Surgical treatment of BPH remains a very current problem in modern urology. Despite the fact that the experts struggling to reduce the rate of surgical interventions, there is still at least a third of patients.
The surgery for BPH is often the only solution, which is able not only to supply the tumor, and improves the quality of life, like problems with urination, it is often impossible to solve by any other methods.
The frequency of the surgical procedure the prostate gland is a solid second place in urology. From time to time smooth, to fight the disease, drug treatment, conservative treatment gives only a temporary effect, three of ten patients are forced under the surgeon's knife.
The choice of specific method of surgical treatment depends on the size of the tumor, the age of the patient, presence of comorbidities, the technical skills, the staff of the clinic. It's no secret that any invasive procedure carries the risk of more complications, and the probability only increases, and the indications, contraindications urologist very carefully.
Indications, contraindications for the surgery
The surgical removal of the prostate gland:
- A strong narrowing of the urethra, disorders of the bladder, when the past lingers large amount of urine;
- Stones in the bladder;
- Chronic renal failure;
- Acute urination, several times;
- Infection, inflammatory lesions of the organs of the urogenital system.
The large cancer, when the prostate volume exceeds 80-100 ml, the presence of multiple bladder stones, structural changes in the bladder wall (diverticula) priority must be given to open radical surgery – adenomectomy.
If the tumor the gland should not exceed 80 ml in volume, then a transurethral resection of the adenoma. In the absence of a strong inflammatory process, the stones, the small adenomas of the desired endoscopic technique using a laser, electrical current.
Like any kind of surgical treatment, the operation of the contraindications, which are the following:
- Severe decompensated pathology of the heart, the lungs (as the general anesthesia, risk of bleeding);
- Acute renal failure;
- Acute cystitis, pyelonephritis (works after the elimination of acute inflammatory effects);
- Acute general infectious diseases;
- The aortic aneurysms, and severe atherosclerosis.
It is clear that many contraindications to move into the category of relative, because the adenoma or you have to remove, if available, the patient is referred to the pre-correction of existing violations, which ensures that the next operation safer.
Types of operations for BPH
Depending on the scope of the intervention and the access to the different methods of tumor removal:
- Open adenomectomy;
- Transurethral resection;
- Minimally invasive, endoscopic procedures, laser vaporization, cryosurgery, microwave therapy, etc.
Surgical treatment of the prostate through open surgery, a three decades ago, it was almost the only way to remove the tumor. Today invented many other methods of treatment, but this intervention does not lose its significance. The indications for such surgery include large tumors (more than 80 ml.), related stones, diverticula of the bladder, the possibility of malignant transformation of the adenoma.
Open adenomectomy via the exposed bladder, which is why it is called abdominal surgery. This procedure requires general anesthesia, and any contraindications to spinal anesthesia.
The operation adenomectomy includes several steps:
- After the treatment, disinfectant solution, shave, hair, skin incision, subcutaneous tissue, the abdomen, the longitudinal, transverse direction (not important and is determined by the doctor settings and tactics, adopted in a given clinic);
- After reaching the wall of the bladder, the latter is separated, the surgeon examines the walls of the content, the theme of the stones, growths, tumors;
- Finger distance, the tumor tissue is removed through the bladder.
The most critical stage of this operation is the removal of the tumor, compressing the openings of the urethra, which the surgeon performed with your finger. Manipulation requires skill, experience, because the doctor acts really blind, pointed out that only the tangible things.
When he reached the index finger to the internal opening of the urethra, the urologist gently tearing the mucous membranes and the finger and delete the tumor tissue, which has been pushed to the periphery of the gland. To facilitate the selection of the adenoma with a finger of the other hand into the anus, the surgeon may move the prostate upward, then forward.
If the tumor is selected, it is removed through the open blister, try to do, be careful not to damage other organs and structures. Received the tumor mass is mandatory is sent to the histological examination.
In the early postoperative period, most likely the bleeding as one of the known methods are not able to eliminate the effect of the intervention. The danger is not so much the blood loss than the formation as a convolution, the blood, the bladder, which close the outlet and block the urine.
The prevention of bleeding, obstruction of the bladder to apply a constant irrigation with sterile saline through a tube placed in the lumen of the organ. The tube stays in the bladder for approximately one week, during which gradually regenerate the damaged tissue, blood vessels, the washing liquid becomes clear, indicating that the performance of bleeding.
The first few days, the patient empty the bladder at least once an hour to reduce the liquid pressure against the walls of the body, just eyes. You can then do it less often – time, the one and a half to two hours. Complete reconstruction of the pelvic organs, it may be three months.
The undoubted advantage of abdominal adenomectomy is considered the radical, i.e., a full, irrevocable removal of the tumor and the symptoms. High efficiency the patient, but the "pay" the prolonged hospital stay (up to six weeks just in case of complications – even further), to "experience" the general anesthesia, the risk of complications in the operating wound (abscess, bleeding, fistulae), the presence of postoperative scar on the anterior wall of the abdomen.
