Prostate surgery 1 city

GKB 1 im. N.I. Pirogov

University clinic of urology of N.I. Pirogov

Address: g

In 1924, on the basis of the hospital, Professor Nikolai Fedorovich Lezhnev founded the clinic of urology. Under the leadership of N.F. The Lezhnev Clinic paid great attention to such issues as the impact of occupational hazards on the course of diseases of the urinary and reproductive systems, the treatment of malignant neoplasms of the genitourinary organs, genitourinary infections (including tuberculosis and gonorrhea), and urolithiasis. For all the time of its existence, the urology clinic of the First City Hospital has been the leader of domestic urology. Such well-known names as A.Ya. Pytel, N.A. Lopatkin, A.F. Darenkov, E.B. Mazo, A.G. Martov, P.A. Shcheplev, S.P. Darenkov. Within the walls of the First City Hospital, for the first time, the method of complete removal of the bladder in case of cancer with transplantation of ureters on the skin was applied

For the first time in the country, the technique of antegrade pyelography has been developed. The problem of nephrogenic hypertension in chronic pyelonephritis was studied for the first time. For the first time in domestic clinical practice, hemodialysis was used.

A young, hardworking team works here, the main principle of which is to provide highly professional, modern medical care to patients with urological pathology in accordance with the latest achievements of the world's leading expert communities. Today, the priority areas of the clinic are: oncourology, reconstructive plastic urology, treatment of urolithiasis, laparoscopic and endoscopic surgery, transurethral interventions, urinary incontinence in men and women, surgical andrology and others.

The clinic has achieved significant success in the radical surgical treatment of prostate cancer. Over the past 2-3 years, the number of annual radical prostatectomy performed within the walls of the First City Hospital has reached 150 interventions. If it is necessary to preserve erectile function, a nerve-sparing prostatectomy is performed. If there is a risk of tumor damage to regional lymph nodes, an extended pelvic lymphadenectomy is performed.

Most of the radical operations performed are performed by classical retropubic access. However, options such as perineal and laparoscopic radical prostatectomy are also available to patients. The well-established technique, operation technique, well-coordinated work of the operating team and the entire medical staff make this complex surgical intervention a routine one with a minimum number of undesirable effects and complications. Thus, the level of urinary incontinence in the late postoperative period is less than 1.5%, which is comparable to the same indicator in the world's leading clinics. In the treatment of diseases such as hydronephrosis, kidney cysts, laparoscopic operations are actively used, new techniques are successfully mastered, for example, retroperitoneoscopy.

Over the past few years, the proportion of open surgical interventions for kidney tumors has been steadily decreasing. Thus, more than 90% of operations for renal cell carcinoma (radical nephrectomy and resection of a kidney with a tumor) are performed laparoscopically. Due to this, most of the patients are discharged as soon as possible after major radical interventions on the upper urinary tract.

Clinic of Urology GKB 1 is rightfully proud of its extensive interventions for large invasive neoplasms of the bladder and other organs of the small pelvis with local spread of the oncological process, requiring exenteration of the small pelvis with the subsequent formation of orthotopic or heterotopic intestinal reservoirs for urine diversion. The experience of performing such operations is steadily growing within the walls of the First City Hospital, which certainly improves the prognosis of the disease, and also significantly increases the overall survival of patients with this severe pathology. About 40 radical cystectomies with pelvic lymphadenectomy are performed annually in our clinic, 30-40% of them end with the formation of an orthotopic urinary reservoir according to Studer, 60% with the formation of an ileoconduit according to Bricker and

It should also be noted that in recent years the number of radical and cytoreductive surgeries performed for kidney cancer with the spread of a tumor thrombus into the renal and inferior vena cava has increased. These interventions are carried out in the scope of nephrectomy with cavatomy and thrombectomy and require high skill, skills in working on large main blood vessels, well-coordinated functioning of the entire operating team and anesthesia service.

Special attention deserves plastic and reconstructive surgery of the urethra in the clinic of urology of the City Clinical Hospital No. N.I. Pirogov. We use all modern types of plastic surgery for various types of strictures (narrowings) of the urethra.With short strictures of the bulbous department, an anastomotic urethroplasty is used end-in-end (by Holtsov). With strictures of the membrane (bullbombular) department, which are the result of the fracture of the pelvic bones (distraction defect), "Bulboprostatic anastomosis" is formed. In order to prevent tension and subsequent ischemia, the following techniques are applied: Mobilization of the bulbous urethra, dissection of the interfractor-free partition and breeding of the feet of cavernous bodies, excision of the symphiz zone and branches of the lane bones (lower poubectomy), mobilization of the feet of the cavernous body, excision branch of the Lonny bone behind it and "Watching" around the cavernous body of urethra (rooting). The effectiveness of anastomotic urethroplasty in strictures of the Bullbose Division of the urethra is 95% or more, and with distraction defects - 90% or more.

