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Catheter after prostate removal
Catheter after prostate removal
Prostatectomy (memo to the patient)
The cycle of surgical treatment of prostate cancer consists of 4 phases:
3 Urine retention
4 Erectile function
Phase 2: Catheter period
When we have completed phase 1, the healing process begins with phase 2 and during this time you must be diligent in following the techniques that will help you successfully move into the next phase.
Drugs/Prescriptions:
There are 3 appointments you will receive before discharge. One of them is a drug for pain relief (Ketorolac or Diclofenac or Celebrex). Viagra drugs are prescribed to restore erection after surgery and should not be taken if you are taking nitrates for heart disease. If you have heart disease, consult your cardiologist before taking Viagra.
Ciprofloxacin should be taken twice a day until the catheter is removed to prevent infection.
Departure from hospital:
If you drive home from the hospital, stop the car every 45 minutes and walk around the car to prevent blood stasis in your legs.
Diet: You can eat and drink whatever you want. Drinking alcohol in small quantities is acceptable (after the end of taking ciprofloxacin). Adapt your diet to avoid constipation, which is supported by a high fiber intake.
Hygiene: you can take a shower after being discharged.
-Water does not harm the postoperative suture or catheter
-Wear the catheter and urinal fastened to the leg or in a special "pouch" to prevent the bandage from getting wet. It is very important to keep your catheter safe.
If the catheter is removed prematurely, it can lead to permanent urinary incontinence.
MOTION/ACTIVITY:
After you leave the hospital, you should:
-Avoid heavy lifting (more than 5 kg) and vigorous exercise (physical training, tennis, strenuous walking) for 4 weeks after surgery. After that, you can gradually increase your activity level, but do it gradually.
-Do not ride a bike for 8 weeks after surgery.
-Avoid climbing stairs, if necessary, climb slowly.
-Walk frequently during the day (6-8 times) for 5 minutes (as you did in the hospital) while you have your urethral catheter in place. After removal of the urethral catheter, there is no restriction on walking.
-Sit in a reclining position (in a reclining chair, sofa, or comfortable chair with a footrest) while the catheter is in place. In addition to comfort, this serves 2 purposes: 1) It elevates your legs, thus improving drainage from your leg veins, which reduces the chance of blood clots (see below); and 2) It reduces the burden of your weight on the perineum (the space between the scrotum and rectum).
There are no other serious restrictions for you. You can remove the stockings 1 week after the catheter is removed and you can drive your car a few days after the catheter is removed.
PROBLEMS: Please see Appendix 1 to be aware of any problems that may arise during this phase.
Catheter Removal: Your catheter should be removed 10-14 days after surgery.
-On the day of the scheduled removal of the urethral catheter, drink plenty of fluids before arriving at the clinic. On the day of removal, we are only interested in whether you can urinate in a strong stream. Recovery of Urinary retention occurs later (see below).
-If you remove the catheter outside of our clinic, please inform us about it.
-IF YOU HAVE BLOOD ALONG THE CATHETER OR ALONG THE CATHETER 2 DAYS BEFORE THE CATHETER IS REMOVED, CONTACT YOUR DOCTOR, IT MAY BE A SIGN THAT IT IS TOO EARLY TO REMOVE THE CATHETER.
Phase 3: Urinary retention
Return to work: You can work from home when you get home.
-Most patients who work in an office sedentary job return to their work gradually within 2-4 weeks from the moment of surgery.
-If you have a strenuous job (for example, lifting weights), you should wait 4-8 weeks from the time of the operation.
-For those men who move a lot for work, it is advisable to wait 4 weeks before returning from a busy work schedule.
-You can drive a car after the catheter is removed.
-You won't have your "normal" stamina for 3-6 months from the time of surgery, so get back to your activity. Activities that did not cause much effort before the operation will lead to fatigue more quickly and you may need to rest a little during the day.
CONTINUE CONTROL: Control problems are common after catheter removal. Dont be upset!
Continence control returns in 3 phases:
Phase I - you're dry when you lie down at night
Phase II - you are dry when you walk
Phase III - you're dry when you get up from a sitting position
In the early stages, your urine stream may be weak if your bladder is not full because most of your urine flows into the pad so it doesn't fill up enough. You can also use more frequent urination after surgery to increase bladder capacity over time. Every patient is different, so we can't predict when you'll be dry.
