness, entails certain consequences.



What are the complications after TUR of prostate adenoma and how to avoid them?


Prostate adenoma is a disease that significantly affects the quality of life of men of different ages. Complications of adenoma often require urgent surgical procedures.


In this case, the urethra is compressed, and disturbances occur in the process of urination. The least traumatic of all surgical methods for getting rid of the disease is transurethral resection.



What is transurethral resection (TUR) of the prostate and bladder?


Transurethral resection (TUR) is a surgical urological technique that is used to remove the prostate gland, as well as tumors, neoplasms inside the bladder.


This is done by introducing special medical instruments into the body of a man through the urethra (urethra).


Transurethral resection of the prostate


Before surgery, it is required to undergo a complete diagnosis, as well as be examined by an anesthesiologist, a general practitioner (to identify concomitant abnormalities). If there are contraindications, inoperability of the neoplasm, the doctor resorts to other methods of treatment.


TUR is the oldest minimally invasive operation in the history of medicine. The most important aspect of this procedure is anesthesia. Minimal invasiveness allows for surgical intervention under epidural or spinal anesthesia. In this case, endotracheal anesthesia is not used.


The essence of the method is the elimination of hyperplastic tissue due to the use of high frequency current.


For this, a special instrument is used (a resectoscope is inserted into the urethra). Modern devices are equipped with special monitors. Due to this, surgeons observe the picture of the surgical field through a special resectoscope on the screen.


Thanks to this effect, there is no severe blood loss, and damage to the organ is minimized. After the operation, a catheter is placed in the urethra for several days. The patient's urination process is soon restored, it becomes painless.



Complications occurring within a month after TUR of prostate adenoma


Already after a short period of time, patients feel satisfactory.


They easily return to active life. However, in some cases, complications appear after the procedure. The most common negative manifestations will be listed below.



High Temperature


In any surgical intervention, the patient may experience inflammation. Accordingly, after the TUR, body temperature may also increase.


Therefore, before the surgical intervention, a blood test is performed, as well as urine. This is necessary to exclude inflammatory changes.


After surgery, broad-spectrum antibiotics are often prescribed. Their use is carried out for 5-7 days.



Flakes, blood in urine


The appearance of flakes, scarlet blood in the urine after removal of a tumor in the prostate gland is not a pathology. Over time, the blood impurity in the blood will decrease.


For most men, this manifestation is a major psychological problem.


Anxiety after TUR should be raised when the amount of blood in the urine does not decrease with time, but rather increases.


Such a manifestation indicates the course of a dangerous process. In this case, immediate treatment of the patient in a hospital is necessary.



Incontinence


After TURP, urinary incontinence is associated with damage to the sphincter.


Such a symptom after this surgical intervention occurs in most cases due to the use of a monopolar resectoscope. "Plasma" or biopolar make it possible to do without this complication in practice.


You can get rid of urinary incontinence after TURP by performing special Kegel exercises designed specifically for men. However, it is important to remember that such loads can be performed no earlier than 2-3 weeks after the operation.



Problems with potency


Sexual dysfunction after TUR is often associated with damage to certain nerve endings. As a rule, complications are temporary, they disappear after the completion of the recovery process.


Retrograde ejaculation is a fairly common complication that occurs after TUR.


In this case, the sperm begins to enter the bladder. Ejaculation (retrograde) does not pose any danger to the patient's health. However, after completion of rehabilitation, the patient may experience infertility.



Urine stream decreased


After surgery, internal tissues may increase in size.


For this reason, the urethra is squeezed. Ultimately, the outflow of urine becomes more difficult. The process of urination causes discomfort, requires additional efforts from the man.


This may cause frequent urges, especially at night. Because of this, the quality of life begins to decline significantly.



Bleeding


Accordingly, this leads to damage to the capillaries, blood vessels, which causes blood loss.


However, plasmokinetic, biopolar types of intervention simultaneously with the cutting process allow coagulation of blood vessels. This helps specialists manage without bleeding.


At the same time, damaged tissues, all parts of malignant neoplasms are completely removed.



Chronic consequences of prostate surgery


After the TURP, chronic inflammatory diseases of the male genital area may occur.


In the process of conducting adequate therapy with the use of antibacterial agents (Floracid, Suprax), such deviations are perfectly treatable.



What to do?


If acute, chronic consequences occur after the TURP, it is necessary to consult a doctor as soon as possible. The specialist will conduct an examination, if necessary, prescribe the most appropriate course of treatment.