Transurethral resection of the
Transurethral resection (TUR) is regarded as the "gold standard" treatment of benign prostatic hyperplasia. This operation is the most common, however, is very complex, requires many skills, jewelry techniques surgeon. TOUR indicated in patients with adenoma, which is the volume of the breast does not exceed 80 ml., a proposed duration of intervention less than an hour. The large tumors, and the risk of malignant transformation of the tumor advantage in open adenomectomy.
The advantages of the TOUR is the lack of stitches, scars, short recovery period, rapid improvement in the health of the patient. Among the disadvantages of impossible to remove a large adenoma, and also that there is a need in the clinic is complicated, expensive piece of equipment that can use a skilled, experienced surgeon.
The point is that the TRANS-urethral removal of the adenoma for excision of the tumour through the urethra. Surgeon using endoscopic tools (resectoscope) penetrates through the urethra into the bladder, view, find the location of the tumor, and remove it from the loop.
The duration of the operation closed within the hour. This is due to the posture of the patient lying on his back, legs raised and separated, as well as the long-term presence of the urethra is fairly large diameter device, which may cause later pain, bleeding.
The adenoma was excised piece by piece, in the form of chips, until appears the field of view of the parenchyma of the gland. The bladder at this time accumulated a significant amount of liquid floating in the "chips" tumors removed with a special tool.
After excision of the tumor, irrigating the cavity, the bladder, the surgeon, again confirming the absence of bleeding vessels can be coagulated by electric current. If everything is ok, the resectoscope to remove the bladder catheter Foley.
After removal of the catheter, the men significant relief, the urine freely, is a good machine, but the first urination can be painted a reddish color. Don't worry, this is normal and should not happen again. In the postoperative period is often recommended for stimulus to prevent the stretching of the bladder walls, which allows you to regenerate mucosa.
Among the gentle methods of treatment of BPH includes laparoscopic removal. Carried out using equipment, into the pelvic cavity through puncture of the abdominal wall. Technically, such operations are complex, require penetration into the body, then the preference will be given to the TOUR.
Minimally invasive prostate surgery
Minimally invasive methods of treatment successfully developed and implemented the different areas of surgery, including urology. These are the following:
- Microwave thermo-therapy;
- Ablation using an electrical current;
- Electrocoagulation of the tumor;
- Laser ablatio.
Advantages of the minimally invasive treatment of relative safety, fewer complications compared to open surgery, a short rehabilitation period, you don't have the general anesthesia or the possibility of its application in men, which surgery is contraindicated, in principle, a number of comorbidities (severe heart failure, pulmonary pathology, blood clotting, diabetes, high blood pressure).
Usually these methods are considered to be access through the urethra without incision of the skin, as well as the possibility that the local anesthesia. The only difference is that the physical energy that destroys the tumor, laser, ultrasound, electric current, etc.
Microwave thermotherapy is exposed to the tissue, the tumors, the high frequency microwave oven, which heats up, the destroy. The method can be applied to both transurethral, through the introduction of the recto-osprey, the rectum, the mucous membrane, where the procedure is not damaged.
Vaporization leads to heating of the tissue, the evaporation of the liquid in the cells destruction. This effect can be achieved, like an electric current, laser, ultrasound. The procedure is safe, effective.
During cryoablation, on the contrary, the adenoma was destroyed by the action of cold. The standard method to the liquid nitrogen. The wall of the urethra during the procedure, warmed, to prevent the damage.
Treatment of BPH by laser is a very effective in the most modern ways of getting rid of the tumor. The idea of the action in the tumor tissue to the laser radiation with simultaneous coagulation. Advantages of laser treatment – the speed, the security, the possibility of use in severe and elderly patients. The efficiency of laser removal of the prostate is similar to the TOUR, the probability of complications is significantly lower.
Laser ablation , as they say, "the last peep" in the field on the minimally invasive treatment of BPH. The exposure is carried out with the laser beam of green rays, which leads to boiling the water in the cells of the tumor, the evaporation and destruction of the parenchyma of the prostate. Complications such treatment practically does not occur, the patient reported rapid improvement in health after surgery.
Possible effects of the surgery, BPH, rehabilitation
No matter how hard the surgeons to completely eliminate the possible complications of radical treatment impossible. In particular, a high risk of abdominal surgery, when the TOUR, as well as in the case of endoscopic removal to a minimum.
The most common complications in the early postoperative period can be considered:
- Infectious-inflammatory changes;
- Thrombosis in the leg veins, pulmonary artery, and the branches.
More long-term effects developing within the organs of the small pelvis. This stricture (narrowing) of the urethra, the background of the proliferation of the connective tissue, sclerosis of the bladder wall, the place of origin, of the urethra, sexual dysfunction, urinary incontinence.
To prevent complications it is important to follow your doctor's recommendations on behaviour immediately after the procedure or at a later date, until the tissue fully recovered. In the postoperative period:
- Limited physical activity no less than a month;
- To exclude sexual activity for at least a month;
- To ensure a good drinking regime in time for bladder emptying (preferably more often);
- Leave the spicy, pungent, salty foods, alcohol, coffee;
- To perform the daily exercise that enhances the blood circulation, improves the general tone.
Treatment of adenoma can be free in a public hospital, but many patients choose paid transactions. The price is very variable, depending on the level of the clinic, equipment and settlement.