Laser ablation of the prostate: existing techniques

Not so long ago, a diagnosis of prostate adenoma sounded like a death sentence for a man on his intimate life.

Modern surgical techniques based on the use of lasers make it possible to treat this disease without long-term negative consequences for erectile function.

Laser enucleation of prostate adenoma is considered the most effective technique. It is suitable for men of any age. Large tumors larger than 100 cm3 can be removed.

What is laser enucleation of prostate adenoma

The term enucleation comes from the Latin word enucleo, roughly translated as “to take the nucleus out of the shell.” This definition denotes the type of operations to remove round tumors and enclosed organs.

Laser enucleation of prostate adenoma is the excision of hyperplastic tissue nodes in a single block using a laser beam.

The operation is considered minimally invasive (low-traumatic), since it is performed through the urethra without incisions on the body.

To excise the adenoma, a laser unit is used, with a resectoscope connected to it, through the working part of which a laser fiber passes. The doctor sees all manipulations on the monitor.

Laser resectoscope

Indications for enucleation:

• Large size of hyperplasia;
• Erectile dysfunction;
• Difficulty urinating or defecating due to pressure from the enlarged adenoma;
• The risk of developing renal pathologies due to accumulating residual urine.

The main advantages of the technique:

1. You can remove hyperplasia of any size efficiently and quickly. There are no areas left from which a new tumor will subsequently develop.
2. The risk of infection and bleeding is minimized, since the laser beam immediately seals and simultaneously disinfects the incised tissue.
3. Large adenomas (up to 200 g) can be removed.
4. Erectile function is quickly restored.
5. Tissue remains for histological examination to exclude a malignant process. After evaporation (vaporization), there is nothing to take for analysis.
6. Minimum period of wearing a catheter (up to 2 days). This allows you to reduce the risk of post-operative infection and speed up the normalization of the urination process.
7. Short rehabilitation period. The patient is discharged within 2-3 days.

The surgeon performing transurethral laser enucleation must be a professional, otherwise the patient will not be able to appreciate the benefits of the technique. Removal of tissue is carried out very painstakingly - 1 g per minute.

General scheme of laser enucleation

Contraindications to laser enucleation of adenoma:

• Hemophilia – pathologically high tendency to bleeding;
• Oncological tumor of the prostate;
• Hypertension;
• Hepatitis;
• Acute inflammatory processes in the body;
• Cardiac ischemia.

A contraindication to enucleation is also the lack of technical ability to place the patient in the desired position and insert the instrument into the urethra. An example is ankylosis of the femoral joints, narrowing of the lumen of the urethra.

Preparing for surgery

Enucleation of the prostate is prescribed after an examination, which necessarily includes TRUS of the prostate or MRI of the pelvis. The doctor must calculate the size of the adenoma, determine the direction of its growth, and also make sure that there is no cancer. This may require a biopsy. After this, the operation can be performed only after 6-8 weeks.

In preparation for the procedure, the patient undergoes a standard set of tests:

1. ECG.
2. Blood for HIV, syphilis, hepatitis.
3. General and biochemical analysis of blood and urine.
4. If necessary, a sample of ejaculate, prostatic juice, and blood is taken for PSA.

As for taking blood thinning drugs, some clinics require their complete withdrawal 4-5 days before surgery, others transfer the patient to low molecular weight heparin. Anticoagulant therapy can be resumed 10 days after surgery.

Before the enucleation procedure, you must not eat for 8 hours. On the day of surgery, a cleansing enema is performed and hair is removed from the groin and upper thighs. If the patient has acute urinary retention, then remove the cystostomy (tube) directly from the bladder.

Preparation also includes a mandatory conversation with an anesthesiologist, who will select the optimal type of anesthesia. Enucleation is usually performed under spinal anesthesia.

This method involves injecting an anesthetic into the space surrounding the spinal cord (into the cerebrospinal fluid washing it). The puncture is made in the lumbar region.

After 3-5 minutes, sensitivity will dull, but consciousness will be preserved.

Scheme of spinal and epidural anesthesia

Carrying out enucleation

There are several types of laser enucleation depending on the type of beam and technique. The operation lasts from 45 to 90 minutes.

Thulium enucleation

Thulium enucleation (ThuLEP - Thulium laser enucleation of the prostate) was introduced into practice in 2005. Russian scientists have created a laser that is superior in its characteristics to foreign analogues. The thulium laser beam differs from the holmium laser beam in the continuity of the radiation flux, as well as in the depth of penetration into the tissue - only 0.2 mm.

