Resection of prostatic hyperplasia complications and consequences

Prostatic hyperplasia, or adenoma, is one of the most frequently recorded ailments of the genitourinary system, which occurs in the male population. This type of pathology creates huge problems in the process of urination, and an advanced stage can cause complications in other organs and systems of the human body. What surgical interventions are used and the alleged consequences of surgery to remove prostate adenoma? This and some other facts will be discussed later.

Indications for the use of the operation

Nowadays, there is a huge selection of surgical methods, and choosing the right one will not be difficult, taking into account the characteristics of each patient and the problems that have arisen against the background of the pathology of excessive proliferation of cellular structures and tissues of the prostate gland.

Surgery is the most effective technique among all others for the treatment of benign Prostatic hyperplasia (BPH). Different types of manipulations in the field of surgery can have different consequences for the male body. For example, for young men who just need to maintain erectile function, more gentle methods are used, but with a less pronounced effect.

There are a number of indications in which surgery is inevitable:

• in the absence of results from another treatment;
• severe problems with the act of urination;
• presence of calculi in the bladder;
• retention of urine and its stagnation during the act of urination;
• if there is no result, after using bladder catheterization;
• infectious inflammatory processes in the genitourinary tract;
• stagnation of urine, leading to impaired functioning of the renal structures;
• the presence of blood fractions in the allocated portion of urine.

Before the removal of prostate adenoma directly through the urethra is prescribed and in order to avoid further consequences, the patient must undergo a thorough examination, which includes:

• passing general urine and blood tests to reveal the general condition of the body and possible other types of problems with organs and systems;
• uroflowmetry technique in allowing to determine the disturbance of urine output and the degree of the problem;
• carrying out transrectal ultrasound examination of the altered gland makes it possible to obtain information about the size of the proliferation of adenoma tissues and other pathological changes;
• performing rectal examination of the gland;
• transfer of tumor markers to PSA levels to exclude malignant neoplasms.

Types of surgical treatment

There are several techniques, including:

• adenomectomy in open lane surgery;
• transurethral excision;
• laser vaporization;
• transurethral incision;
• arterial embolization;
• method of laparoscopy;
• Hulling the nucleus of a prostate adenoma.

TUR (transurethral resection)

One of the most commonly used methods that can help the patient and relieve him of suffering.

For this type of resection, there are a number of indications, which include:

• the total volume of the gland should be no more than 8 cm;
• surgical intervention no more than 60 minutes.

This type of manipulation is carried out using advanced technologies using an endoscope. A resectoscope is inserted through the urinary canal to the very base of the gland, and with the help of diathermocoagulation, the pathologically overgrown tissues are excised.

A high temperature acts on the cut tissue, and at the site of the incision, the tissues are irrigated with the aim of cooling. A similar operation, but during which the tissues are not cut out, but an incision of the prostate gland is made at the site of narrowing of the urethral canal, is called transurethral incision.

This type of surgery allows urine to exit from the urinary tract. Incision is performed if the prostate gland has a small volume, and if there is no suspicion of malignant cell proliferation.

Adenoectomy

Previously, this type of manipulation was the main one for removing adenoma of the male gland. In modern medicine, this technique is used in the case when other types of surgical intervention are not possible or are not suitable for some parameters.

Assign open operation when:

• large prostate enlargement (more than 8 centimeters);
• when identifying in the process of diagnostics factors that complicate the conduct of other types of manipulations into calculi in the bladder, a volvulus formed in the bladder cavity, which must be removed.

Direct resection includes an incision of tissues in the lower abdomen. At the time of the operation, an incision of the bladder is possible.

Prostate resection by laparoscopy

This type of manipulation is the most effective and has a gentle effect. In the area of the patient's abdomen, small incisions are made into which the necessary equipment is inserted. With the help of video surveillance, adenoma is resected. The cut tissue is removed from the patient's body using a special instrument in an ultrasonic knife.

This method has significant advantages, namely:

• low invasiveness;
• blood loss is minimized;
• high efficiency of getting rid of the symptoms of the disease.

Compared to other methods of laparoscopy, it has an advantage, expressed in the fact that it is possible to perform an intervention even if the prostate gland is enlarged by more than 10 cm.

Embolization of the arteries of the prostate (EAP)

The essence of the method of endovascular X-ray surgery is to block the arteries that supply food to the prostate gland.

Embolization is performed using special angiographic equipment.

The indications for the operation are:

• if you have concomitant health problems;
• blood clotting disorders;
• severe diabetes mellitus.

Contraindications for minimally invasive X-ray endovascular surgery are:

• presence of thrombi of a floating nature in the veins of the legs;
• vascular disease.

Laser vaporization

This technique allows you to get the smallest list of postoperative complications, among other types. It is indicated for use even for patients with severe blood clotting disorders. Equipment is inserted through the ureter, and with the help of a laser beam, tissues are evaporated, prostate adenoma and prostate adenoma are removed, there is nothing to eat, the vessels that feed it are cauterized with a laser beam. There is practically no bleeding.

Photoselective vaporization is carried out using a special green laser. It has a specific wavelength that is preliminarily passed through crystals of potassium, titanium and phosphate.

The technique has several advantages:

• low invasiveness;
• high efficiency;
• getting rid of possible complications in violation of sexual function, bleeding;
• performing a resection in an outpatient setting;
• short recovery period after benign prostatic hyperplasia resection;
• Possibility of performing prostatectomy in patients with bleeding problems.

Having a number of advantages, there are some contraindications:

• the manipulation takes a long time;
• the equipment for the operation is quite expensive and is not available in all clinics.

Enucleation

This technique involves peeling off the overgrown tissue using a laser beam. The technique, in its effectiveness, can replace TUR and open adenoectomy surgery.

Moments of a positive nature are:

• extraction of tissue from a benign neoplasm to check for malignant tumor;
• the ability to remove gland hyperplasia, the size of which is more than 200 g;
• short postoperative period;
• manipulation of patients with a pacemaker, the presence of metal devices in the skeleton, in case of bleeding disorders.

Contraindications for conducting:

• reduced bladder;
• unsatisfactory general condition of the patient before the operation;
• processes of inflammation in the body;
• blockage of the ureter.

Possible complications and their types

The operation to remove prostate adenoma and the consequences that may be, depend on the general condition of the body, the age of the patient and the qualifications of the specialist who performed the manipulation.

During TUR, there may be bleeding from tissues with impaired integrity, the penetration of fluid, which is used to wash the bladder during the operation, into the bloodstream.

After surgery to remove prostate adenoma, there may be some consequences, such as:

• development of urinary incontinence;
• functional disorders in the sexual sphere.

Statistics show that about 2% of patients again go to the clinic for appropriate treatment, which is associated with the emerging postoperative complications. But 5% of those operated on, after removal of the prostate adenoma by the TUR method, come for repeated removal.

The consequences immediately after such removal of the prostate adenoma as adenoectomy, associated precisely with the features of this method. Complications associated with a violation of the integrity of the skin and the walls of the bladder, as well as the appearance of fistulas, infection of wound surfaces, urine leakage. In addition, the postoperative period lasts more than 10 days.

Preparation for surgery and recovery period

First of all, before surgery, you need to communicate with an anesthesiologist, who will be able to choose the right drugs for anesthesia later. Next, it is necessary to eliminate the presence of diseases of a chronic nature, to pass a biochemical blood test. When carrying out certain techniques, it is possible for a doctor to prescribe antimicrobial agents prescribed to prevent the occurrence of negative infectious processes.

After the operation to remove the adenoma of the prostate, the bladder is washed, antimicrobial drugs and pain relievers are prescribed.