The surgical treatment of benign prostatic hyperplasia remains very relevant to the issue of the urology modern. Despite what the professionals of all the forces that try to reduce the percentage of surgical interventions, they still need not less than one-third of the patients.
The operation of the adenoma of the prostate often becomes the only way out, not only able to rid the man of the tumor, but also improve your quality of life, as well as urinary problems often is not possible to solve the problem by any other technique.
By the frequency of prostate surgery occupy a solid second place in urology. Up to the time of his postpone, battling the disease with the use of drugs, but conservative therapy gives only a temporary effect, so that three out of every ten patients are forced to lie down under the scalpel of a surgeon.
The choice of a particular method of surgical treatment depends on the size of the tumor, the age of the patient, the presence of comorbidities, the technical capacity of the clinic and the staff. It is not a secret, that any interventional procedure is the risk of various complications, and with the age of your probability only increases, therefore, the readings and contraindications the field of urology are adjusted very carefully.
Indications and contraindications to the surgery
Indications to the surgical removal of the adenoma of the prostate are:
- A strong narrowing of the urethra, with the dysfunction of the bladder, when the latter is delayed by a large volume of urine;
- The stones in the bladder;
- Chronic renal failure;
- Acute urinary retention that is repeated several times;
- The infection and inflammatory changes in the organs of the urinary system.
In the case of tumors, when the volume of the prostate exceeds 80-100 ml, it has a lot of stones in the bladder, the structural changes of the bladder wall (diverticula) priority will be given to the open and radical surgery – adenomectomy.
If the tumor of the mammary gland do not exceed 80 ml in volume, can be passed transurethral resection adenoma. Without a strong inflammatory process of the stones, a small adenoma are preferable to endoscopic of the methodology with the use of laser, electrical current.
As with any type of surgical treatment, the surgery has its contraindications, including:
- Heavy decompensated pathology of the heart and of the lungs (due to the need to perform a general anesthesia, the risk of bleeding);
- The acute renal failure;
- Acute cystitis, pyelonephritis (operate after the removal of the inflammatory phenomena treble);
- Acute general infectious diseases;
- Aneurysm of the aorta and heavy of atherosclerosis.
It is clear that many of the contraindications they can go in the category of relative, since the adenoma in one way or another, there is to remove, so in your case the patient be sent to a correction of the violations, which will make the operation more secure.
Types of operations in the adenoma of prostate
Depending on the amount of intervention and the access distinguish different forms of removal of the tumor:
- Open adenomectomy;
- Transurethral resection;
- Minimally invasive and endoscopic procedures, laser vaporization, kriodestruktsiya, microwave therapy etc
Treatment of adenoma of the prostate through open surgery three decades ago was almost the only way to remove the tumor. Today invented many other methods of treatment, but this intervention does not lose its relevance. Indications for the operation of this type are the large tumors (more than 80 ml), related to stones and diverticula of the bladder, the possibility of malignant transformation of the adenoma.
Open adenomectomy occurs through the open end of the bladder, by what is called the abdominal operation. This intervention requires general anesthesia, and in its contraindications, it is possible for the anesthesia.
The progress of an operation adenomectomy includes several steps:
- After treatment of the disinfectant solution and the shaved hair, it is made the incision of the skin and subcutaneous tissue of the abdomen in longitudinal and cross-sectional (does not play the beginning of the function and determines the preferences of the doctor and the tactics adopted, in particular, of the clinical);
- After reaching the front of the wall of the bladder, the last cut, the surgeon examines the wall and the contents of the authority on the topic of the stones, bumps, neoplasms;
- Digital selection and extraction of tumor tissue through the bladder.
The most responsible stage of the operation is considered to be the removal of the tumor itself, the compression spaces of the urethra, the surgeon makes with the finger. Manipulation requires skill and experience, after that the doctor acts practically blind, focusing only on their tactile sensations.
When you reach the toe of the inner hole of the urethra, the urologist gently breaks down the mucus membrane and the finger clean of the tumor tissue, which has already pushed the gland periphery. To facilitate the selection of the adenoma-finger of the other hand introduced into the anus, the surgeon may move the prostate upward and forward.
When the tumor is highlighted, is obtained through open of the bladder, trying to act with the utmost care to not damage other organs and structures. Received tumor mass in the form of compulsory targets histologically.
In the early post operative period high chance of bleeding, since none of the methods is not able to completely remove that is the consequence of the intervention. The danger consists, not so much in the volume of blood loss, but in the possibility of the education of a convolution of the blood in the bladder, which can close the outlet opening and block the exit of the urine.
For the prevention of bleeding and obstruction of the bladder to apply a constant wash sterile solution physics with the help of the tubes positioned in the lumen of the authority. The tube is left in a bubble for about a week, during which we gradually restored the damaged tissue and the wall of the vessel, the washing liquid is clean, that indicates the completion of the hemophilia.
The first few days the patient is recommended to empty the bladder, not less than once each hour, to reduce the pressure of the fluid on the wall of the authority, and that only imposed by the seams. Then, you can do it with less frequency, instead of an hour and a half-two hours. The full recovery of the pelvis can take up to three months.
Undoubted advantage of abdominal adenomectomy is its radical, that is to say, the complete and permanent removal of the tumor and its symptoms. By the high efficiency of the patient, in turn, "selfish" the long duration of the hospital stay (up to a week and a half, when, without complications, to the current, and in the case of complications during more time), the need to "survive" the general anesthesia, the risk of complications from the wound (pus, bleeding, fistulae), the presence of the scar on the front of the abdominal wall.