Technique:

1. An endoscope is inserted into the bladder.
2. A laser fiber is immersed into the channel of the device so that its end is 1 cm away from the optics and directed downwards - at 6 o'clock.
3. Next, incisions are made through the entire thickness of the hyperplastic tissue at the 5 and 6 o'clock positions. To seal the vessels, the fiber is moved back 5 mm.
4. By making several incisions, the left lobe is first removed, the tissue is sent to the bladder, and then the right.
5. The laser fiber in the working part of the endoscope is replaced with a morcellator knife, which is used to suction, grind and remove tissue from the bladder.
6. The final step is to insert a catheter connected to the flushing system into the bladder and remove all remaining particles.

The above technique is called two-lobe. If the middle lobe is also very pronounced, then a three-lobe lobe is used.

Schematic representation of enucleationVideo of laser enucleation with a pulsed beam

Holmium enucleation

Holmium enucleation is the excision of an adenoma using a laser beam that is formed by a holmium crystal (Ho:YAG). There are two varieties: HoLRP and HoLEP.

In the first case, the cut tissue is removed through the ureter, in the second, it is pushed into the bladder and then washed out from there using a morcellator. The last method is more advanced.

Technically, holmium enucleation is carried out in the same way as thulium enucleation.

Advantages:

• This type of beam provides a clear cut line.
• Damaged vessels twist without forming blood clots. This is very important when removing large adenomas.
• No carbon deposits accumulate at the end of the working part.
• The beam does not cause injury because the pulse does not penetrate deeper than 0.4 mm.

Professor, Deputy Director for Innovative Technologies at the Urology Clinic of Sechenov University Dmitry Tsarichenko and surgeon Dmitry Enikeev talk about how holmium enucleation (HoLEP) is performed

The clinical effectiveness of the technique is not lower than classical TURP, but the safety is much higher. However, HoLEP is still not widely used because it requires lengthy training for specialists. According to various sources, a doctor must perform from 30 to 50 enucleations to achieve the required level of skill.

Alternative methods of endoscopic enucleation of the prostate: mono- and bipolar

Mono- and bipolar enucleation refers to electrosurgery methods. In the first case, a monopolar electrode is used. The technique is called MEP. In the second - bipolar.

Monopolar electrode and clinical picture of adenoma tissue dissection

Bipolar enucleation of the prostate is performed using an electric loop located at the end of the resectoscope. The international designation of the technique is TUEB (TransUrethral Enucleation with Bipolar). In terms of efficiency, it is not much inferior to laser enucleation; it is also suitable for removing large adenomas, but it is significantly cheaper.

Working part (tip) of a resectoscope for bipolar enucleation Stages of TUEB Recommendations of the European Association of Urology on the choice of treatment method for adenoma (2016)

Rehabilitation after laser enucleation of prostate adenoma

In the first 12 hours after enucleation, blood may be discharged from the urethra, including during urination. During this period, you should drink as much water as possible to rinse your bladder and surgical area. Small spots of blood may appear for several weeks - this is not dangerous.

On the first day you can already eat light food: porridge, stewed vegetables, mashed potatoes. You can’t eat flour, spicy, fatty foods, as well as legumes, apples, cabbage. Increased gas formation and constipation will cause pain in the groin and rectal area.

Possible consequences

In the first week after enucleation, the patient may experience the following complications:

• Slight burning sensation when urinating, increased urge;
• A small amount of blood in the urine;
• Cystitis.

In the first 6 weeks, urinary incontinence is possible. If the pelvic floor muscles are trained, the problem is solved faster. Kegel exercises speed up the recovery of urinary function.

More serious complications include:

1. Infection of the kidneys and testicles.
2. Detection of tissue remains in the bladder.
3. Urethral stricture.
4. Scarring of the bladder neck.

The quality of sexual life should not deteriorate, but only if it was satisfactory before enucleation. Intimate life can be resumed after a month.

Characteristics of erectile function six months after holmium enucleation (based on the practice of the Urology Clinic of Sechenov University) After thulium enucleation

88% of men after complete enucleation do not have sperm during orgasm. This is due to damage to the muscular obturator mechanism (retrograde ejaculation) and lack of prostatic juice.

