Types of surgical removal of prostate adenoma

Adenoma of the prostate is a tumor of the prostate gland that looks like a nodule. The cause of the occurrence is often age-related changes, as a result of which deviations in the work of the endocrine system occur. These neoplasms are benign, but if you do not consult a specialist in a timely manner, the condition can worsen significantly. The sooner a man seeks a doctor's advice, the easier the treatment will be.

Nevertheless, drug therapy, carried out during the prescribed period, does not always give the opportunity to completely cure prostate adenoma. In this case, specialists can completely cure the patient only through an operation and remove the adenoma. When an adenoma of the prostate gland is detected, the operation has long been considered the most optimal way to deal with the disease, since it does not bring any harm to the body, but it is possible to avoid the occurrence of atypia.

Do not cure the disease without surgery in such cases:

• The volume of residual urine increases in the bladder cavity;
• There is a delay in urination;
• There is blood in the urine;
• Stones appeared in the bladder;
• Renal failure has appeared;
• If other methods of treatment do not bring positive dynamics;
• Difficulty urinating;
• If pathway catheterization has not improved the patient with acute urinary retention;
• If the disease has caused the development of an infection in the urinary tract;
• If the delay in urine, which is provoked by the disease, has led to complications in the functioning of the kidneys;

When choosing a method of surgical intervention, all the factors mentioned above are taken into account. There is no single type of surgery for prostate adenoma. Removal of adenoma is due to many factors, so the choice is made only by a qualified specialist in each case individually.

The decision on complete or partial surgical removal of the prostate is made individually with each patient.

This will depend on a number of factors:

• Pain - at the initial stage of the disease, analgesics and antispasmodics are used in order to reduce symptoms, and sometimes even injections of novocaine are required. If the disease is started, then even after taking medication, the pain does not stop.
• Medication is not effective. Hyperplasia can occur regardless of adequately prescribed therapy. The drugs included in the course of treatment are conservative. In the case when the treatment is carried out for six months and there are no dates of good results, an operation is performed.
• Age - patients over 65-70 years old do not undergo surgery due to the fact that there is a risk to the patient's life. Before deciding whether to perform an operation, pay attention to the condition of the patient as a whole, and identify conditions in which the implementation of manipulation is contraindicated.
• Rapid prostate growth - rapid progression of hyperplasia - is one of the main indications for surgery.
• Possibilities of the clinic to which the patient applied;
• The presence of concomitant diseases;
• The patient's consent to the removal of the prostate adenoma by the method suggested by the doctors;
• Presence of atypia.

Examination before surgery

To choose a method of treatment, a man undergoes a full examination, which includes:

• Delivery of urine and blood tests to determine the general condition and other health problems, if any;
• Uroflowmetry. An analysis that helps to determine the degree of disturbance in the flow of urine;
• Rectal examination of the prostate gland;
• Transrectal ultrasound of the prostate is the main method for obtaining accurate data on the size of adenoma and other indicators;
• Identifying the degree of PSA - an analysis that clarifies the presence of atypia.

Surgical treatment options for the disease:

• Adenomectomy.
• Transurethral resection.
• Laser vaporization.
• Transurethral incision.
• Arterial embolization.
• Laparoscopy.
• Enucleation of adenoma.

Transurethral resection (TUR) is one of the most commonly used types. For the appointment of this particular method of removing adenoma, there are indications: the size of the prostate gland is up to 80 ml, and the doctor predicts that it will last no more than 60 minutes.

All manipulations are carried out using endoscopic equipment. The resectoscope is placed through the ureter to the location of the prostate gland. Elimination of tissues is carried out through diathermocoagulation. The tissue to be removed is influenced by high temperature. In the area of operation of the apparatus, tissues are irrigated in order to cool them.

Transurethral incision is carried out in the same way as the operation of TURP of prostate adenoma, but the tissue is not removed, but only the dissection of the prostate gland is carried out in the place where the ureter is narrowed. This improves the flow of urine through the urethra. This operation is performed if the prostate gland is small and when there is no atypia.

Adenomectomy

Not so long ago, this operation was the main option in the presence of such a disease as prostate adenoma. Today, this option is chosen if, for health reasons, other options for removing adenoma are contraindicated.