Prevention of complications after surgery


It takes a long time to recover quickly after TUR.


Experts recommend excluding sexual contact, eating fatty foods, and physical activity.


At the same time, the patient must be regularly examined by the attending doctor.


Thanks to this, it will be possible to control the general condition of the body, as well as prevent the recurrence of the development of a benign or malignant tumor.Further medication-based therapy depends on the histological diagnosis and test results.



Related video


Complications after TUR in the video:



How should rehabilitation proceed after TUR of prostate adenoma?


Restoring men's health, especially after TUR of prostate adenoma, requires a serious approach and takes a lot of time. But, unfortunately, without this it is impossible to restore your male power. The result of even the most unique prostate surgery will not be satisfactory if recovery measures are stopped immediately after discharge from the hospital.


More than half of men over the age of 45 experience some form of prostate disease, and prostate adenoma is considered the most common of them. This is a benign growth of adenomatous (glandular) tissue that is not life-threatening, but causes a lot of trouble with urination and sexual function. The gland is located under the bladder and covers the urethra. Increasing in size, it compresses the urinary tract in a man, provoking the development of such pathologies as:



  • Cystitis
  • Urolithiasis,
  • Hematuria
  • Orchiepididymitis,
  • The threat of cancer.

More than a hundred years, in 1909, transurethral resection was developed, a low-traumatic technique for removing prostate tumors. TURN is in progress.


Prostate adenoma today with all modern technologies. The technique of the operation has been brought to the highest level. But, as after any surgical intervention, the recovery period after its completion is of great importance.


The time for a patient after TUR of adenoma can be divided into two important periods, these are:


Compliance with all the measures that the doctor prescribed after the operation was performed will help you forget about the disease forever.



Transurethral resection of adenoma and indications for its implementation


Benign tumors, which include adenoma, do not spread to other tissues, and their cells cannot travel with the bloodstream or through the lymphatic system, since the growth is enclosed in a membrane. But, an increase in the volume of pathological tissue of prostate adenoma squeezes nearby organs, which causes some harm. In addition, the degeneration of tumor cells into malignant tissues is not excluded.


Prostate adenoma is a rather insidious disease. The tumor can grow for a long period without showing itself. And when men begin to feel the first symptoms, the adenoma can reach a large size.


One of the radical methods of treatment is the operation of TUR for prostate adenoma, which is effective at almost any stage of the disease.



Indications for surgery


Indications for the appointment of surgical intervention are such factors as:



  • Significant increase in urge to urinate;
  • Problems emptying the bladder completely;
  • Forced straining when urinating;
  • Slow bladder emptying or intermittent urine stream;
  • Painful urination;
  • Frequent bladder and urinary tract infections;
  • Sexual dysfunction;
  • Stones in the bladder or prostate;
  • Signs of kidney failure or other kidney pathology;


Features of transurethral resection


The operation is performed under spinal or general anesthesia. During surgery, it includes such steps as:



  • Introduction of the resectoscope through the urethra to the base of the prostate;
  • Excision of tumor tissues with simultaneous coagulation of vessels;
  • Removal of cut tissues;
  • Installation of a urinary catheter into the cavity of the bladder.

The TUR adenoma operation, thanks to modern improvements and high-tech equipment, is the gold standard in the treatment of prostate tumors. During the operation, the patient's body does not inflict any unnecessary injuries, and the risk of complications is minimized.


But, nevertheless, no one is immune from the occurrence of complications.



Possible complications after surgery


After the operation was completed, the man's body is weakened, and naturally defenseless against negative external factors. This is the most responsible time, when the slightest mistake or oversight can lead to undesirable consequences.


The following conditions are considered to be the next complications after the operation:



Internal bleeding


After removal of prostate adenoma by transurethral resection, bleeding occurs mainly due to the individual characteristics of the patient's body.During the operation itself, all dissected vessels are coagulated, but the possibility of incomplete cauterization is not ruled out, which, against the background of low blood clotting, will lead to bleeding in the postoperative period.


Symptoms of bleeding appear in the very first days after the operation, while the patient is under the supervision of medical staff, so the relief of the condition is performed by a doctor or nurse at his direction. Usually, intravenous administration of aminocaproic acid or infusion of the same drug through a catheter is sufficient.



Infectious inflammation


If the medical staff violates the rules of asepsis and antisepsis or the patient violates the doctor's recommendations, an outbreak of nosocomial infection may occur. These are quite rare cases in the conditions of modern medicine, but they cannot be completely ruled out yet.