Difference between vaporization and enucleation

The laser vaporization technique involves evaporation of tissue, that is, nothing remains for histological analysis. The dead particles will continue to come out along with the urine for some time.

Vaporization is used to remove small adenomas (30-80 cm3). Rehabilitation takes only a day. The chance of relapse is 20%. Enucleation efficiency is 99%.

Laser enucleationLaser vaporization

Where is the operation performed?

Enucleation is expensive due to the technical difficulty of performing it. If the gland is very large, with a developed vascular network, then you can only trust a very experienced surgeon operating in a public clinic.

Where can enucleation be performed:

• Clinic of Urology of the University. Sechenov (Moscow);
• Clinic "MEDSI" (Moscow);
• Military Medical Academy (St. Petersburg);
• Alexandrovskaya Hospital (St. Petersburg);
• Central Clinical Hospital of the Russian Academy of Sciences (Moscow).

The cost of laser enucleation of BPH starts from 75 thousand rubles. The operation can be done free of charge under the compulsory medical insurance policy, having received a referral from the attending physician.

Patient reviews

Alexander, 58 years old: “I removed a large adenoma using holmium enucleation at the Sechenov Institute. It was expensive, but the result is worth the money: after a month I forgot about any discomfort, after 3 months urination was restored.”

Dmitry, 61 years old: “I was unlucky with the operation for an adenoma. They did TURP, and after a few years the adenoma began to grow again, pressing down on the urethra. I already did it with a laser for the second time. They completely peeled it off. I hope there will be no more relapses. There have been no signs for 4 years.”

Conclusion

Enucleation of adenoma with a thulium and holmium laser is considered the safest and most effective technique with an extremely low risk of relapse.

Hyperplastic tissue is removed completely, bloodlessly and quickly enough. The downside is the high price and low prevalence.

Enucleation is the best option for surgical treatment of large adenomas; the larger the formation, the technically easier it is to remove it.

Sources:

Source: https://muzhchina.info/prostata/adenoma/lazernaya-enukleaciya

Rehabilitation after laser enucleation of adenoma

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Prostate adenoma with pronounced clinical manifestations is an indication for surgical intervention. Currently, surgical care for benign prostatic hyperplasia is carried out using various methods, both traditional surgical and using the latest technologies - laser, radio waves, plasma. Even prostate adenoma is treated in one session.

Adenomectomy is performed in a traditional way, requires general anesthesia and has associated contraindications.

Transurethral resection is the surgical removal of hyperplastic prostate tissue with access through the urethra and is an endoscopic technique.

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In addition, mini-interventions are used, such as needle ablation, when needles (electrodes) are inserted into the prostate tissue and coagulate the tissue locally.

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The advantages of laser methods are their minimally invasiveness, targeted and controllable effects, parallel coagulation of the tissue being removed and a significant reduction in the risk of bleeding and infectious complications. Laser techniques include ablation, resection, enucleation and vaporization. They all differ from each other in the way they affect the affected tissue.

The most innovative method of vaporization using a green laser is the evaporation of glandular tissue. The process of patient rehabilitation after such an intervention is not long and does not require significant costs.

The laser method is especially indicated for patients with severe concomitant pathologies - diabetes, hypertension, and coronary heart disease.

To the question “What is the safest laser treatment for prostate adenoma?” We can answer that today, of all the proposed methods, the safest is the laser vaporization method.

Prices for laser treatment of prostate adenoma vary significantly depending on the level of the clinic and the territorial location of the surgical intervention. Since this is an innovative technique, such equipment is not available everywhere.

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• In Ukraine, the price for removing prostate adenoma with a laser varies slightly depending on the location; treatment of prostate adenoma with a laser will cost from 12 to 24 thousand hryvnia, in Kyiv the minimum price is from 16 thousand, and in Kharkov from 12 thousand hryvnia.
• In Russia, laser installations are present in large medical centers and departmental associations. Depending on the city and institution, the lower price limit varies from 10,000 rubles per procedure, in cities such as Kirov, Samara, Rostov, Voronezh, Saratov, Krasnodar. In St. Petersburg and Novosibirsk, the lower price level is 20 thousand rubles. In Moscow, laser technologies are represented quite widely; the price for removing prostate adenoma with a laser starts from 30 thousand rubles, while the average price in Moscow is about 55 thousand rubles. Prices for laser surgery in Moscow are the highest in Russia, the maximum cost is noted at 150 thousand rubles.
• Laser treatment of prostate adenoma in Belarus is carried out in Minsk, the average price is about 3 million Belarusian rubles.
• Treatment abroad will cost more. The price of the operation in Israel is about 16 thousand dollars, in Germany about 14 thousand euros, in Turkey 10 thousand euros, in South Korea from 4.5 thousand dollars.