The minimum invasive urethroplasty without intersection of the spongiosis body is developed and is actively being implemented. To date, our clinic has accumulated the greatest experience in the treatment of patients using this surgical technology. With extended strictures, a magnifying (aggregative) plastic is used due to the insertion of the free tissue flap (graft / graft). Today, the most common plastic of urethra using the mucosa of the inner surface of the cheek (buccal urethroplasty) is the most common. In some cases, skin flap is used as a material for the aggregation plast. The clinic contains a database based on the results of all types of the plastle of the urethra, regularly enter into light publishing, covering our experience of performing these operations, prepare doctoral dissertation work on this topic.

In the clinic of the urology of the First Hospital, all types of modern surgery about the urolithic disease are available to patients. Depending on the localization, dimensions, the density of the concretions: remote shock-wave lithotripsy, endoscopic removal of ureteral stones (contact ureterolithotripsy), percutaneous puncture nephrolithotomy. The latter method implies percutaneous removal of kidney stones and the upper third of the ureter by incoming puncture, endoscopy and removal of stones under visual control. The method is one of the most frequent interventions on the urolithiasis in the walls of the GCB 1. N.I. Pirogov and allows in most cases to completely deliver the patient from the kidney constraints. Also applies a method of indifferent percutaneous nephrolithotomy, which does not require the presence of nephrosty and an internal stent after surgery and allowing to prepare a patient for almost the next day after the intervention.

Various modern minimally invasive and endoscopic methods are successfully used in other diseases. Thus, in the treatment of adenoma of the prostate gland of small and medium-sized, transurethral bipolar resection of the prostate is widely used, which allows you to fully restore the adequate quality of urination to the patient after 1-3 days after the operation. Transuretral resection is also used in overwhelming majority when the diagnosis and treatment of non-invasive bladder tumors.

In the treatment of patients with varicocele, accompanied by a violation of fertility in men, microsurgical varicocelometomomy from subpatch access (Operation of Marmara) is a golden standard for the treatment of varicocele. This operation is carried out only with the use of an operating microscope and is performed daily in 36 Urological branch of the GCB 1 N.I. Pirogov.

Actively conducts treatment, both men and women with urinary incontinence. Practically weekly operations are performed on the implantation of a synthetic penetral loop in women, allowing in a short time (1-2 days) to save patients from such a severe socially disadapting disease. When urinary incontinence, men are used both the implantation of the "male" loop and the installation of an artificial urinary sphincter.

After the internship of the urology clinic doctors in Miami (USA), the minimum-invasive method of phalloprotezing with a resistant organic erectile dysfunction was actively mastered and implemented. The method allows you to install complex 3 component systems for 20-30 minutes, which significantly reduces the frequency of periprosthetic infection and allows for early rehabilitation of patients.

The team of the Urology Clinic continues to develop not only its surgical skills, but also continuously improved at various courses and master classes. With the support of the Department of Health, specialists of the department were improved courses in Switzerland clinics and Belgium, where they were trained in robot-assisted surgery (Davinci system), as well as in France (Strasbourg) and G.Kazan for laparoscopic surgery

About 250 patients are examined and treated in the department every month, both on a planned and emergency basis. The vast majority of patients undergo a complete pre-hospital examination at the Clinical and Diagnostic Center of the City Clinical Hospital. N.I. Pirogov, which resulted in the operation being performed the next day after hospitalization.

Today, the Department of Urology, City Clinical Hospital No. N.I. Pirogov is general urological, i.e. assistance to patients is provided with any pathology of the genitourinary organ. The employees of the Department of Urology are always ready to provide highly specialized care to patients with the most complex urological diseases, correct other people's mistakes and come to the rescue, it would seem, in a hopeless case.

The main areas of operational activity of the 36th department are:

1. general urology

Trauma of the genitourinary organs - all types of emergency and planned reconstructive plastic surgeries

2. oncourology

Treatment of complications of oncourological operations (urinary incontinence, erectile dysfunction, strictures of the ureter and urethra)

3. urolithiasis

4. reconstructive plastic urology

5. andrology

6. neurourology

7. laparoscopy in urology - all variants of kidney operations

8. urogynecology

Surgery for prostate adenoma: indications, types of interventions, consequences

Surgical treatment of prostate adenoma continues to be a very urgent problem of modern urology. Despite the fact that specialists are doing their best to reduce the percentage of surgical interventions, at least a third of patients still need them.