Long-term complications in the period after TUR of adenoma, that is, problems that may not arise immediately after the operation of prostate adenoma, but after discharge from the hospital, are:



Problems with urination


Significant increase in the flow of urine flowing from the bladder, false urge to urinate, pain when urinating, streaks of blood in the urine. Restoring normal mode takes some time, it may take some time even after discharge. In fact, this condition cannot be considered a complication. After TUR adenoma, when there is a surgical wound on the body of the prostate, and the muscles are spasmodic, it is quite natural that a man experiences slight pain during urination, because the flow of urine, flowing from the bladder, affects the damaged tissues of the prostate gland.


The appearance of blood clots in the urine stream is explained by the rejection of dead cells after the resection has been performed. This is neither a complication nor a pathology. Treatment for the patient in this situation is not required. The condition normalizes on its own, when a little time passes - the tissues will recover.



Incontinence


Before the patient underwent surgery to remove the adenoma, the bladder muscles worked in an enhanced mode. In the postoperative period and the first time of recovery at home, cases of urinary incontinence are quite possible until the tissues of the bladder return to normal.



Scarlet blood in urine


The appearance of an admixture of scarlet blood in the urine after removal of a prostate tumor is not a pathology. Gradually, the admixture of blood will decrease, and the patient will forget that she was. For a man, this is more of a psychological problem. Not many people can remain psychologically calm, seeing blood in the urine, even knowing that they recently had an operation.


Anxiety after TUR of adenoma should be raised when the admixture of blood does not decrease, but increases every day. This is an indicator of such a dangerous complication as bleeding after surgery, requiring immediate treatment in a hospital.



Postoperative period in the hospital


After the prostate adenoma has been removed, the patient undergoes conservative treatment in the hospital, the scheme of which is prescribed by the attending surgeon - urologist individually. The speed of recovery depends on many treatment factors, and above all on the patient himself.


In the first days of recovery after removal of prostate adenoma, antibiotic therapy is mandatory to eliminate the risk of secondary infection and possible inflammation.


The wound surface is irrigated with an antiseptic solution through a urinary catheter. This helps to quickly flush the cavity from blood clots and residual urine, as well as locally act on the focus if an infection has been introduced.


A urinary catheter in a man's canal may be left for several hours or several days. It all depends on the course of the operation, the general condition of the patient, the effectiveness of the treatment and the nature of the discharge. The length of stay in the hospital after the operation of each man is also determined individually



Recommendations before discharge


Before discharge, the doctor conducts a conversation with each patient, giving detailed recommendations and explaining the need for their implementation. Standard instructions contain tips such as:



  • Hard physical labor is prohibited for 2 months. You can’t play professional sports, and at work you need to temporarily switch to light work.
  • Sexual life can be resumed after a month after TUR of adenoma.
  • It is wise to alternate physical activity and rest.
  • Stick to the prescribed diet.
  • It is obligatory to come to the control examination at the agreed time.


Features of home recovery


The first months after discharge from the hospital, a man needs to behave very carefully. It is categorically impossible to lift weights exceeding 3 kg in weight, no matter how much the family asks him to do so.In addition, it is important not to make sudden movements, as this can lead to trauma to the postoperative wound and the occurrence of complications.


Removal of an adenoma, even with such a low-traumatic method as a TUR operation, requires compliance with a careful behavioral regimen for at least 2 - 2.5 months after discharge from the hospital.



  • Drink as much liquid as possible per day. The most useful are natural juices, mineral, non-carbonated waters. And it is better to temporarily refuse strong tea or coffee.
  • Try not to push while having a bowel movement. This can be facilitated by a nutritionist by prescribing a special diet.
  • You must refrain from riding a bicycle or driving a personal vehicle. But you need to walk as much as possible, this contributes to the restoration of all functions and the speedy regeneration of tissues.
  • Never allow hypothermia.
  • Regularly undergo a professional examination by a urologist to avoid recurrence of the disease.

The ideal option would be sanatorium treatment for the entire recovery period. This will help to avoid many difficult situations, including a psychological state.



In conclusion


The main problem of most men is false shyness and fear of surgery. As a result, many people come to the doctor at the stage of extreme neglect of the disease, when the issue can be radically resolved only with a strip operation.


Remember that a timely appeal to a specialist will save you from many unnecessary problems and will allow you to prolong male activity for a long time.