As a rule, high-quality surgical intervention for prostate adenoma provides the patient with a long period without symptoms of urinary disorders, about 10-14 years, and with proper prophylaxis of prostate adenoma even longer. Repeated operations are performed extremely rarely. In case of severe recurrent course of the disease, palliative intervention is performed - the patient is placed a stent in the lumen of the bladder at the site of compression by prostate tissue.

The rehabilitation process after removal of an adenoma takes about 2 weeks, during which the patient is advised to drink plenty of fluids, perform rational physical activity and physical therapy exercises, while avoiding heavy physical activity and sudden movements.

If necessary, antibiotic therapy is carried out. It is necessary to normalize your diet and give up all spicy fried and salty foods, do not drink alcohol, monitor the regularity of bowel movements and avoid constipation. You should also abstain from sexual activity for 1-2 months.

After surgery, swelling of the urethral mucosa is possible, so you will need to use urinary catheters for some time. Rehabilitation should take place under the supervision and control of the attending physician.

Laser enucleation of prostate adenoma: review and prices

Among modern methods in the surgery of benign prostatic hyperplasia, the use of a holmium laser for surgical procedures has good reviews among patients.

The laser enucleation method involves removing prostate adenoma tissue that obstructs the outflow of urine. Its other name is Holmium laser enucleation of the prostate (HoLEP).

The area of ​​the male external genitalia is treated with antiseptics to prevent infection. Then, through transurethral access, prostate tissue is isolated and separated from the capsule by laser lobes.

Next, the use of a special device is required - a morcellator, the use of which allows them to be divided into small pieces and removed from the patient’s bladder.

Laser enucleation of prostate adenoma essentially resembles a traditional adenectomy performed with a scalpel. It shows good results, but requires appropriate equipment and highly qualified surgeons, therefore it is not performed in all medical institutions.

The price for laser enucleation of prostate adenoma in the former CIS varies, and its lower level ranges from 30-40 thousand rubles. The method is presented in large scientific institutes in Moscow, St. Petersburg, Novosibirsk.

When treated abroad for laser enucleation of prostate adenoma, the price will range from 4.5 to 18 thousand dollars.

Laser vaporization of prostate adenoma: types of surgery and price review

This method affects those gland tissues that have good vascularization, this occurs due to the photoselectivity of laser radiation to hemoglobin. Laser removal of prostate adenoma occurs by evaporation of vascularized glandular tissue, preserving the stroma and capsule.

Since the laser beam penetrates the tissue no more than one millimeter, laser vaporization of prostate adenoma is carried out layer by layer, one millimeter at a time, under the visual control of the surgeon.

Laser vaporization of prostate adenoma with a green laser is performed under local anesthesia through transurethral access.

After tissue removal with this method, there is no need to remove the excised areas, and the risk of bleeding is minimal. A disadvantage in this case may be the impossibility of histological examination of the removed material.

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Vaporization is carried out in many medical centers and is presented not only in Moscow, but also in clinics in other cities, for example Izhevsk, Yekaterinburg, Tula. For surgical treatment of vaporization of prostate adenoma with a surgical laser, the price greatly depends on the level of the clinic and territorial location.

Laser resection of prostate adenoma: how the operation is performed

Laser resection of prostate adenoma is similar to transurethral resection (TUR) and differs in the use of the Holmin laser (HoLRP). This is an effective type of surgical intervention, with a significant size of the prostate gland, it allows for partial resection, reducing the volume of the gland and removing obstacles to the outflow of urine.

This method can also be used in case of kidney tumor. During the operation, the doctor removes the prostate tissue adjacent to the urethra in small pieces and removes them.

Prices for laser resection of prostate adenoma in Moscow range from 50 to 100 thousand rubles.

