Removal of prostate adenoma in the Botkin hospital

Urology department

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Clinic of Urology and Surgical Andrology at the Botkin Hospital

The Clinic and Department of Surgical Andrology and Urology of the State Educational Institution DPO RMAPO has ample opportunities for modern diagnostics and treatment of various diseases of the genitourinary system. Also, the department offers those who wish to undergo postgraduate education in the framework of general urology and its subspecialties ample opportunities for learning.

The central premises of the clinic can be found in the 16th building of the hospital named after S. P. Botkin. This building of the city clinical hospital was renovated in accordance with all modern requirements and received the equipment necessary for a full-fledged hospital infrastructure.

On each of the three floors of the building there are urological departments, which in total are ready to accept up to 60 patients in new comfortable wards. These departments have two operating units for endovideosurgical, open and endoscopic surgery, as well as diagnostic rooms. The building is equipped with a clinical diagnostic laboratory and an intensive care unit.

On the ground floor there is a spacious conference room equipped with all the necessary multimedia equipment, which, among other things, allows you to watch broadcasts of live surgery from operating rooms. As for the 10th building of the hospital, it houses the emergency urology department of the Botkin hospital, designed for 30 patients and equipped with its own operating unit and diagnostic departments.

Attention should also be paid to the 22nd surgical building, which was equipped in accordance with all modern standards. There are 9 urological beds and all the equipment necessary for remote lithotripsy and endovideosurgery. Also in this building there are full-fledged operating rooms.

Key areas of work

At the moment, the department, as well as the clinic of urology and surgical andrology, has the status of a modern academic center representing all subspecialties of urology. A lot of attention is paid to early diagnosis and screening. Moreover, the diagnosis is focused on the detection of actually the most common malignant tumor in men, prostate cancer. As for the main direction of the work of the department and the clinic, it is the diagnosis of neoplasms of the genitourinary system and subsequent surgical treatment, which in fact is operational oncourology.

In addition to the usual diagnostic measures (transrectal ultrasound, blood test for PSA), stationary and multipoint biopsy of the prostate gland was introduced into the practice of the department. Also, such curative operations as perineal and radical retropubic prostatectomy (including mini-access) are often performed. Due to the fact that the urology department of the Botkin Hospital uses the latest low-traumatic surgical techniques, after such operations, patients are discharged from the hospital within 4-5 days.

Another priority area of the urology clinic is the surgical treatment of bladder cancer. At different stages of this disease, surgeons perform both transurethral resection of the bladder and radical cystectomy (various methods of urine diversion are used, including orthopedic cytoplasty).

When working with kidney tumors, both organ-preserving surgical techniques for kidney resection and radical transabdominal nephrectomy are used.

Surgical urogynecology is actually one of the strengths of the clinic. All operations related to stress urinary incontinence and pelvic organ prolapse in women are performed at a high level of professionalism. The specialists working in the clinic have a wealth of experience, which, combined with the original methods of operations developed by Professor, Head of the Department Laurent O. B., allow achieving the maximum result in the treatment of urogenital fistulas in women.

Active development is also carried out in the field of reconstructive plastic surgery. The specialists of the clinic undertake the most complex types of reconstruction of the lower and upper urinary tract. Open and endoscopic plastics of the pelvic-ureteral segment, augmentation cystoplasty and various options for ureter reconstruction are performed. For the treatment of patients suffering from urogenital and ureteric fistulas, reconstructive plastic surgery is performed using the latest technologies and techniques.

The specialists of the clinic pay special attention to the development of surgical andrology.In addition to classical methods, the clinic also uses such modern methods of surgical correction of the male infertility factor as direct sperm sampling from the testicle and its epididymis, microsurgical varicocelectomy, as well as microsurgical operations aimed at reconstructing the vas deferens.

Doctors of the clinic widely use penile prosthetics, using modern models of implants in the case of diagnosing erectile dysfunction. The clinic also has departments of endourology and endovideosurgery (separate operating rooms are equipped for transurethral resection, laparoscopic operations, percutaneous interventions and contact ureterolithotripsy).

Surgeons of the Urology Clinic of the Botkin Hospital are able to offer minimally invasive removal of urinary stones of virtually any localization and size. This result became available due to the active use of the latest endovideo technologies. Since the treatment is carried out with the help of a competent combination of metaphylactic and preventive measures with new methods of lithoextraction, litholapaxy and lithotripsy, the clinic has the status of a full-fledged modern center for the treatment of urolithiasis. Professional diagnostics of the causes of stone formation, carried out individually for each patient, also deserves attention.

