Laser enucleation of prostate adenoma in Kazan

Laser enucleation of prostate adenoma

Laser enucleation of prostate adenoma is one of the types of surgical treatment of benign prostatic hyperplasia. This technique allows you to remove even large prostate adenomas with minimal side effects and complications.

In laser enucleation of prostate adenoma, a holmium laser is used, which is widely used in urology, not only for removing the prostate gland.

The holmium laser has been used to treat benign prostatic hyperplasia for more than a decade. But over the past five years, thanks to the improvement of technologies and equipment, there has been a significant expansion of the range of options for the treatment of benign prostatic hyperplasia from simple vaporization to complete removal, or rather enucleation of prostate adenoma.

Drawing. Laser unit used for laser enucleation of prostate adenoma and other laser operations.

At present, laser enucleation in combination with morcellation (morcellation - division into fragments) makes it possible to remove large adenomas (more than 100 cm3), which in turn avoids open adenomectomy.

Laser enucleation of prostate adenoma is performed by transurethral (through the urethra) access. The optical equipment of the endoscope allows the surgeon to see everything that happens during the operation. Through an additional port in the endoscope, a laser is applied to the adenoma, with the help of which it is enucleated.

Enucleation means the removal of the lobes of the prostate gland without violating the integrity of the capsule. The operation of the laser is based on the effect of tissue heating, therefore, during the procedure, the surgical field is constantly irrigated to cool it down. After the lobes of the prostate are separated, using a special tool, the surgeon divides them into fragments for easier extraction. After the operation, a catheter is inserted into the bladder. It is removed the day after the operation.

On average, the duration of laser enucleation of prostate adenoma takes 60-120 minutes.

After laser enucleation, the resulting fragments are sent for examination under a microscope to exclude prostate cancer.

The postoperative period does not differ from those for other surgical interventions, you can read about this in the article "After removal of adenomas are simple".

Drawing. Laser enucleation and transurethral resection of prostate adenoma.

Frequent (more than one in ten interventions):

• Temporary mild burning, bleeding (blood in the urine) or frequent urination;
• In 75% of cases, after complete enucleation of the prostate, the phenomenon of "dry orgasm" can develop - during ejaculation, seminal fluid enters the bladder.
• Weak erection (impotence can develop in 14% of cases);
• Infections of the genitourinary system;
• Incomplete removal of prostate adenoma in 10% of cases requires re-treatment several years after the first operation;
• Temporary urinary incontinence occurs in 10-15% of cases and usually resolves 3-6 weeks after laser enucleation of prostate adenoma;

Infrequent (develops in 1 in 50 cases):

• Injury to the urethra followed by its narrowing;
• The need to insert a catheter into the bladder to drain urine (in case of bladder weakness);

Rare (less than 1 in 100 operations):

• Detection of prostate cancer in removed fragments, which requires more serious treatment;
• Residual fragments of prostate adenoma in the bladder not removed during surgery, which requires a procedure to extract them;
• Long-lasting urination disorder (in 1-2% of cases);
• It is extremely rare for a complication such as bladder damage to develop.

Laser enucleation of prostate adenoma is a reliable, effective and well-tolerated surgical technique for the treatment of benign prostatic hyperplasia. It is associated with minimal Side effects and a short period of hospitalization and recovery.

Laser enucleation of prostate adenoma allows you to deal with a pathology that has reached a fairly large size. This method minimizes the possibility of complications due to the use of a holmium laser. What are its advantages over other methods?

Laser enucleation of adenoma is a modern approach to the treatment of prostatic hyperplasia, which has reached a large size. With its help, you can effectively deal with neoplasms, the volume of which exceeds 100 cubic meters. cm, which means that it is quite possible to return the normal state of the patient even in advanced cases.

Surgery is performed transurethral, using an endoscopic camera, to which a laser is connected. It allows you to completely or partially remove the damaged tissue of the gland. This approach in the treatment of adenoma refers to minimally invasive, as it allows you to maintain the integrity of the prostate chamber.

During the operation, the surgeon separates the lobes of the prostate, and at the end of the procedure, they are removed using a catheter, which is removed the next day. The average duration of the procedure can vary from 60 to 120 minutes, depending on the volume of the prostate gland.

Fragments of the gland that were separated during the operation are sent for examination, which will determine the propensity for the transformation of the tumor into a malignant one. If the tests show the presence of signs of a malignant neoplasm, it is necessary to take a number of measures to detect a possible tumor, make a diagnosis and direct treatment.

When it comes to oncological diseases, the most rapid and comprehensive intervention of doctors is necessary. The longer the tumor is in the body, the higher the chances of failure during its elimination.

Treatment of prostate adenoma with a laser has a number of advantages that allow you to effectively use this method to remove adenoma:

The disadvantages include the high cost of this type of operation, as well as the need for a sufficiently high level of skills of the medical staff who will be involved in the removal.