Plasma ablation of prostate adenoma: description and advantages

The name ablation itself implies local burning, or coagulation of tissue, in this case the prostate gland. Ablation can be needle ablation, when a needle is inserted transurethrally into the thickness of the tissue - an electrode for subsequent exposure. Through a needle, they are locally exposed to radio waves, lasers, and plasma, causing the formation of small foci of necrosis, with their subsequent scarring and, due to this, a decrease in the volume of proliferation of prostate tissue and, accordingly, an obstacle to urination.

This method allows you to reduce symptoms and solve the problem of difficulty urinating, especially in older patients, since it is minimally invasive, performed under local anesthesia and avoids complications of general anesthesia. The rate of complications such as hematuria, acute urinary retention, and urethral stricture after ablation is quite low.

In the postoperative period, minor intoxication phenomena associated with absorption into the blood and excretion of necrotic tissue are possible; after surgery, drinking plenty of fluids is recommended. Also, such interventions are contraindicated in patients with impaired renal function.

The effectiveness of ablation in eliminating the symptoms of difficulty urinating and the subsequent prognosis depends on the extent of the intervention performed.

Source: http://testosteron-prostatit.ru/prostatit/reabilitatsiya-posle-lazernoj-enukleatsii-adenomy/

Laser vaporization, ablation and enucleation of prostate adenoma

An alternative to classical surgery for patients with BPH is a relatively new surgical method - laser removal of prostate adenoma.

The obvious advantage of this method is that it is minimally invasive and there is no need for general anesthesia.

The method has its own variations, advantages and disadvantages, which the patient should know in advance before deciding to consent to surgery.

Vaporization method

Not long ago, a method of minimally invasive surgical intervention on the prostate became available - this is laser vaporization of prostate adenoma, which has many advantages and is considered the safest method in surgery .

A special feature of this method is the use of a green laser with photoselective radiation . It affects only those tissues that need to be removed, while preserving the stroma and capsule.

Equipment is passed through the ureter, the laser penetrates the tissue layer by layer to a depth of one millimeter, evaporating the glandular tissue. During this process, the nearest vessels exposed to the laser are cauterized.

This avoids bleeding.

The process takes place under local anesthesia, and the doctor sees everything that happens on the monitor. The duration of the procedure depends on the size of the benign tumor, but lasts no more than one hour.

Advantages

• absence of scars visible on the body;
• minimal risk of complications such as bleeding;
• relatively short postoperative period;
• erectile and reproductive function is preserved;
• complete cure from adenoma;
• no symptoms for 15 years;
• minimal possibility of relapse of the disease;
• the effect is visible to the patient after a few days.

Flaws

• high cost of the procedure;
• unavailability of the method in some clinics;
• inability to perform a biopsy during the process;
• The operation time is longer than with the TUR method.

A method such as laser vaporization of prostate adenoma is allowed for people suffering from diabetes, heart and blood diseases!

Video: Urology-andrology operations in Moscow.

Laser resection method - enucleation

Laser-assisted resection, otherwise known as enucleation, is very similar to TUR (transurethral resection). It is performed even when the tumor reaches a large size.

In this case, it is possible to either remove the prostate adenoma or partially reduce its size to free up access to the outflow of urine. The process is performed with a Holmin laser , when excess tissue is crushed into pieces, which are then removed.

Bipolar and monopolar enucleation are used. The entire procedure is performed under local anesthesia.

Advantages

• the ability to alleviate the condition of patients with large tumors, up to 200 g;
• a small percentage of cases of patients seeking re-operation;
• indicated for people with kidney problems, heart and blood diseases;
• the ability to perform tissue biopsy;
• short rehabilitation period.

Disadvantages and complications

• risk of bleeding;
• the possibility of developing TUR syndrome;
• Scarring may occur in the urethra, causing it to narrow;
• the possibility of sexual dysfunction, but the risk is minimal;
• a highly qualified surgeon is required, and there are few of them;
• the impossibility of performing surgery on patients with a wrinkled bladder, severe general condition, or inflammation.

Although this method of TUR using a laser has a number of advantages, it is primarily used in relatively advanced stages of the disease. In some cases, laser enucleation of prostate adenoma is an effective replacement for traditional TUR.

Video: operation using the enucleation method.

Laser ablation

Burning prostate adenoma using laser equipment is called laser ablation method . This method also resembles TUR, but has its own characteristics, advantages, and disadvantages.

To perform an operation to remove prostate adenoma, a pulsed laser device Auriga is used, which removes prostate hyperplasia by burning it out.