Surgery for prostate adenoma often becomes the only way out that can not only save a man from the tumor, but also improve his quality of life, since problems with urination often cannot be eliminated by any other methods.

In terms of frequency, surgical interventions on the prostate gland occupy a strong second place in urology. For the time being, they are put off, fighting the disease with the help of medications, but conservative therapy gives only a temporary effect, so three out of ten patients are forced to go under the surgeon's knife.

The choice of a specific method of surgical treatment depends on the size of the tumor, the age of the patient, the presence of concomitant diseases, the technical capabilities of the clinic and the staff. It is no secret that any invasive procedure carries the risk of a number of complications, and with age, their likelihood only increases, so urologists approach indications and contraindications very carefully.

Of course, every man would like to be treated in the most effective way, but the ideal way has not yet been invented. Given the possible complications and risks from open surgeries and resections, more and more surgeons are trying to save the patient from the problem of "little blood" by mastering minimally invasive and endoscopic procedures.

In order for the surgical intervention to go as smoothly as possible, it is important to seek help in time, but many patients do not rush to the doctor, starting the adenoma to the stage of complications. In this regard, it is worth reminding the strong half of humanity once again that a timely visit to a urologist is as necessary as the treatment itself.

Indications and contraindications for surgery

Indications for surgical removal of Prostate adenoma are:

• Severe narrowing of the urethra with disruption of the bladder, when a large volume of urine is retained in the latter;
• Stones in the bladder;
• Chronic kidney failure;
• Acute urinary retention, repeated many times;
• Bleeding;
• Infections and inflammatory changes in the organs of the genitourinary system.

In case of large tumors, when the volume of the prostate exceeds 80-100 ml, the presence of many stones in the bladder, structural changes in the walls of the bladder (diverticula), the advantage will be given to the open and most radical operation - adenomectomy.

If the tumor with the gland does not exceed 80 ml in volume, then transurethral resection or dissection of the adenoma can be dispensed with. In the absence of a strong inflammatory process, stones, a small adenoma, endoscopic techniques using a laser, electric current are preferable.

Like any type of surgical treatment, the operation has its own contraindications, including:

It is clear that many contraindications can become relative, because the adenoma needs to be removed one way or another, therefore, if they are present, the patient will be sent for preliminary correction of existing disorders, which will make the upcoming operation the safest.

Types of operations for prostate adenoma

Depending on the volume of intervention and access, there are different ways to remove the tumor:

• Open adenomectomy;
• Transurethral resection and incision;
• Minimally invasive and endoscopic procedures - Laser vaporization, cryosurgery, microwave therapy, etc.

Open adenomectomy

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

Open adenomectomy occurs through the opened bladder, so it is also called abdominal surgery. This intervention requires general anesthesia, and if it is contraindicated, spinal anesthesia is possible.

The course of the adenomectomy operation includes several stages:

The most important stage of the operation is the removal of the tumor itself, which compresses the urethra, which the surgeon performs with a finger. Manipulation requires skill and experience, because the doctor actually acts blindly, focusing only on his tactile sensations.

When the forefinger reaches the inner opening of the urethra, the urologist gently tears the mucous membrane and with a finger exfoliates the tissue of the tumor, which has already pushed the gland itself to the periphery. To facilitate the selection of adenoma with a finger of the other hand inserted into the anus, the surgeon can move the prostate up and forward.

When the tumor is isolated, it is removed through the opened bladder, trying to act as carefully as possible so as not to damage other organs and structures. The resulting tumor mass is mandatory sent for histological examination.

In the early postoperative period, there is a high probability of bleeding, since none of the known methods is able to completely eliminate this consequence of the intervention. Its danger lies not so much in the volume of blood loss, but in the possibility of the formation of a blood clot in the bladder, which can close its outlet and block the exit of urine.

For the first few days, the patient is advised to empty the bladder at least once an hour in order to reduce the pressure of the fluid on the walls of the organ and the newly stitched sutures. Then you can do it less often - once every one and a half to two hours. Full recovery of the pelvic organs can take up to three months.