Regarding the work of the Department of Endovideosurgery, it is worth noting that it performs the following operations using laparoscopic techniques: radical and simple nephrectomy, resection of kidney cysts, hydronephrosis plasty, varicocelectomy, ureterolithotomy and pelvic lymphadenectomy.

Directly at the department itself, a lot of attention is paid to the diagnosis and effective treatment of urinary tract infections and inflammatory diseases of the urogenital area. Due to the fact that modern diagnostics, rational antibiotic therapy and competent drainage of the urinary system are used in the treatment process, patients after urological operations and procedures quickly go through the rehabilitation process.

As for the faculty of the department, they take an active part in the process of postgraduate medical education. Every year, up to 300 doctors at the department undergo advanced training in the specialization of urology with subsequent certification. Those specialists who intend to constantly improve their level of knowledge will definitely be interested in the thematic improvement cycles in surgical andrology, oncourology, outpatient urology and urogynecology. Moreover, the opening of a cycle in laparoscopic urology is already planned.

In addition, the specialists of the department are constantly active in scientific activities. Candidate's dissertations were defended by 26 specialists, and doctoral dissertations by 5.

Employees working at the department every year speak at the congresses of the European and American Urological Associations. The department is open to the transfer of experience and knowledge to colleagues, in order to increase the dynamics of the development of urology on a national scale, which will bring it closer to the level of international standards of treatment.

Department of Urology, 14th Botkin Hospital

This department is located on the 2nd floor of the 10th building of the hospital and is designed for 35 patients. It is noteworthy that the compact and cozy building 10 is located directly in the central part of the hospital and is easy to spot due to the bright red brick finish.

Urological patients are admitted in emergency mode every day and around the clock. In the urology department 14, both women and men suffering from various urological diseases are treated. To ensure that all the tasks assigned to the department were carried out as efficiently as possible, it was equipped with all the necessary modern equipment. There is an x-ray room, which is equipped with an electron-optical converter. Thanks to him, it becomes possible to carry out various manipulations under x-ray control. The department also operates an ultrasound diagnostic room, in which each staff member received the necessary work experience. For surgical treatment of patients, an operating room is equipped, designed for 2 tables, on which any surgical urological aids are performed, ranging from radical retropubic prostatectomy and cystoprostatvesicolectomy with the formation of various methods of urine diversion and ending with trocar cystostomy. Endourological operations on the urethra, bladder and prostate are constantly practiced.

In turn, the diagnostic range of the department has many directions: they work with patients suffering from tumors of the bladder, prostate, kidneys, inflammatory diseases of the genitourinary system, urolithiasis, etc.

In addition to the scientific component of the work of the department, active pedagogical and scientific activities are carried out on an ongoing basis.The duties of the senior resident of the department are performed by Yengay V. A. He managed to defend his Ph.D. thesis, which was devoted to the diagnosis and treatment of kidney cancer.

PhD students and clinical residents are trained in the department on a permanent basis.

Urology Department 41

A 60-bed urogynecological department was opened at the Botkin City Clinical Hospital in 1976. 32 years after the repair work, it gained a new life as a urological one, designed for 24 beds in 10 wards with comfortable conditions of stay. There is a branch on the territory in building 16 on the 3rd floor. The department receives patients with various urological problems for examination and treatment (by conservative and surgical methods). Highly qualified surgeries of the widest profile are carried out here with priority areas in female urology, urological oncology, laparoscopic and reconstructive surgery.

The clinic of the International Center for Pelvic Surgery is based in the urology department of the Botkin Hospital to provide highly specialized care to patients with such ailments as:

• Enuresis or stress urinary incontinence in women (TVT and TVT-O sling procedures; Birch laparoscopic method);
• Pelvic organ prolapse (laparoscopic sacrocolpopexy, Prolift vaginal extraperitoneal colpopexy);
• vesicovaginal, ureterovaginal, vesico-vaginal-rectal fistulas;
• mechanical or postoperative injuries on the ureters, bladder and anterior wall of the rectum (reconstructive laparoscopy);
• tumors and cysts of paraurethral and vaginal;
• combined urogenital pathologies requiring surgical treatment.