-Exercise: To speed up your recovery, interrupt your urine stream every time you urinate. To do this, you must stand up to urinate. To stop your urine stream, tighten the muscles you are tensing to keep gas from escaping. Wear pads or a disposable diaper until retention is fully restored. You can buy diapers or pads at a general store or pharmacy.
-Pads: After regaining continence, it is infrequent that patients continue to wear protective pads for "safety" even when they are not needed. To make sure you don't need pads, experiment without pads when you're at home and not at work. Many patients have a sensation of losing urine, when in fact they find that there is no leakage of urine on the underwear.
-Important points:
Avoid the use of artificial devices: do not wear a urinary retention device such as a penis clamp or condom catheter. If you do this, you won't develop the musculature to control the hold.
Liquid Restriction: Until urinary retention returns, avoid excessive fluid intake. Also, limit your intake of alcohol and caffeine, which can exacerbate the problem. After removing the urethral catheter, limit the liquid to a volume that will be sufficient to satisfy your thirst.
Don't wait until your urine stream is very weak so you don't have to push or squeeze urine out. Contact us if you notice a progressive weakening of the urine stream, in the early stages, a simple expansion of the vesico-urethral junction area can solve the problem.
Phase 4: ERECTION
Erects return gradually (much slower than retention) and continue to improve up to 4 years after surgery. Be patient. As we told you before surgery, the return of sexual function depends on the age of the patient, the extent of the tumor (when the nerves are removed) and the level of sexual function before surgery. Men who have decreased sexual function before surgery are more likely to have erection problems after surgery. Erections return gradually and the quality improves month after month with effort.
Expectations: After surgery, it is important for a man to have realistic expectations for the quality of his erection. At first, the first erections will be partial and not strong enough for penetration. But a partial erection is already a success! Feel free to open a bottle of champagne if you have a partial erection, because with continued effort it will be enough for penetration. For most men, erections do not return to "just like before surgery." In men who regain erections sufficient for sexual intercourse, it is usually difficult to achieve and maintain an erection, and because of this, libido (desire for sexual activity) often decreases.
Tactile more than visual stimulation: erection stimuli will vary during the first year. Visual and psychogenic stimuli will be less effective, and tactile sensitivity will be more effective. Of course, the main stimulus during the first year is tactile sensitivity. For this reason, don't be afraid to experiment with sexual activity - you won't do any harm. When you get a partial erection, try vaginal penetration, many patients report that erections are better maintained when erect than when lying down and vaginal penetration is easier from behind. Lubricating the vagina with a moisturizing gel can be helpful. Vaginal stimulation will be the main factor that maintains further erections. You don't have to wait until you have a "great erection" before you have sexual intercourse. In addition, you must be able to have an orgasm even if you don't have an erection. There will be no ejaculation during orgasm as the prostate and seminal vesicles have been removed.
Turnstile / "erection" rings: when erectile function returns, many patients complain that their erection drops when they try to have intercourse. This is due to venous leakage.This can be overcome by using a soft tourniquet at the base of the penis prior to erotic stimulation. The task of this touriniquet is to leave blood in the penis after it has arrived after stimulation. Do not worry; the tourniquet will not impede blood flow in the penis. Our patients tell us that rubber rings, or "cock rings" (available from erotic stores), work.
Prescribing Medications: Viagra (or another phosphodiesterase-5 inhibitor such as Cialis or Levitra) can be very effective in helping to improve erections during the recovery period. Do not take these drugs if you are taking nitrates for heart disease (coronary heart disease). When you are ready to begin sexual activity, we recommend that you take the 100mg tablet 1-2 hours before sexual activity on an empty stomach. Do not use Viagra more than once a day.
Early Experimentation: It is wise to start experimenting with sexual activity after the removal of the urethral catheter, when you feel ready. Don't expect erections to return to their previous levels - they won't come back without a lot of persistence and tolerance from both partners. Patients who continue to try to induce an erection are more likely to recover Erectile function in the long term. Start experimenting with erection as soon as possible after the catheter is removed and this will increase the likelihood of recovery. If the erection does not return, we will discuss other treatment options with you.
