Types of operations for adenoma and indications for their implementation

With a disease of prostate adenoma, the prostate gland gradually increases in size (a benign tumor or hyperplasia develops). In the early stages and with timely access to a doctor, the disease can be successfully treated with medication. The growth of neoplasms and the disorder of urinary function are reduced. A neglected form of the disease and lack of treatment leads to erectile dysfunction, severe disorders, pain during urination, acute kidney disease and prostate cancer.

Most often, the diagnosis is made in elderly men, and the exact cause of the development of adenoma has not been identified. The examination is not complicated and the doctor makes a diagnosis based on symptoms and complaints. Most doctors came to the conclusion that the disease is due to old age and an increase in chronic diseases of the genitourinary organs. To determine the need for surgical intervention, it is important to first consider the stages of the gradual appearance and development of the disease, as well as what are the indications for surgery for adenoma.

Development stages and indications for operational measures

At the first stage of the development of the disease, patients experience a weakening, and difficulty in emitting urine, the need for additional tension in the abdomen. Unfortunately, many people ignore such inconveniences, considering them age-related changes. This connivance and patience leads to the subsequent progression of the disease. At this stage, the treatment of adenoma is quite effective and it is possible to do without surgery.

Patients with this diagnosis most often complain of frequent and nocturnal urge to urinate, a feeling of a full bladder, erectile dysfunction.

Second period.

The next degree of prostate adenoma formation is determined by pronounced signs:

• outwardly noticeable presence of blood particles in the urine (late appearance of pus);
• painful completion of ejaculation;
• the process of passing urine is accompanied by severe pain and exit literally drop by drop;
• repeated emissions and leaks of urine at night.

A good urologist will try to avoid surgery, but with such symptoms it will be difficult to do without surgery. Difficulties in the work of the urinary system lead to a retention of residual urine in the bladder. In turn, there is an active multiplication of infection and, as a result, stones appear in the bladder and kidneys.

The multiplication of infection in the genitourinary system is accompanied by the following symptoms:

• body aches;
• low fever and chills;
• pain when passing urine;
• lumbar pain;
• the appearance of purulent formations and blood particles in the urine.

Despite the similarity of symptoms in prostatitis, prostate cancer and urethral stricture, the diseases are significantly different. Unlike adenomas, prostate cancer and stricture can only be treated with surgical removal.

At the third stage of the course of the disease, the following signs are observed:

• accumulation in the urine of an excessively large (about 2 liters) volume of urine;
• renal dysfunction;
• intoxication of the body;
• pronounced symptoms of hematuria;
• failure and disturbances in the work of the liver, cardiovascular system;
• stone formation in the bladder.

With this form of the disease, urgent surgical intervention is necessary. In the extreme stages, there is an acute urinary retention, which can be eliminated only by placing a urethral catheter. Inflammation of the prostate gland leads to the development of complications and subsequent forms of infectious diseases: epidymitis, urethritis, pyelonephritis, prostatitis.

Preparation period

Operations on the prostate gland are preceded by a preparatory stage.

The neglected form of the disease before the operation requires a number of procedures:

• Drainage of the urinary tract to achieve azotemic detoxification;
• Comprehensive prevention to restore the normal functioning of the liver;
• A set of therapeutic measures to improve and improve the functioning of the cardiovascular system and kidney function.

Contraindications

Surgery on the prostate gland has contraindications.

The presence of the following abnormalities in the body is a direct and categorical prohibition on operative manipulations:

• heart and renal failure (cor pulmonale);
• aortic aneurysm, vascular atherosclerosis, pyelonephritis and acute cystitis;
• prostate cancer;
• complications after previous surgery;
• inflammation of other organs of the body;
• high temperature.
• For patients who are contraindicated for surgical treatment due to poor health, doctors sometimes recommend therapeutic exercises.

Methods and types of surgical care

The use of the TUR (or transurethral resection) method is considered by doctors to be the most effective method and is even called the golden method in eliminating the problem of hyperplasia. This technique allows you to remove the tumor without leaving a single incision on the body. The affected tissue is completely or partially removed by inserting a special instrument into the urethra.

The principle of operation of TUR is the passage of high-frequency current through the wire loop and removal of the affected organ. Coagulation of blood vessels is also carried out. Using a cystoscope, doctors visually monitor, control and direct the entire course of the operation and the patient's condition. Due to this, this type of surgical intervention is otherwise called endoscopic surgery.

The positive result of this method is a very short period of postoperative rehabilitation. Patients stay in the hospital for only 2 days, and about 85% of men have a significant improvement in health.

The next type is prostatectomy, performed in an open way. When the adenoma of the prostate gland reaches a very large size (exceeding 80 g), it is treated only by surgical removal. During this procedure, only the prostate adenoma is removed; the removal of the testicles is not performed. Abdominal surgery can be performed either in the retropubic region (in the lower abdomen) or in the perineal region (between the scrotum and anus). The excised tissue is removed from the bladder. One week after the removal of the tumor, a catheter remains in the patient's urethra, and during this period he is under the supervision of doctors.

Less and less often, surgeons resort to adenomectomy. It is performed using general anesthesia. If the weight of the prostate is more than 82 g, the procedure is performed by making an incision and carefully separating the bladder wall. This method helps the surgeon to clearly see the existing violations. But the disadvantage is the long recovery time after the procedure. The patient is monitored by doctors for three months.

The method of laparoscopy is more modern and minimally invasive. The procedure does not require large incisions in the abdomen and internal organs. During the operation, several small holes are made in the patient's abdomen through which the camera and surgical instruments are inserted. The camera displays a clear image of the entire operating process on monitors. The affected tissue is eliminated with an ultrasonic knife. This method allows you not to injure neighboring organs and avoid large blood loss. The catheter remains in the patient's urethra for about six days.

Laser therapy. Prostatectomy is performed using a laser emitting wavelengths of various lengths. Laser treatment is effective in case of poor blood clotting and contraindications to other traditional methods. A very low rate of postoperative complications in the form of urinary incontinence, retrograde ejaculation, impotence. But they use laser therapy if the size of the adenoma is not more than 30 g.

Prostatic stent. The technique consists in gradually introducing independently expanding flexible devices into the urethra. Such a device allows the free passage of urine through the canal. The self-expanding function allows the device to expand in volume at the required time.

Positive aspects of such an operation:

• absence after the procedure of a long recovery period and negative consequences;
• short duration of surgery and local anesthesia;
• performing the procedure on an outpatient basis;
• minimal blood loss;
• no need for a catheter in the postoperative period.

If the disease is not started, the size of the prostate is not very enlarged and the man wants to maintain an active sexual function, he undergoes a transurethral incision (dissection) of the prostate gland. The method allows not to remove organs and tissues, and not to perform their histological analysis. For several years after the operation, the patient has a full sex life, but later the prostate gland will have to be removed.

Rehabilitation

For a faster recovery after surgery, it is important to properly follow all the recommendations and advice of doctors.

The postoperative stage of such a complex disease is as follows:

If you are attentive to your health and respond correctly to all changes in the body, you can prevent the development of a complex form of the disease. Timely referral to medical personnel and determination of the correct treatment method will help to avoid serious consequences.

With a responsible approach to treatment, the risk of re-intervention by surgeons is significantly reduced by about 14 years for one in ten men.