Highly qualified care is also provided to cancer patients with diagnoses:

• cancer of the bladder and kidneys;
• Malignant and benign prostatic hyperplasia.

In addition, the department also hosts the laparoscopic department of the urological clinic of the Russian Medical Academy of Postgraduate Education. Laparoscopy is a very promising method of surgical intervention due to its low trauma, which can significantly reduce the length of stay in the hospital (on average, no more than 7 days) and the recovery period. The laparoscopic method can be used in various urological situations, including operations for the radical removal of organs (nephrectomy, prostatectomy) and pyeloplasty for hydronephrotic transformation of the kidney. Moreover, few centers in the world can perform microlaparoscopy through instruments with a 3mm lumen and a single access to the surgical field, which avoids noticeable postoperative scars on the patient's body.

Thus, the following types of operations are performed in the department:

• radical removal of the prostate (prostatectomy), including laparoscopic extraperitoneal removal;
• removal of a kidney (nephrectomy), incl. laparoscopic method;
• kidney resection for oncology;
• removal of the bladder (cystectomy);
• sparing surgery for enuresis and prolapse of the pelvic organs in women (TVT, TVT-O, Prolift);
• plasty of the renal pelvis with hydronephrotic transformation by abdominal and laparoscopic methods;
• transurethral surgery for Prostate adenoma and bladder tumors;
• any general urological intervention.

The stay in the clinic is also very comfortable due to the conditions created for patients: most of the wards of the urology department are designed for 1 or 2 people, there is a refrigerator, TV, shower and toilet rooms, a communication system with staff and oxygen access. Postoperative boxes are equipped with modern panels for round-the-clock monitoring of the patient's vital signs with data output to the computer display of the resuscitator on duty. Comfortable spacious waiting rooms complete the picture of the department.

Urology Department 56

This department is located on the 4th floor of the 22nd medical building. Here, patients are offered various types of reconstructive plastic and oncourological surgical interventions. The key activity of the department's specialists is the surgical treatment of patients with oncourological diseases (cancer of the kidney, prostate, testicle and bladder). In addition to the effective treatment of oncology, the surgical department is aimed at maintaining the level of quality of life and functionality of patients who have undergone treatment.

Patients who have been diagnosed with urological diseases of any complexity can count on effective treatment and a quick recovery.Such results are actively promoted by the high level of comfort in the department, the constant clinical practice of the hospital specialists that meets international standards, and, of course, the dedication of the team to their work.

Robot-assisted surgery has been at the forefront of operative urology for the past few years. Due to the fact that digital equipment, computer technology and robotic instruments are constantly being improved, the specialists of the department were able to bring minimally invasive surgery to a fundamentally new level of visualization and accuracy.

Operating Block 56 uses the latest generation of the da Vinci Si system. This robotic system has two components:

The robot itself consists of a rack equipped with four manipulators, one of which is used for the camera, and the rest for working tools. The surgeon, who is behind the remote control console, controls the movements of the manipulators and the camera. Small robotic instruments are placed into the abdominal cavity through special ports, which are incisions with a diameter of 1-1.5 cm. Thanks to the ability to use high-definition 3D magnification (3D HD), the surgeon is able to visualize the anatomical structures in maximum detail. Combined with the use of precision instruments that have high freedom of movement, this technique provides extremely accurate tissue dissection.

The following types of robot-assisted surgical interventions are performed in Urology Department 56:

Robot-assisted adenomectomy (in case of severe infravesical obstruction and large prostate);

Radical prostatectomy (if indicated, a nerve-sparing technique is used);

Robot-assisted sacrocolpopexy in case of diagnosing pelvic organ prolapse in women;

Robot-assisted nephrectomy (kidney resection in the presence of a tumor lesion);

Robot-assisted Boari operation for diagnosing strictures of the lower third of the ureters;

Robot-assisted plasty of the ureteropelopelvic segment (hydronephrosis, UMS stricture).

Laser vaporization of prostate adenoma

Prostate adenoma is a benign prostate tumor. Another disease is called prostatic hyperplasia. Increasing, the tumor compresses the urethra, which causes difficulty in the process of urination. The urologist deals with the treatment of this disease.

Urologists work at the center of the Central Clinical Hospital of the Russian Academy of Sciences, among which there are doctors of medical sciences and specialists of the highest qualification category.