Long-term follow-up: you need to visit an oncourologist 1 month after surgery, then 3 months, 6 months, 9 months and 1 year after surgery. The PSA blood test is the only indicator that should be observed during the first year after the operation.
What should be avoided in the first 100 days after surgery?
-Do not lift more than 5 kg
-Do not make sudden uncontrolled movements (washing windows, hanging curtains, painting walls, etc.)
- Refrain from doing heavy physical work (gardening, playing sports, indoor and outdoor home improvement work, etc.)
-Don't ride a bike
-Do not visit the bath, sauna
-Avoid especially strong stressful situations
-Do not eat or drink salty or spicy foods. You can not drink mint tea, coffee is allowed only in small quantities.
-Before you "preventively" go to the toilet, wait until the bladder is full and pressure is felt
-Do not strain the muscles of the hip joint and buttocks, trying to prevent the exit of urine.
-Avoid overworking with pain or fever.
What can be done to support the healing process?
-Drink a sufficient amount of fluid during the day (2-3 liters), but reduce the amount of fluid intake 2 hours before bedtime (drink depending on the feeling of thirst)
-Go to bed more often, let your body recuperate, relax as often as possible
-Try with each next time to linger for a while with the time of visiting the toilet.
-Regularly, but no more than 3 times a day, do physiotherapy exercises.
-To facilitate the work of the muscles, perform heavy physical work, such as lifting weights, while inhaling.
Exercises to restore bladder contraction after prostatectomy
Exercises to sharpen your own perception of muscles:
-Squeeze the muscle of the anus, pull inward and lock briefly in this position, then relax again
-Slightly tighten the muscle of the bladder (no more effort than is required when urinating), fix for a moment, relax and "listen" to your feelings
Breathing exercises:
-Fold your hands on your stomach, take a deep breath through your nose, to the lower abdomen, slowly exhale through your mouth, releasing the air in a thin stream
Please note:
-Start doing exercises only after removing the catheter
-Exercise daily 3 times a day up to 10 sets at a time, a large load will harm rather than benefit and cause additional stress
-After each muscle tension, take a short break, during which you take a deep breath and exhale several times to relieve tension
-When training the muscles of the bladder, try to measure the efforts and not strain the muscles of the anus and buttocks at the same time as the bladder.
Exercise for 1 second (perform 5-10 times)
-Tighten your muscles quickly + carefully, hold the tension for 1 second, then relax again
-Train your reaction when coughing, sneezing and laughing
Exercise for 3 seconds (perform 5-10 times)
-Gently tighten the muscles of the bladder, hold the tension for 3 seconds, then relax again
-Train the ability of the musculature to adapt to changes in external pressure, such as bending over when tying shoelaces, turning the whole body, climbing stairs, turning over, changing body position.
Exercises for 10 seconds (perform 5-10 times):
-Tense the closing muscle slowly and carefully, fix the tension and feel this state for as long as possible, maximum 10 seconds, then relax. Do not hold your breath during the exercise
-Train muscle endurance for longer activities like walking.
Sacral mobilization exercises
Goal: stimulation of blood circulation and release of muscles from tightness - can be performed from the 3rd day after the operation
The following exercises can be done multiple times a day for at least one minute per set in a relaxed state:
Lying on your back, legs extended:
- Alternately move your outstretched legs from the hip forward and backward, without lifting your legs from the floor and without bending them at the knees
Lying on your back, legs bent at the knees:
-Smoothly tilt the legs closed at the knees alternately to the right and to the left towards the floor, the back remains pressed to the floor, the arms are extended and slightly apart, the bent legs imitate the swing of the pendulum.
Lying on your back, legs bent at the knees:
-Imagine that you are lying on the clock face, 12 is in the direction of the head, above the navel, 6 is in the direction of the legs, under the coccyx. Perform rolling circular motions with the pelvis alternately from top to bottom, from 12 to 6 and in the opposite direction, make sure not to tear the pelvis and shoulders off the floor.