Since laser enucleation is a minimally invasive method of surgical treatment of adenoma, the likelihood of complications is quite small, but the patient may temporarily experience:

• urinary incontinence;
• frequent urination accompanied by burning sensation;
• blood in the urine during the first days after surgery;
• Urinary infections;
• temporary erectile dysfunction;
• After a few years after the procedure, a second operation may be necessary - the trend is observed in 1 out of 10 patients.

The last point is very important, since the patient must understand that such operations do not go unnoticed, and there is a risk of recurrence of the disease after a certain period of time. This probability depends on the volume of the adenoma, the quality of the equipment, as well as the skills of the surgeon who will perform the operation. In the case of hyperplasia, none of the existing methods can guarantee a 100% result of a complete cure, since one affected cell remaining in the body is enough to start the process of tumor formation again. The only measure that can be taken is preventive examinations every 6 months, with the help of which it will be possible to detect a growing adenoma in advance and eliminate it by a conservative method.

Additional complications can also include narrowing of the urethra due to physical damage that could occur directly during the operation, as well as loss of elasticity of the bladder tissues, as a result of which it is necessary to catheterize the patient.

Laser enucleation cannot be performed in the following cases:

• the presence of inflammatory diseases in an acute form;
• The resectoscope cannot be passed through the urethra due to its physical features;
• The patient is taking anticoagulants.

In the process of laser enucleation, small bleeding will form in the places where the laser works, which are a kind of "invitation" for microorganisms that cause infectious diseases. Before proceeding with such an operation, it is necessary to completely recover from these ailments.

It is also necessary to pre-prepare for enucleation when the patient is taking anticoagulants. A week before the operation, the patient stops drinking medication, and recovers after a course of rehabilitation and the permission of the doctor during the next visit.

If you have been diagnosed with prostate adenoma, you should not hesitate to treat it, even if it cannot be done by a conservative method. Removal of hyperplasia is currently the most effective means, and methods such as laser enucleation or its analogues make the procedure quick and painless even with local anesthesia.

Remember that an adenoma is a benign tumor that not only prevents you from living and fulfilling your natural needs, but at any moment it can begin to show signs of a malignant neoplasm, and it already falls under the competence of oncologists. Treatment of prostate cancer is much more complicated and less safe than adenomas, and the effectiveness is much less.

It is believed that in men after 30 years, active growth of prostate adenoma begins. The first symptoms of the disease begin to appear: frequent urination (especially at night), urinary incontinence, weak stream.Few people pay attention to this, but after a while such symptoms lead to more serious consequences. By the age of 50, doctors diagnose prostate hyperplasia in most men.

Today we will talk about the most modern, common and safe method of treating prostate adenoma - holmium laser enucleation of the prostate.

Before the operation, the patient must undergo several examinations:

• biochemical blood test;
• blood pressure and ECG are measured;
• general analysis of urine and blood;
• determination of blood type and Rh factor;
• HIV test;
• ejaculate analysis.

Then the urologist interviews the patient. The patient should talk about what medications he has taken recently, whether there are any allergies to certain medications, whether there are infectious or chronic diseases, whether heart surgeries have been performed.

Laser enucleation of prostate adenoma allows you to fight a pathology that has reached a fairly large size

A few days before the operation, the patient undergoes a consultation with an anesthesiologist. The doctor selects the type of anesthesia individually for each patient. There are 2 types of anesthesia in total. With one of them, the patient falls into a deep sleep and does not feel anything. In the second case, a person understands and hears everything, but does not feel anything below the waist.

After all these procedures, the patient is completely ready for surgery.

The operation is performed using a holmium laser. Due to his ability to cut and ablate soft and hard tissues, he gained fame in such branches of medicine as gynecology, urology, otolaryngology.

The surgeon inserts an endoscopic camera into the patient's urethral canal, with which he can observe the progress of the operation. A holmium laser is connected to the camera, with the help of which part or all of the gland is removed.

The operation takes place in several stages. First, the surgeon divides the prostate into parts, and then, using special tools, divides them into fragments and moves them into the bladder. From there, the parts are removed with a morcellator (a special device inside which there are blades that cut the fabric). After the operation, a catheter is inserted into the bladder, which is necessary for the outflow of urine. It is removed the day after laser enucleation.

The duration of the operation is approximately 60-120 minutes.

Minimally invasive surgical methods are highly effective: they reduce the patient's recovery time, reduce the risk of postoperative complications

Due to the special technique of the operation, the patient's rehabilitation takes place within 1-2 weeks. The patient feels better almost immediately. A long stay in the hospital after the operation is not necessary, and the patient can go home, after 2-3 days you can already go to work.