When is it necessary to carry out diagnostics and tests?

A man needs to think about visiting a urologist if he observes symptoms of prostate adenoma. These include:

• Frequent urination at night
• Painful difficulty urinating
• Burning sensation after urination
• Feeling incomplete urination
• Increased urination time
• Painful ejaculation
• Weak urine flow
• The presence of impurities in the urine
• Dry mouth
• Lack of appetite
• Constipation
• Fatigue and irritability.

The sooner a person sees a doctor, the better. So you can avoid the undesirable consequences that this disease leads to. For example, acute urinary retention, requiring the installation of a urethral catheter, cystitis, pyelonephritis, urethritis and other inflammatory processes of the urinary system, urolithiasis, kidney failure, and so on.

Removal of prostate adenoma by laser

Laser vaporization of prostate adenoma at the Central Clinical Hospital of the Russian Academy of Sciences is the removal of overgrown tissue by evaporation. It is performed endoscopically. This is an endourological operation, which involves passing the instrument through the urethra i.e. without cuts. The operation is carried out under the control of the eye. This means that the surgeon sees the evaporation zone on the monitor screen.

For this operation, we use the latest laser system. The use of a flexible light guide with a curved tip, for more perfect and efficient contact evaporation. This method has a rate of removal of prostate adenoma tissue equal to 3-4g/minute, while maintaining the most effective coagulation zone to minimize the risk of side effects. The wavelength of the diode laser is 980 nm. It is well absorbed both in water and in hemoglobin, which allows you to quickly evaporate and simultaneously coagulate the underlying deep layers, avoiding bleeding.

Due to high water absorption, the use of such a unique system eliminates accidental damage to the bladder and other non-target areas.In contrast to the green laser with a wavelength of 532 nm, which is well absorbed only in hemoglobin and poorly in water. This means poor evaporation and good coagulation, which is no longer enough in our time.

However, the evaporation efficiency of the green laser is lower, since the wavelength of 532 nm penetrates tissues only superficially. Layered and non-contact evaporation by this method is effective for prostate adenoma up to 60-80 cm3. With large volumes of 100-120 cm3, clinics use a combination of a green laser and Transurethral resection (TUR) of prostate adenoma, and this is another operation with other complications.

How is the evaporation treatment carried out?:

This procedure is carried out in contact, in layers. The evaporated tissue is washed out along with the washing liquid. Deep resection can lead to perforation of the capsule of the prostate gland, bladder, abdominal cavity and rectum and subsequently to peritonitis in combination with water intoxication of the body, i.e. TUR syndrome, which already poses a threat to the patient's life. Typically, such complications require open surgical revision and correction.

Evaporation of all three lobes of prostate adenoma is performed alternately. Usually they start with the middle lobe, which can be quite pronounced and go deep into the bladder. Here one should be wary of the proximity of the mouths of the ureters. After evaporation of the middle share, you can proceed to the removal of the side shares. Due to the high power of the device and the curved light guide, the evaporation of even large adenomatous nodes and their hard-to-reach areas is not difficult. High-efficiency vaporization combined with deep coagulation allows large volumes of tissue to be quickly removed with virtually no bloodshed. Which, in turn, allows the surgeon to control every movement of the light guide in order to avoid damage to the sphincter apparatus and the seminal tubercle.

Who is at risk

The disease mostly affects men over 45 years old.

Although scientists cannot say for 100% what is the cause of the development of adenoma, many of them agree that the disease appears mainly due to hormonal imbalance. Those. the amount of male hormones decreases and the proportion of female hormones increases.

Among other causes of prostate adenoma are:

• Inflammation of the urethra
• Kidney inflammation
• Inactivity or with a decrease in body activity
• Atherosclerosis
• Alcohol abuse, smoking, unhealthy diet
• Overweight

Advantages of prostate adenoma vaporization at the Central Clinical Hospital of the Russian Academy of Sciences

As a result, after laser evaporation of all adenomatous nodes, we get a channel in the prostatic part with a diameter of about 3-3.5 cm. This will allow the patient to urinate with high quality for the next 15-20 years. At the same time, without experiencing such problems as urinary incontinence, retrograde ejaculation and erectile dysfunction.

According to our observations, the quality of erection is not only preserved, but also enhanced.