POTENTIAL PROBLEMS AFTER PROSTATECTOMY
Symptom, its cause and recovery measures
Your bowel function should return to normal after surgery (usually within 2-4 weeks). However, drugs that can cause constipation should be discontinued. The rectum and prostate are close together and large and hard stools that require straining can lead to blood in the urine.
Adjust your diet to avoid constipation.
If you have problems with constipation, you can take drugs like Duphalac to soften the stool. If constipation persists, take mineral oil or milk or magnesia
Isolation of blood along the catheter when straining to empty the bowels or blood in the urine.
This is not uncommon. Don't worry, it will stop. This may occur from excessive walking or spontaneously. The admixture of blood in the urine is usually insignificant and resolves spontaneously.
Drink plenty of fluids, it will dilute the blood and it won't clot or clog the catheter and stop bleeding sooner.
Blood along or along the catheter 2 days before catheter removal.
May be a sign that the catheter is too early to remove.
Leakage along the catheter
This is very common, especially when you are walking. The tip of the catheter is not at the highest point of the bladder; the balloon that holds the catheter in the bladder lifts the tip of the catheter away from the bladder neck. For this reason, many patients experience leakage along the catheter when walking.
This can be prevented by using diapers or other absorbent materials.
After prostate cancer surgery
Immediately after prostate cancer surgery
Immediately after the end of the operation, you will be transported to the postoperative ward, where the resuscitator will monitor your general condition, the process of awakening and restoring consciousness. On the second day after the operation, you will be transferred to your room in the department.
Drainage after surgery
Drainage, located in the bed of the prostate gland, is necessary for the outflow of excess fluid (lymph) and blood remaining or released in the wound. In the first few days, ichor will be released through the drainage, as a rule, by the third or fourth day, the drainage is removed.
Urinary catheter after prostate cancer surgery
A urinary catheter drains urine from the bladder, preventing it from leaking out through the urethra, and thus allowing it to heal quickly After prostate cancer surgery. A urinary catheter is attached to a drainage bag that collects urine from the bladder. The bladder catheter is removed 8-10 days after the operation.Sometimes it may take longer for the urethra to heal (usually after radiation therapy), at which point your doctor will tell you to remove the catheter. In the first few days after surgery, the catheter may cause bladder spasms, discomfort in the lower abdomen, and a feeling of needing to urinate. Over time, the discomfort will decrease. As a rule, after surgery, we only discharge the patient home when the urethral catheter is removed. However, if the patient wishes, he can be discharged earlier with a urethral catheter. In this case, when you are discharged, your doctor will explain to you how to care for your urinary catheter and drainage bag. The top of the head of the penis, where the urinary catheter exits, must be treated with paraffin oil at least once a day to prevent injury and microcracks.
Earlier removal of the catheter can lead to a number of complications, including urinary incontinence or, conversely, Acute urinary retention.
You can remove the catheter at your local clinic, but it is best to contact your operating surgeon for help. Removal of the catheter is a painless procedure that takes only a few seconds.
After your urinary catheter is removed, it takes some time for your bladder to "remember" how to function properly. Over time, the functions of the muscles of the bladder and control over the act of urination will be restored. By the end of the first month after surgery, 60% of men regain full control over the act of urination. By the third month after surgery for prostate cancer, the function of the bladder and pelvic floor muscles is restored in 90% of men, and after 6 months - in 92-95%.
Exercises aimed at strengthening the muscles of the pelvic floor, namely the Kegel exercise, will help to restore control over the act of urination more quickly.
Kegel exercise to strengthen the pelvic floor muscles
They consist of three parts (slow shrink, shrink and extrude):
The first stage is slow contraction: during this exercise, you need to slowly tighten the muscles of the pelvic floor, as you usually do, for example, to stop urination or defecation. Hold the tension for 3-5 seconds. Relax and repeat the exercise after 10 seconds.
The second stage is contractions: you need to quickly strain and relax the muscles of the perineum.
The third stage is pushing out: when performing the exercise, it is necessary to push as when urinating or defecation.
The exercise of each stage is performed 5-10 times, and the whole complex - 3-5 times a day. Each week, increase the number of exercises performed by 5 until the number of repetitions of each exercise reaches 30-40 times.