After the operation, although rare, complications can occur. The risk of their occurrence is very low. Here are the main ones:

• appearance of blood particles in the urine;
• burning when urinating;
• temporary incontinence;
• possible erectile dysfunction;
• genitourinary infections.

For faster recovery after surgery, you must follow a few rules:

• drink plenty of fluids;
• Take pain medication for severe pain (only as prescribed by a doctor);
• Only take special medications with a doctor's prescription.

The operation is performed in clinics only if there is modern equipment, so the cost is quite high. The price depends on the location.

The postoperative period after laser enucleation of BPH plays a key role in patient recovery

The main advantages of treating adenoma with a holmium laser:

Enucleation of the prostate with a laser has several disadvantages:

• the operation is quite expensive;
• not all medical institutions do it. The operation requires special modern equipment;
• Surgery should only be performed by an experienced laser-trained surgeon.

For the treatment of prostate adenoma, various methods are used: the use of a urethral stent, transurethral resection of the prostate, adenectomy, drug treatment. Laser enucleation of prostate adenoma is considered the most modern treatment method: the prostate is removed using an endoscope and a laser. In order for the operation to take place with the least harm to the body, a holmium laser is used.

A week before the date of the operation, the patient should stop taking medications, especially blood-thinning ones. You can start taking permanent medication again 10 days after you are discharged.

Before the operation, the patient undergoes an outpatient examination

The day before, an outpatient examination is carried out: the patient's pressure is measured, and the general state of his health is assessed. He must tell the doctor about the medications he has taken before; whether he had operations on the blood vessels and the heart, infectious or chronic diseases, bypass surgery; whether there are allergic reactions to certain drugs. The following factors can affect the quality of the operation and the patient's condition: prostheses of blood vessels and joints, artificial heart valves, implants, coronary artery stent, CSF shunts, intolerance to various drugs, staphylococcus aureus.

Before the operation, the patient is examined by an anesthesiologist and prescribes a suitable premedication. Such operations are performed under general anesthesia: the patient is conscious, but does not feel anything below the waist. If desired, you can ask for a full anesthesia: in this case, the person is in a state of deep sleep. Antiseptics are also used.

The operation can take up to 1.5 hours on average. The laser involves minimal intervention in the patient's body. With it, the adenoma is carefully cut off from other tissues, then transferred to the bladder and crushed. The remains are carefully removed from the body.

Laser enucleation of prostate adenoma

Postoperative period

After the patient regains consciousness, they are informed about the results and checked for well-being. If a person feels discomfort in the pelvis or pain, he should definitely report it.

The catheter is still worn for a day or two, then it is removed. The patient should be prepared for the fact that at first he will visit the toilet more often and urination will be painful - special drugs are prescribed for pain relief. Involuntary urination is possible, but the process is getting better after the restoration of the working capacity of the pelvic muscle tissues. After a few days, the body recovers.

The body recovers a few days after the operation

The patient is given a medical statement, which indicates information about the operation performed, the state of health and the results of the tests.

The following side effects may occur after prostate surgery:

• The appearance of blood in the urine;
• Stinging sensation after going to the toilet;
• Frequent trips to the toilet;
• Pain when going to the toilet for a short time;
• urethral injury;
• Spread of infection in the bladder, testicles and kidneys, leading to surgery;
• Injury to the urethra and prolonged incontinence.

After the operation, the patient is given recommendations on how to eat better in order to recover faster. At first, drinking plenty of fluids is shown - this will help get rid of tissue remnants and clean out the bladder. You can start eating by the evening after the operation.

You can not allow physical activity during the period indicated by the doctor, and at first you should refrain from sexual intercourse. Erection in case of successful operation will return gradually and naturally. The normal period for the restoration of sexual function is one month.

At first, a person may feel unwell, feel the need for rest, observe tissue remnants in the urine. After the operation, a sick leave is issued for a period of two weeks. If the work is associated with physical exertion, the period can be doubled. The attending physician will prescribe a sick leave to the patient in accordance with his lifestyle.

After the operation, the doctor gives recommendations on how to restore the body and explains how normal recovery should occur. Unpleasant side effects at this time are common operating consequences. But there are a number of cases when you need to contact a specialist for additional help immediately:

• The presence of severe and long-lasting pain. If the pains are tolerable and subside with time, this is a normal symptom, but if they are very strong and do not subside with time, you should definitely see a urologist.
• Bleeding that occurs is a reason to immediately go to the hospital.
• Missing erection for more than a month. Usually in a month the patient fully recovers; if this did not happen within the specified period, the help of a specialist will be required.

The lower limit is 30-40 thousand. Overseas treatment is in the range of 4.5-18 thousand dollars.