Photos of the department

The Urology Department of the Central Clinical Hospital of the Russian Academy of Sciences treats patients:

• with inflammatory diseases of the urinary tract and genital organs (cystitis, urethritis, pyelonephritis, chronic prostatitis);
• with tumors of the bladder and kidneys;
• with urolithiasis;
• with prostate adenoma;
• and other diseases of the genitourinary system.

The main areas of work of the urology department:

• restoration of the patency of the urinary tract of all parts of the urinary system, installation of a stent catheter, surgery to eliminate urinary incontinence;
• percutaneous minimally invasive nephrostomy, kidney resection, nephrectomy for kidney masses, puncture, laparoscopic and conventional surgery for kidney cyst;
• endourological surgery for urolithiasis;
• cystectomy, transurethral resection (TUR) of the bladder;
• plastic surgery for strictures of various localizations;
• plastic surgery on the penis and scrotum;
• transurethral resection (TUR);
• laser vaporization of the prostate gland, ;
• prostatectomy;
• remote shock wave lithotripsy (ESWL) ;
• contact (endoscopic) laser lithotripsy ;
• UHF prostate therapy;
• laparoscopic surgery (nephrectomy, adrenalectomy, prostatectomy, resection of a kidney cyst and bladder diverticulum, reconstructive plastic surgery on the organs of the urinary system);
• Contact lithotripsy.

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Unique Operations

Pelvic surgery

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You can read more about the technique of performing surgical interventions below.

Oncourology

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Today, okourology accounts for more than 50% of the operations performed in our clinic. Operations such as radical prostatectomy, kidney resection, radical nephrectomy, radical cystectomy with bladder plastic surgery, TURBT are standard interventions, the technique of which has been carefully developed. In total, more than 3,000 operations have been performed for oncourological diseases over the past 10 years. You can read more about the technique of performing surgical interventions below.

Laparoscopy

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What is laparoscopy?

Laparoscopic, endoscopic or minimally invasive surgery is a method of performing an operation without the need for a large incision, which can significantly reduce the recovery time after the operation, the length of stay in the hospital, reduce postoperative pain and cosmetic defect. Today, in leading urological clinics, following the wishes patients, laparoscopic access has almost completely replaced the traditional technique using large incisions. Laparoscopically performed operations such as nephrectomy (removal of the kidney), plastic surgery of the ureteropelvic segment in case of hydronephrosis, prostatectomy in case of prostate cancer, operations for cryptorchidism and varicocele. thin long instruments are inserted into the cavity and, under the control of a miniature television camera, manipulations are performed that are adopted for the treatment of a particular surgical disease (for example, removal of a kidney, stone or hernia).

How is laparoscopic surgery performed?

The method lies in the fact that through small (5 to 10 mm) punctures, thin long instruments are inserted into the abdominal cavity and, under the control of a miniature television camera, manipulations are performed that are accepted for the treatment of a particular surgical disease (for example, removal of a kidney, stone or hernia). Moreover, during the introduction, the instruments do not cut the tissues, but only push them apart. Operations are performed under anesthesia. The most important element in the instrumentation used is the optical system, the so-called laparoscope, which has two optical channels. Powerful cold light is fed into the abdominal cavity through one fiber-optic channel, and through the other, the image is transmitted to a television camera, and then to a television, which the surgeon looks at during the operation. In order to create space in the abdominal cavity for examination and work, a sterile gas, most often carbon dioxide (CO2), is injected into it. After that, all the organs of the abdominal cavity become clearly visible on the screen. Removed organs or their parts are removed from the abdominal cavity through a small cosmetic incision in the navel. After that, sutures are applied to the skin punctures and to the tissues in the navel area, and this is where the operation ends.

On the first day after the operation, the patient does not eat, although you can drink without any special restrictions. On the evening of the day of surgery (after complete recovery from anesthesia), you must get up and walk. On the second day, you can begin to take light food in moderation (fruit, cottage cheese, broth, boiled lean meat, etc.). On the third day, the diet is close to normal. The issue of the timing of discharge is decided by the doctor in each case. Usually it is 2-3 days after the operation. Sutures are removed on an outpatient basis, for 7-10 days. The recovery time is determined individually, but usually is 12-15 days after the operation. After recovery, the patient can lead his normal life without restrictions on physical activity and diet.

What are the advantages of laparoscopy?