Pain after surgery
After prostate cancer surgery, you may experience pain or discomfort around the surgical site. To combat pain in a hospital, both narcotic and non-narcotic analgesics are used. If you had an epidural with a catheter during anesthesia care, it can be used for prolonged postoperative pain relief.
In case of moderate pain and discomfort at home, you can use non-steroidal anti-inflammatory drugs such as ibuprofen, paracetamol, etc. Pain can last up to 14-20 days after surgery on average.
Sexy function
The operation may affect your sex life. Sexual function is to achieve erection, ejaculation and orgasm. during ejaculation, seminal fluid is released to the outside, most of which is produced in the prostate and seminal vesicles. Therefore, after radical prostatectomy, during which the prostate and seminal vesicles are removed, only a small amount of ejaculate is released during ejaculation, or it may not be at all. As a rule, the operation does not affect your ability to experience an orgasm, even with a small amount of ejaculate.
An erection occurs when the penis fills with blood. This occurs in response to stimulation of the nerve endings located in the penis. Nerve signals travel along two nerve bundles located on either side of the prostate. Sometimes these nerves can be damaged during surgery. However, even the preservation of the integrity of the nerve bundles does not always guarantee the restoration of an erection after surgery. As a rule, the restoration of an erection after surgery for prostate cancer is much slower than the restoration of urinary function. The average erection recovery time is 6-18 months, sometimes dragging on for 2-3 years.
There are several methods that can help you improve your erection, such as the use of phosphodiesterase type 5 inhibitors, a vacuum erection device, and others.As a rule, their use is allowed no earlier than 4-6 weeks after the operation.
These methods should only be used after consultation with your doctor.
You can resume sexual activity after the urinary catheter has been removed and the postoperative wound has healed, and as soon as you feel that your sexual function has fully recovered.
Unfortunately, during the operation, the communication between the urethra and the seminal ducts is disrupted, as a result of which spermatozoa cannot be released outside and participate in the fertilization process - the man develops infertility.
Postoperative wound
It is very important to keep the wound clean and dry After prostate cancer surgery. In the early days, the wound must be treated with antiseptic solutions to prevent infection. The stitches are removed 7-14 days after the operation. If the edges of the wound are sutured with special staples (staples), then they must also be removed 7-10 days after the operation, while if absorbable suture material was used, the sutures will disappear on their own by 10 days after the operation.
Antibacterial therapy
After radical prostatectomy, the doctor will prescribe a prophylactic course of antibacterial drugs, which you will start receiving while still in the hospital. To prevent the development of a urinary tract infection, antibiotics must be taken for the entire period the catheter is in the bladder. Sometimes prolonged antibiotic therapy can provoke the appearance of a fungal infection, manifested by inflammation in the scrotum. In this case, you can use antifungal creams.
At home after surgery
You can shower at home the day after you leave the hospital. Avoid bathing until the urinary catheter is removed.
It is important to take daily walks. This will not only speed up the recovery process, but also prevent the formation of blood clots in the veins of the lower extremities.
Do not lift weights for at least 6 weeks after surgery, i.e. until complete healing of postoperative wounds.
Diet and bowel function
When you return home, you will be able to eat the same food you ate before your surgery. However, do not forget that a healthy diet will help you not only shorten the recovery period after surgery, but also maintain your physical health as much as possible.
It is very important to avoid constipation after surgery. To prevent constipation, you can use various drugs, such as lactulose. However, in no case should you perform an enema for at least 4 weeks after surgery. The wall of the rectum, close to the area of operation, has a high risk of damage in the first three months after surgery.
Contact your doctor immediately if:
- high temperature;
- severe pain syndrome not relieved by non-steroidal anti-inflammatory drugs;
- uncontrolled nausea and vomiting;
- constipation that does not go away after the use of lactulose;
- divergence of the edges of the wound or the appearance of signs of infection (redness and swelling);
- problems with the urinary catheter.
After the operation, you will be under the supervision of your doctor at all times. Postoperative follow-up is important for early diagnosis of recurrence. In addition, the doctor will monitor the process of restoring the function of urination and sexual activity. Postoperative monitoring consists of regular monitoring of the PSA level and performing a digital rectal examination. In the first year after the operation, regular check-ups and a PSA test are carried out once every three months, then every six months.