The undoubted advantage of abdominal adenomectomy is its radical nature, that is, the complete and irreversible removal of the tumor and its symptoms

Transurethral resection

Transurethral resection (TUR) is considered the "gold standard" in the treatment of prostate adenoma. This operation is performed most often, and, at the same time, it is very complex, it requires impeccable skill and jewelry technique of the surgeon. TUR is indicated for patients with adenoma, in which the volume of the gland does not exceed 80 ml, as well as when the planned duration of the intervention is not more than an hour. In case of large tumors or the likelihood of malignant transformation in the tumor, preference is given to open adenomectomy.

Among the disadvantages are the inability to remove large adenomas, as well as the need for complex and expensive equipment in the clinic, which a trained and experienced surgeon can use.

The essence of transurethral removal of an adenoma is to excise the tumor with access through the urethra. The surgeon, using endoscopic instruments (resectoscope), penetrates the urethra into the bladder, examines it, finds the location of the tumor and removes it with a special loop.

The most important condition for a successful TUR is good visibility during manipulations. This is ensured by the continuous introduction of fluid through the resectoscope with its simultaneous removal. Blood from damaged vessels can also reduce visibility, so it is important to stop bleeding in time and act very accurately and accurately.

The duration of the operation is limited to an hour. This is due to the peculiarities of the patient's posture - he lies on his back, his legs are divorced and raised, as well as with a long stay in the urethra of a rather large diameter instrument, which can later provoke pain and bleeding.

Transurethral removal of prostate adenoma

The adenoma is excised in parts, in the form of shavings, until the moment when the parenchyma of the gland itself appears in the field of view. By this time, a significant amount of fluid has accumulated in the bladder with tumor “shavings” floating in it, which are removed with a special instrument.

After excising the tumor and washing the bladder cavity, the surgeon is once again convinced that there are no bleeding vessels that can be coagulated by electric current. If everything is in order, then the resectoscope is removed outside, and a Foley catheter is inserted into the bladder.

Installation of a Foley catheter is necessary to compress the site where the adenoma was (the catheter has an inflating balloon at the end). It also produces a constant washing of the bladder after the operation. This is necessary to prevent obstruction of the outlet section by blood clots and a constant diversion of urine, providing rest to the healing bladder. The catheter is removed after a few days, provided there is no bleeding or other complications.

After removing the catheter, men notice significant relief, urine flows freely and in a good stream, but at the first urination it may be colored reddish. Don't worry, this is normal and shouldn't happen again. In the postoperative period, it is recommended to urinate frequently in order to prevent stretching of the walls of the bladder, allowing its mucosa to regenerate.

For a small prostate with an adenoma that compresses the urethra, a transurethral incision can be performed. The operation is not aimed at excising the neoplasm itself, but at restoring the flow of urine, and consists in dissecting the tumor tissue. Given the "non-radical" method, one cannot count on a long-term improvement, and TUR may follow the incision after some time.

Laparoscopic removal is one of the gentle methods of treating prostate adenoma. It is carried out with the help of equipment introduced into the pelvic cavity through punctures of the abdominal wall. Technically, such operations are complex, they require penetration into the body, so TUR is still preferred.

Video: transurethral resection of prostate adenoma

Minimally invasive prostate surgery

Minimally invasive methods of treatment are successfully developed and implemented in various areas of surgery, including urology. They are carried out through transurethral access. These include:

• Microwave thermotherapy;
• Vaporization using electric current;
• Electrocoagulation of the tumor;
• Cryodestruction;
• Laser ablation.

The advantages of minimally invasive treatment are relative safety, fewer complications compared to open surgeries, a short rehabilitation period, no need for general anesthesia and the possibility of its use in men for whom surgery is contraindicated in principle for a number of concomitant diseases (severe heart and lung failure , pathology of blood coagulation, diabetes mellitus, hypertension).

Access through the urethra without skin incisions and the possibility of local anesthesia can be considered common in these techniques. The differences are only in the form of physical energy that destroys the tumor - laser, ultrasound, electricity, etc.

Microwave thermotherapy consists in exposing neoplasm tissue to high-frequency microwaves, which heat it and destroy it. The method can be applied both transurethral and by inserting a rectoscope into the rectum, the mucosa of which is not damaged during the procedure.

Vaporization leads to heating of the tissue, evaporation of fluid from the cells and their destruction. This effect can be achieved by acting with electric current, laser, ultrasound. The procedure is safe and effective.

In cryodestruction, on the contrary, the adenoma is destroyed by the action of cold. Liquid nitrogen is the standard medium. The wall of the urethra is warmed during the procedure to prevent damage.