Removal of prostate adenoma by this method is recommended in the following cases:

• The prostate gland has a volume of more than 80 ml.
• If the patient has concomitant diseases, such as kidney stones.
• If a large diverticulum in the bladder needs to be removed.

The operation involves an incision in the lower abdomen. Depending on the choice of method of penetration to the gland, the bladder may also be affected.

Laparoscopy

This method of performing the operation is considered to be quite effective and less traumatic. The laparoscope is placed in the site of the node excision using several small incisions in the abdomen. The operation to remove the adenoma takes place under the close supervision of video equipment. The tissues to be removed are removed using a special knife. The catheter, which is inserted at the end of the operation, is removed on the 6th day after the operation. The main advantages of this operation are noted: low trauma, minimal blood loss, quite effective.

This variant of surgical manipulation is suitable in cases where the tumor is already quite large. The gland can have a volume of more than 100 cubic centimeters.

Embolization of the arteries of the prostate (EAP)

This option is carried out using angiographic equipment. The adenoma becomes smaller by blocking the arterial vessels, through which it is nourished.

This method of combating the disease is used in such cases:

• There are abnormalities in blood coagulation,
• Abnormal kidney function,
• Diabetes mellitus type II.

However, this type of manipulation has a number of limitations:

• Presence of blood clots in the veins of the legs.
• Presence of vascular diseases.

This type of manipulation has been used not so long ago. Nevertheless, the use of this method will be a full-fledged alternative to adenomectomy, as well as TUR of adenoma.

Laser vaporization

A new treatment option for prostate adenoma, which dates the minimum number of complications. Suitable even for those men who have abnormalities in the process of blood coagulation. The device is placed in the area of manipulation through the ureter. The tissue is evaporated under the influence of the laser beam. In the process, blood vessels that are in the area of \ u200b \ u200bthe beam are welded, preventing blood loss.

Photoselective vaporization - the influence of a green laser. The specific wavelength laser beam that is passed through the potassium titinal phosphate crystals turns green and can vaporize tissues. All manipulations appear on the monitor screen. The use of this method is justified when the volume of the prostate gland is 60-80 cubic centimeters.

In hospitals, two options are often combined: laser vaporization and TUR with a gland size of more than 100 cubic centimeters.

Advantages of the method:

• Less traumatic.
• Effective.
• There are no complications associated with sexual dysfunction.
• No bleeding.
• An outpatient procedure can be performed.
• Short postoperative period.
• Suitable for men with bleeding problems.

This method still has negative sides:

• Takes quite a long time (2 times longer than the TOUR).
• An expensive device that not every clinic can afford.

Enucleation

This option is based on "peeling" the tissue that needs to be removed using a laser. This method has become an excellent substitute for TUR and adenomectomy.

Advantages:

• Extracted tissue can be sent for histological analysis to check for abnormal cells.
• This manipulation can be performed when the prostate grows up to two hundred grams and even more.
• Short postoperative period.
• The method is suitable for patients who have a pacemaker, metal parts and devices built into the skeleton.
• Patients with bleeding disorders can be manipulated.

However, the procedure has a number of limitations:

• Shrunken bladder.
• The general condition is serious.
• Inflammation in the body.
• Inability to pass a resectoscope through the ureter.

In the main, contraindications are related to all options for the operation.

Complications

The negative consequences of TUR include:

• Large blood loss.
• Fluid that is used to flush the bladder may enter the patient's vascular bed.
• The likelihood of complications increases with the duration of the operation. The duration of the manipulation directly depends on the volume of the prostate gland.
• In the future, the man may experience the consequences of the operation.
• Urinary incontinence may be frolicking.
• Abnormalities in the reproductive system.

During open surgery to remove adenoma of the prostate gland, complications will be the same as during TUR.

After adenomectomy, more complications will be added, which are due to the peculiarities of this method:

• Appearance of urinary fistulas.
• Attachment of infection to wounds.
• Urinary leakage.
• Long recovery period - up to 10 days.

There are many methods of dealing with this pathology, but the main link in taking the necessary therapy is the doctor.