Add to the above, in our practice we never discharge a patient until the urethral catheter is removed. This procedure is very important after prostate cancer surgery. Moreover, before removal, we always inject a contrast fluid into the bladder and perform an X-ray examination. Only with the complete integrity of the anastomosis between the urethra and the bladder can the catheter be removed. Another day the patient is under our supervision. After making sure that urination is fully restored, we let the patient go home.
How does a catheter help with prostate adenoma?
The procedure of bladder catheterization for prostate adenoma in men is carried out only when there is a threat of various infectious complications, as well as if it is necessary to wash the bladder or remove urine from it after various surgical interventions. This measure is the "gold standard" for the treatment of benign prostatic hyperplasia, used in case of residual urine in the urethra.
A catheter for Prostate adenoma does not cure the patient completely, but only eliminates some of the symptoms of this disease - namely, it helps to normalize the function of urination. Therefore, in the case when conservative methods of treating this pathology do not give the desired effect, the doctor recommends the patient a more effective method of therapy - an operation to remove prostate adenoma. These surgical interventions can be minimally invasive (enucleation and vaporization) or standard (for example, transurethral resection). The specialist decides which method of treating the disease, taking into account the size of the benign neoplasm and the volume of the prostate gland. In this article, we will dwell in more detail on issues related to the need for bladder catheterization in men with adenoma, and also learn about the complications of adenomectomy and the most effective ways to treat them.
How and why is a catheter used for prostate adenoma?
The final stage of the operation to remove a benign prostate tumor is the installation of a catheter, which is necessary to drain urine from the bladder cavity. After the doctor places the catheter into the patient's bladder, the balloon is inflated, thus securing the instrument in place. The installed urinary catheter is attached to a special reservoir for collecting urine.
A catheter for prostate adenoma is used in the early postoperative period. Its use is of great importance in the treatment of this disease, since with the help of a urinary catheter complete "rest" is provided for the wound formed after surgery, which leads to faster and better healing. In addition, the installation of a catheter favors the discharge of blood clots and fragments of the prostate after surgery. This reduces the risk of developing acute urinary retention, which often develops in patients due to obstruction of the urethra by fragments of the removed gland and blood clots.
Depending on the type of adenomectomy performed, the specialist determines the duration of the use of the urinary catheter in the postoperative period. So, after light minimally invasive interventions, such as laser vaporization or enucleation, it is installed for a relatively short time - no more than 24 hours. In the case of more complex operations, the catheter for prostate adenoma can be used much longer. For example, after transurethral resection of a benign neoplasm of the prostate gland, the urinary catheter is usually in the patient's urethra for 2-3 days.
Men who have residual urine of up to 200 ml or more before surgery usually suffer from problematic urination for quite a long time after adenomectomy. It is for this reason that such patients are often discharged home with a catheter installed in the bladder. This instrument is removed, as a rule, after 4-5 weeks, after the complete restoration of the urinary tract.
Types of surgical interventions to remove prostate adenoma
The surgical method of treating this disease is to perform an operation to remove a potentially dangerous neoplasm. There are several types of such interventions, each with its own advantages and disadvantages. There are light (minimally invasive) and complex adenomectomy, let's consider them in more detail.
Minimally invasive surgical interventions
Vaporization is the removal of prostate adenoma without dissection of the outer tissues, by using a special laser. In this case, access to the affected organ is carried out directly through the urethra. This method of treating prostate adenoma is increasingly being used by modern urologists, as it is considered one of the advanced achievements of medicine, and has a number of advantages compared to standard or abdominal operations.
- After laser vaporization, patients recover much faster.
- Significantly reduces the risk of postoperative complications.
- There is no traumatization of healthy organs and tissues of the male body during the operation.
Laser removal of prostate adenoma is a more gentle method of treating patients than even the currently popular transurethral resection of the gland. In addition, the use of this method of treating this disease avoids the development of retrograde ejaculation, which is one of the most common consequences of adenomectomy.
Enucleation - this type of surgical intervention is used to treat patients with benign prostatic hyperplasia with fairly large tumor volumes. For this purpose, a special apparatus is used - a holmium laser.This device allows you to divide a large tumor into smaller parts without violating the integrity of its capsule, which is located in close proximity to the affected gland tissues. As in the case of vaporization, during enucleation, access to the diseased organ is provided through the urethral canal.