Prostate adenoma laser treatment is quite effective and one of the most modern ways to get rid of the tumor. Its meaning lies in the action of laser radiation on the tumor tissue and simultaneous coagulation. The advantages of laser treatment are bloodlessness, speed, safety, and the possibility of using it in severe and elderly patients. The effectiveness of laser removal of the prostate is comparable to that of TUR, while the likelihood of complications is several times lower.

Laser vaporization is, as they say, the "last peep" in the field of minimally invasive treatment of prostate adenoma. The impact is carried out by a laser emitting green rays, which leads to the boiling of water in the tumor cells, its evaporation and destruction of the adenoma parenchyma. Complications with this treatment practically do not occur, and patients notice a rapid improvement in well-being immediately after the operation.

Laser adenoma removal is especially indicated for men with concomitant hemostasis disorders, when the risk of bleeding is extremely high. Under the action of a laser, the lumen of the vessels is sealed, as it were, which practically eliminates the possibility of bleeding. The procedure can be performed on an outpatient basis, which is also a definite advantage.In young men, after laser vaporization, sexual function is not disturbed.

Video: laser vaporization of prostate adenoma

Possible consequences of surgery for prostate adenoma and rehabilitation

No matter how hard the surgeons try, it is impossible to completely exclude the possible complications of radical treatment. The risk is especially high with abdominal surgery, it is with TUR, and in the case of endoscopic removal it is minimal.

The most frequent complications of the early postoperative period can be considered:

More long-term consequences develop within the pelvic organs. These are strictures (narrowings) of the urethra against the background of proliferation of connective tissue, sclerosis of the bladder wall at the site of the urethra discharge, sexual dysfunction, urinary incontinence.

To prevent complications, it is important to follow the doctor's recommendations regarding behavior immediately after the intervention, as well as at a later date, until the tissues recover completely. In the postoperative period it is necessary:

• Restrict physical activity for at least a month;
• Exclude sexual activity for at least a month;
• Ensure a good drinking regimen and timely emptying of the bladder (better - more often);
• Refuse spicy, spicy, salty foods, alcohol, coffee;
• Perform daily exercises to activate blood flow and increase overall tone.

Reviews of men who have undergone surgery for prostate adenoma are ambiguous. On the one hand, patients note a significant relief of symptoms, improved urination, and reduced pain, on the other hand, with the most common types of treatment (abdominal and TUR), the majority are faced with urinary incontinence and impaired potency. This cannot but affect the psychological state and quality of life.

The blame for the high probability of some complications is also borne by the men themselves, because not everyone is used to visiting a urologist every year in adulthood and old age. It is almost a standard situation when a patient with a large adenoma comes to the appointment, requiring more active treatment than laser, coagulation, cryodestruction, and hence urinary incontinence, impotence, bleeding. To facilitate both the operation itself and recovery after it, you should immediately consult a doctor as soon as the first signs of trouble in the genitourinary system appear.

Treatment of adenoma can be done free of charge in a state clinic, but many patients choose paid operations. Their cost varies greatly depending on the level of the clinic, equipment and locality.

Removal of prostate adenoma

Removal of prostate adenoma by laser

At present, laser technologies are widely used in the treatment of prostate adenoma. Depending on the characteristics of the laser system, it is possible to influence the adenomatous tissue in different ways, namely: vaporization, resection and enucleation.

Vaporization, i.e. removal of prostate adenoma by evaporation is performed mainly using the Biolitec AG laser system (photo 1) and GreenLaser (photo 2)

Removal of prostate adenoma with Biolitec AG laser

The Biolitec AG laser has a wavelength of 1480nm and a power of 180W. During operation, the laser beam continuously penetrates to a depth >1mm. With its help, evaporation of adenomatous tissue occurs. The operation is performed under spinal anesthesia.

The operation to remove prostate adenoma ends with drainage of the bladder for 2-3 days with a urethral catheter. The length of stay in the hospital is about 5 days. The patient takes antibacterial and anti-inflammatory therapy as prescribed by the doctor. For 2.5-3 months, intense physical activity, warming procedures (baths, saunas), and spicy food are prohibited.

Also, the removal of prostate adenoma with the Biolitec laser can be performed with urethral strictures, bladder calculi, urethral condylomas, also as a palliative treatment for prostate cancer, as the first stage before a Hi-Fu therapy session.

The Biolitec AG laser does not affect sexual function, the minimum amount of bleeding during the operation to remove prostate adenoma. It can be used in patients taking anticoagulant therapy.