The cost of the operation varies from $30,000

The price depends on the technology used, equipment, clinic. The most modern at the moment is a holmium laser. It effectively removes a small tumor and at the same time avoids many complications and consequences after surgery. This type of laser has been successfully used for more than a decade.Surgical equipment has also been significantly updated, which made it possible to expand the scope of the laser application and increase the number of patients successfully cured with it.

The rest of the prostate adenoma laser enucleation is a modern, efficient and reliable procedure that gives an excellent result and is well tolerated by the patient. Side effects are minimal, hospitalization and recovery last long. The patient must necessarily fulfill all the recommendations in the recovery period, in case of severe unpleasant side effects, immediately seek help and maintain contact with the attending physician to complete recovery.

Prostate laser enucleation

For many years, transurethral resection of prostate (TurP) was adopted as a gold standard of surgical treatment of obstructive urination dysfunction in men with a benign prostate gland hyperplasia (DGPA). However, this historical standard has been repeatedly issued in question over the past decade by consistent data, demonstrating the superiority of the Golmian laser enucleation of the prostate (Holep).

This is a new and highly specialized surgical procedure for the treatment of DGPA. It is especially useful for people with a very large size of the prostate, which is not suitable for the usual laser operation at the prostate.

However, the laser enucleation of the prostate and the "green laser" are similar in terms of what is safe ways to reduce prostate in men with obstructive symptoms that conservative drug treatment did not help.

Holep avoids the metabolic complications of the old TurP procedure and causes minimal bleeding.

What patients fit laser enucleation of the prostate:

• People with a very large prostate (more than 80 grams).
• people who are taking medicines, thinning blood.
• Men of all ages with obstruction of urine outflow caused by increased prostate gland.

Contraindications:

• The only absolute contraindication to the procedure is the inability of the patient to be in the "lying on the back" position.
• It is not recommended to perform a laser enucleation of the prostate in hemorrhagic diathesis.

Preparations for prostate laser enucleation:

• As with any other surgical procedure, preoperative preparation consists of a physical examination of a patient with a doctor, the collection of history and laboratory tests.
• The latter include: general and biochemical blood tests, determining the level of PSA, as well as a general urine analysis and urine bakpospose. Any increase in the PSA should be accompanied by the relevant prostate biopsy before carrying out laser enucleation.
• Ultrasound can assign a transrectal ultrasound study (CUTH) to determine the volume of prostate.
• Before the operation of the patient, the anesthesiologist necessarily consults about the preferred type of anesthesia and possible drug allergies.
• If the patient takes anticoagulants (for example, warfarin), their reception should be stopped 3-5 days before the operation.

Procedure for the procedure

The purpose of the laser enucleation of the prostate is to reduce the pressure of the excess fabric of the prostate on the urethra.

Operation is performed under spinal or general anesthesia with a telescopic chamber inserted through the penis into the prostate gland.

Holmium high-power laser The doctor separates the hyperplasned prostate tissue along its capsule from the surrounding fabric.

Then carved adenoma or three fragments move to the bladder. Special tool called Morceller Used to crush prostate fabrics in the bladder on very small pieces and then remove them. And finally, the catheter is placed in the penis to dry the bladder overnight.

How long will the patient have to stay in the hospital?

Usually, the entry takes place after 1-2 days, most men, in the morning after the operation, will remove the catheter and will allow return home. Patients taking dangling drugs drugs usually remain in the hospital within two days for more thorough observation.

Advantages of laser enucleation of prostate compared to traditional Turk or open prostatectomy:

• Risk of bleeding.
• shorter stay in the hospital.
• fast recovery.
• low frequency complications.
• No metabolic or electrolyte complications.
• during the operation you can destroy the stones in the bladder.
• Operation can be performed by patients receiving medications that dilute blood.
• Some studies have shown that patients undergoing laser enucleation of the prostate actually had improved erectile function, but almost all of them had retrograde ejaculation (that is, orgasm without ejaculation).
• All patients experience hematuria within one to two weeks after the procedure, but the need for blood transfusion is very low, in the range of 1%.
• There is no risk of hyponatremia (a decrease in serum sodium levels below 135 mmol/l), regardless of prostate size.

These benefits make laser enucleation the preferred choice for men seeking surgical relief from BPH problems.

The disadvantage of laser enucleation of the prostate is that the procedure takes a little longer than TURP and requires special preparation.

Possible complications and side effects of laser enucleation of the prostate:

• Burning, tingling, and frequent urination occur in most patients, but resolve within a certain period of time after the procedure.
• After surgery, there may be blood in the urine, so it is recommended to drink plenty of water for several days after laser enucleation. Blood clots sometimes disappear 10-14 days after surgery, but they are part of the healing process.
• Retrograde ejaculation ("dry orgasm"). This condition is harmless and occurs in most cases.
• Bladder infections that occur i

Y 2015, Republican Hospital. V.A.Baranova