Prostate adenoma is removed in two stages: first, the affected part of the gland is separated from its healthy tissues, after which the neoplasm is dissected into smaller lobes, which are removed in a safe way. After adenomectomy by enucleation, the patient must be given a urinary catheter - with prostate adenoma, it ensures the outflow of the contents of the bladder for a period of time until the work of the male urinary tract is restored in full.
In this situation, the installed catheter for prostate adenoma is removed after the first 24-36 hours. The obtained fragments of the neoplasm are subjected to histological examination to refute or confirm the malignant nature of the disease.
Complex and abdominal operations to remove benign prostatic hyperplasia
- Two-stage transvesical Holzow surgery
This type of surgery is intended for debilitated patients who suffer from impaired renal function and require a fairly long bladder drainage.
The first stage of such an operation is the imposition of a special hole in the suprapubic area, and the installation of drainage, through which urine is removed from the patient's urethra. Drainage in this case lasts a relatively long time - from 3-4 weeks to 5-6 months. The duration of this event depends on how quickly the functional ability of the kidneys and the process of urination are normalized.
The second stage of surgery is the enucleation (removal by laser) of prostate adenoma directly through the bladder. A clear disadvantage of such an operation is the need for long-term drainage of the urinary tract, which can lead to a fairly large number of various infectious complications.
- Transvesical simultaneous intervention according to Fedorov-Freyer
This operation has a relatively simple approach to the treatment of pathology and low mortality - about 1-2%. This type of adenomectomy can be supplemented by a number of activities, the sole purpose of which is to ensure hemostasis (stop bleeding). In this case, it can be achieved by suturing the prostatic bed, by suturing the edges of the affected organ. A special catheter equipped with a balloon also helps to maintain hemostasis in such a situation.
This therapeutic method of treating the disease significantly reduces blood loss in the body of a man, as a result of which the risk of such dangerous complications as blood poisoning (sepsis) or kidney failure is reduced.
This method of treatment of prostate adenoma is the suturing of the prostate after surgery to remove a benign neoplasm. During the surgical intervention, a catheter is removed from the patient's bladder, the tissues remaining after enucleation are removed, and several sutures are applied to the prostatic bed along the edge of the affected organ.
When the bleeding has stopped completely, the bladder is sutured tightly, and a small graduate is inserted into the lower edge of the wound. Urine after surgery is removed from the urethra using a permanent catheter, installed for 10 days. This method of therapy shows excellent results, especially with proper postoperative care for the patient. On the 1-2 day after adenomectomy, the bladder is treated with a warm solution of sodium chloride or sodium citrate to prevent the appearance of blood clots in its cavity.
- Posterior pubic adenomectomy
In our time, such surgical intervention is performed quite rarely due to the large number of postoperative complications that occur in 12-15% of all patients.
Using this method of treating prostate adenoma, access to the affected tissues of the prostate is carried out using an incision - vertical or horizontal. The capsule of the diseased organ is also opened with an incision, which is located in the region of the bladder neck. The neoplasm is excised with surgical instruments, separating it from the walls of the bladder to the center of the urethra. An adenoma is removed in the region of the bladder neck, also excising the cuff of the mucous membrane of this organ in order to prevent urinary tract obstruction.
Several permanent sutures are applied to the prostatic capsule, and the bleeding vessels of the gland are coagulated (cauterized). During the operation, a catheter is also installed for the patient, the wound surface is sutured, and a special graduate is removed from the lower edge of the wound.
At the moment, this method of treating the disease is practically not used, as it leads to the development of serious complications: impotence, incontinence or urinary retention, the appearance of fistulas in the perineum.
The development of such consequences of the operation is quite easy to explain, because in this case the tumor is excised through the caudal region of the gland, which is closely interconnected with the tissue structures of the external sphincter. That is why Young's adenomectomy is now considered a hopelessly outdated and ineffective method of treating benign prostatic hyperplasia.
At the moment, the most popular standard approach to the treatment of adenoma. The operation is performed using modern electrosurgical equipment. It is performed by an endovascular surgeon, and a urologist, who directly treats the patient, monitors the course of the surgical intervention.