Removal of prostate adenoma with GreenLaser

GreenLaser has a wavelength of 532nm and a power of 120W, due to which the laser has a green color (photo 3). During operation, its beam penetrates 0.8 mm. Like the Biolitec AG laser, the GreenLaser is used to vaporize prostate adenoma and remove it by evaporation. The execution technique is similar to Biolitec.

The operation ends with drainage of the bladder with a urethral catheter. The patient takes antibacterial and anti-inflammatory therapy as prescribed by the doctor. The length of stay in the hospital is about 3 days. Within 2.5-3 months, intense physical activity, warming procedures (baths, saunas), and spicy food are prohibited.

GreenLaser can be used for bladder calculi, as a palliative treatment for prostate cancer, as a 1st step before Hi-Fu therapy.

It is worth noting that when performing vaporization of prostate adenoma, the surgeon does not receive material for histological examination, as a result of which the operating doctor must have accurate information that excludes prostate cancer.

In our clinic, holmium laser enucleation of prostate hyperplasia (HoLEP) is widely used and has proven its effectiveness.

Before HoLEP, holmium laser resection of prostatic hyperplasia (HoLPR) was used, which was first performed by Gilling in 1996. However, it had a significant disadvantage associated with the duration of the implementation of this operational manual. As a result, a tool was invented - a morcellator, thanks to which it became possible to refuse resection of adenomatous tissue and remove it as a single unit - enucleation.

In our clinic, HoLEP is performed with the Lumenis PowerSuite laser machine (photo 4), which has a power of 100 W and a wavelength of 2.1 nm, and the Lumenis Versacut morcellator (photo 5).

The holmium laser has a penetration depth of 0.4 mm.

Progress of the operation to remove prostate adenoma

In order to avoid retrograde ejaculation, the adenomatous tissue is dissected with a laser fiber anteriorly 1 cm from the seminal tubercle (the points are connected at 4 o'clock c.c. with 8 o'clock c.c.) Subsequently, an incision is made from the bladder to the seed tubercle and the creation of two furrows at 5 and 7 o'clock, thereby highlighting the middle share. Due to the tube of the instrument, it is necessary to mechanically lift the adenomatous tissue of the middle lobe (anatomical separation of the layers of the adenoma) and cut it off from the prostate capsule. After the middle lobe of prostate adenoma, the instrument is mechanically displaced into the lumen of the bladder. The second stage is the exfoliation of the right and left lobes of the adenoma.

It must be remembered that the laser fiber must move from the center to the periphery (from 5 and 7 o'clock c.c. to 2-3 and 9-10 o'clock c.c.). Further furrows from 12 o'clock at.ts. laterally connected at 2 and 10 o'clock. The right and left lobe of prostate adenoma is also displaced by the instrument into the bladder. The next step is hemostasis (it is necessary to change the instrument to a monopolar or bipolar). The final stage of the operation: morcellation of adnomatous tissue displaced into the lumen of the bladder using a morcellator. Postoperative material is sent for histological examination. The operational manual ends with drainage of the bladder with a urethral catheter for two to three days.

Photo 6 (picture before surgery)

Photo 7 (picture after surgery)

There are a number of advantages of HoLEP over other operations for adenoma: complete removal of the entire tissue of prostate adenoma, blood loss during surgery is negligible or absent. The volume of the adenoma does not limit the performance of HoLEP, the ability to use physiological saline as an irrigation fluid during surgery, the duration of stay in the clinic is from 3 to 5 days, the duration of emptying the bladder with a urethral catheter is about 2-3 days, HoLEP does not affect the erectile function.

Before removal of prostate adenoma

To conduct HoLEP in the urological clinic of the First Moscow State Medical University. THEM. Sechenov, the patient must pass and undergo the following tests and procedures:

Anesthesia for removal of prostate adenoma

Spinal anesthesia is used for HoLEP (Photo 8, Figure 1).

Photo 8

Fig 1.

The patient must also provide the following information to the attending physician:

After removal of prostate adenoma

During the day after the operation, the patient needs complete rest in order to prevent postoperative bleeding. After 8-10 hours after surgery, the patient is allowed to eat. For 2-3 days, the bladder will be emptied with a urethral catheter.

There may be an admixture of old blood in the urine. After removal of the urethral catheter, the patient may notice pain during urination for 1 day. Together with urine, clots of old blood can leave the bladder.

After the patient is released from the hospital, the following recommendations of the attending physician must be observed:

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