Transurethral resection of the
Transurethral resection (the TOUR), who is considered the "gold standard" in the treatment of benign prostate hyperplasia. This operation is performed more often, and, however, it is very difficult, it requires the perfection of the master and the jewelry of the technique of the surgeon. The TOUR shows that patients with adenoma of the breast volume not to exceed 80 ml, and when the expected duration of the intervention no more than an hour. In the case of tumors, or the probability of malignant transformation of tumors of preference open adenomectomy.
The advantages of the TOUR, is the lack of postoperative seams and hems, short rehabilitation period and quick improve the well-being of the patient. Among the shortcomings of the inability of the removal of large adenomas, as well as the need to work in the clinic of more sophisticated equipment and expensive, who knows how to use trained and experienced to the surgeon.
The essence of the trans-urethral removal of the adenoma is in the section of tumors of access through the urethra. The surgeon with the endoscopic instruments (resectoscope) penetrates into the canal of the urethra into the bladder, you see, is the place of the location of the tumor and extracts of your group tie.
The duration of the surgery is limited to out-of-hours. This is related to the characteristics of the posture of the sick – he is in the back, feet apart and raised, as well as with a long-term presence in the urethra of a fairly large diameter of the tool, which may cause later pain and bleeding.
Adenoma excised by parts, in the form of chips, up to the moment, as it appears in the view box of the parenchyma of the gland. The bladder at this time accumulates a considerable amount of fluid with the float in it "thin chips" of the tumor, which is removed by a special instrument.
After excision of the tumor and the washing of the cavity of the bladder surgeon once more verify the absence of bleeding vessels, which can be coagulated power. If everything is in order, a resectoscope is retrieved to the outside, and in the bladder, inserted a Foley catheter.
After removal of the catheter men notice a significant relief of the urine comes out free and a good jet, but the first time that the urine may be reddish in color. Fear is not worth, this is normal and should not happen again. In the postoperative period it is recommended to urinate frequently, to avoid the stretching of the walls of the bubble, allowing it to regenerate the mucosa.
Between soft techniques of treatment of adenoma of prostate lead to laparoscopic removal. Is carried out with the help of machinery introduced into the pelvic cavity through the perforations of the abdominal wall. Technically, these operations are complex, require penetration into the interior of the body, therefore, the preference of the same is given BACK.
Minimally invasive operations on the prostate
Minimally invasive ways of dealing with success are developed and are incorporated in the different fields of surgery, in particular, and of urology. These include:
- A thermo-therapy;
- Vaporization with the aid of electric current;
- Electrocoagulation tumor;
- Laser ablationem.
The advantages of the minimally invasive treatment are the relative safety, the less number of complications in comparison with the operations, a short period of rehabilitation, without the need of general anesthesia and the possibility of its application in men, the surgery is contraindicated, in principle, by a number of co-morbidities (severe failure of heart and lungs, the pathology of the blood clotting disorder, diabetes mellitus, arterial hypertension).
Common in these techniques, it may be considered that the access through the urethra without cuts of the skin and the possibility of local anesthesia. The differences consist only in the form of physical energy, which destroys the tumor – laser, ultrasound, electricity, etc
Area of thermotherapy consists in the influence in the tissue of the neoplasms of high radar, which is heated and destroyed. The method can be applied as transurethral, and through the introduction of a straight-osprey in the rectum, the mucosa during the procedure it is not damaged.
The vaporization takes the heat from the fabric, the evaporation of liquid from the cells and their destruction. This effect can be achieved by acting electric, laser, ultrasound. The procedure is safe and effective.
When kriodestruktsii, on the contrary, the adenoma is destroyed by the action of the cold. The standard tool for this purpose is liquid nitrogen. The wall of the urethra during the procedure is heated to avoid damage.
The treatment of adenoma of the prostate with laser is very effective and one of the most modern methods of getting rid of a tumor. Its meaning lies in the action in tumor tissue of the laser radiation and at the same time of coagulation. Advantages of laser treatment – the speed, the security, the possibility of applying the heavy-duty and elderly patients. The effectiveness of the laser removal of the prostate is comparable with such when ROTATED, with the possibility of complications times less.
Laser vaporization is, as the saying goes, "the last peep" in the field of minimally invasive treatment of adenoma of prostate. The impact carried out with laser, emission of green rays, which gives rise to the boiling of the water in the cells of the tumor, evaporation, and destruction of the parenchyma adenoma. Complications related to the treatment almost does not happen, and patients notice rapid improvement of well-being after the surgery.
Possible effects of surgery on the adenoma of the prostate, and the rehabilitation of
No matter surgeons, exclude possible complications of radical treatment is not can. Have an especially high risk when an abdominal operation, you have the TOUR, and in the case of the ablation endoscopy is minimum.
The most frequent complications early post-operative, can be considered:
- Infectious-inflammatory changes;
- The thrombosis of the leg veins, pulmonary artery and its branches.
Most of the long-term effects develop within the organs of the pelvis. Is a narrowing (stricture) of the urethra in the background of the expansion of the connective tissue, sclerosis of the bladder wall in place of discharge from the urethra, disorders of the sexual function, incontinence of urine.
For the prevention of complications, it is important to follow your doctor's instructions about the behavior immediately after the intervention, as well as at later dates, until the fabric is fully recouped. In the postoperative period should be:
- Limit physical activity no less than in the month;
- Exclude sexual activity in a month, as a minimum;
- Have a good regime of drinking, and timely emptying of the bladder (the better – more often);
- Give up spicy, spicy, salty, alcohol, coffee;
- Every day you perform the exercise to activate blood flow and improve the overall tone.
The treatment of adenoma can pass free of charge in a public hospital, but many patients choose to pay for the operation. Its cost is very variable, depending on the level of the clinic, of the machinery and of the town.