Transurethral resection is used to eliminate various urinary dysfunctions in men suffering from benign hyperplasia or malignant disease of the prostate, as well as a tumor or sclerosis of the bladder neck.
What are the consequences of bladder catheterization
A catheter for prostate adenoma, installed in the postoperative period, performs a very important function - it ensures the removal of urine from the urinary tract until the moment when independent urination and the work of the urogenital system of a man are normalized. However, the use of this medical instrument can not only help, but also harm the patient. The fact is that using a catheter for prostate adenoma, the patient may encounter various infectious complications - diseases of the urinary and reproductive systems. In particular, unpleasant consequences of catheterization can be:
- Urethritis - often occurs against the background of the frequent use of a urinary catheter, especially when it is not installed aseptically enough. To eliminate such a complication, it is necessary to remove the catheter, disinfect the urethral canal with a special antiseptic solution, and undergo a course of antibiotic therapy.
- Cystitis - this complication very often develops due to dysfunction of urination, urinary stasis, mechanical damage to the bladder mucosa after the introduction of the catheter. In patients who have undergone adenomectomy, cystitis is quite difficult, as it is difficult to treat, therefore, against the background of acute urinary retention, it can last several months.
- Adenomitis - can also accompany this disease. In such a situation, the inflammatory process directly affects the tissues of the adenoma, in which small abscesses appear. Symptomatically, this ailment can be manifested by difficulty urinating, pain and heaviness in the perineum. As a result of bacterial infection, the adenoma may increase in volume, which often leads to acute urinary retention, excretion of urine mixed with pus or blood.
- Chronic prostatitis - characterized by the formation of dense nodules, which are very difficult to distinguish from the tissue structures of a benign neoplasm. These nodes are inflammatory in nature and multiple in nature, but disappear quickly enough with proper treatment of the patient.
- Acute prostatitis - usually in the presence of benign hyperplasia, it proceeds latently, causing only poor general health in a man. In this case, pathology can only be recognized by examining the affected organ through the rectum.
- Orchiepidemitis - is one of the most frequent companions of adenoma. This disease develops against the background of recent acute prostatitis, as well as due to catheterization of the patient's bladder after adenomectomy. Especially often, such a complication develops after a permanent catheter is installed for a man with prostate adenoma. Orchiepidemitis has an acute course and is characterized by frequent abscess formation of the affected organ, especially in debilitated or elderly patients.
- Pyelonephritis is a severe purulent lesion of the kidneys, which can also occur with adenoma. The infection penetrates the kidneys through the blood or ascending - from the underlying organs of the urinary system. Bacteria cause the formation of purulent abscesses in the causative organs, as a result of which the function of urination is seriously impaired, which leads to very serious consequences.
Acute urinary retention in BPH - a modern solution to the problem
Acute urinary retention is usually called a patient's condition in which urine accumulates in the bladder, due to the impossibility of self-emptying of this organ.
Such a pathological condition in most cases can be found in males.At the same time, acute urinary retention occurs sporadically 1-2 times in 5 years in each patient. At the age of 70-80 years, this condition develops in every third patient.
It becomes clear that such a frequent occurrence of acute urinary retention is due to the anatomical features of the structure of the male reproductive system. The most common cause of this pathological condition in men is prostate adenoma, which occurs in 50-65% of all patients. That is why the development of acute urinary retention is divided into two categories: urinary retention that occurs due to prostate adenoma and manifests itself for another reason. This condition in patients suffering from adenoma can be divided into two types, provoked and spontaneous. Provoked acute urinary retention occurs against the background of catheterization, surgery, after anesthesia or the use of certain drugs. This category also includes acute urinary retention caused by hypothermia, alcohol intake, immobilization, etc.
In this case, there is only one way to solve the problem - the withdrawal of urine from the cavity of the bladder. This is achieved either by performing a catheterization procedure, or by performing such an operative intervention as cystostomy (installation of a special drainage catheter into the bladder cavity directly through the abdominal wall due to a puncture or tissue incision). The latter is performed relatively rarely, since in most cases the patient is initially placed with a catheter for prostate adenoma in order to avoid the development of acute urinary retention.