To prevent the harmful effects of the laser on neighboring healthy tissues, an agent is applied to the adenoma tissue. Plasma acts as an agent.

The laser ablation method is used not only for the prostate itself, but also for the removal of tumors and calcifications in the urethra, kidneys and urinary ducts.

Advantages

• minimal risk of complications associated with urinary retention and bleeding;
• the possibility of performing laser ablation of prostate adenoma in elderly patients; local anesthesia

Disadvantages and complications

• performing laser surgery only on small prostate adenomas;
• the impossibility of laser treatment for men whose kidney function is impaired;
• the risk of developing general intoxication caused by the entry of burnt tissue fragments into the bloodstream.

As you can see, laser ablation of benign hyperplasia has very few disadvantages, and complications can be quickly eliminated. For example, intoxication is eliminated by drinking plenty of water.

Video: ablation surgery.

Conclusion

Any of the listed methods for removing prostate adenoma or laser surgery are highly effective.

But the main advantage is for a reasonable patient who, after surgery, changes his habits for the better and takes preventive measures.

Then, such operations, in combination with the efforts of the patient, can lead to getting rid of prostate adenoma without the need to be treated for it again in the future.

Source: https://ProStarenie.ru/bolezni/adenoma/lazernaya-vaporizaciya-ablyaciya-ehnukleaciya.html

How is laser removal of prostate adenoma performed in men?

Laser removal of prostate adenoma is a promising and most effective method of relieving men of urological problems associated with one of the most common pathologies of adulthood. The choice of tactics for surgical treatment of a benign prostate tumor is determined by many parameters.

The volume of the enlarged gland in men, the nature of the concomitant pathology, the presence of complications, as well as the financial capabilities of the patient play a dominant role in the method of surgical treatment of prostate hyperplasia.

Indications for surgical treatment of prostate adenoma

The main indication for surgery for adenoma is the lack of effect from long-term drug therapy.

Doctors distinguish two groups of indications for surgery: absolute and relative. Absolute (mandatory) include:

1. Presence of renal failure.
2. Dilation of the renal pelvis and ureters on both sides.
3. The amount of urine after urination is more than 200 ml.
4. Stones.
5. Bladder diverticula.
6. Acute urinary retention, lack of effect from catheterization.
7. Chronic urinary tract infection due to BPH.
8. Constant presence of blood in the urine.

Relative indications include:

• Lack of effect of drugs for the treatment of adenoma.
• Excessive growth of the middle lobe covering the urethra.
• The man's age has not reached 45 years.

At the first stage of the disease, drugs are traditionally used - alpha-blockers and 5-alpha reductase enzyme inhibitors. The drugs restore normal urination and reduce tumor size within a few weeks of starting their use.

But patients with a benign tumor at the first stage do not always see a doctor and begin treatment. In addition, medications are not a panacea and cannot completely stop the progression of the hyperplasia process. Sooner or later, some men have to consult a doctor complaining of problems with urination.

It is especially difficult to choose an intervention method for men who have concurrent diseases of the heart, lungs, liver, and kidneys. Such patients form a high surgical risk group. The modern method of using laser radiation will minimize the likelihood of postoperative complications.

Types of surgical interventions for BPH include:

1. Operations with access through the urethra: TUR (transurethral resection, laser treatment, microwave hyperthermia).
2. Laparoscopic method.
3. Abdominal surgery.
4. Embolization of prostate arteries.

The most commonly used procedure is TURP of the prostate. Using an electric loop to which current is supplied, the surgeon excises tissue with access through the urethra. However, this method has a number of significant disadvantages associated with complications and contraindications to intervention.

Prostate adenoma, which requires surgical intervention, is usually diagnosed in older patients whose medical history is burdened by many diseases and metabolic disorders.

Experts note that the most complex course of prostatic hyperplasia is observed in men who have blood clotting problems and take anticoagulants.

It is obvious that classical surgery, in particular TUR, laparoscopy or abdominal surgery, is impossible, as it creates the risk of bleeding, which poses a danger to the patient’s life.

Important!

Surgery to remove prostate adenoma with a laser is the “number one” intervention for concomitant blood clotting pathology. The specificity of the technique ensures parallel sealing of blood vessels, which makes the operation bloodless.

Types of laser operations

• vaporization (evaporation);
• enucleation (husking, extraction) of a specific area or node, the entire gland from the capsule;
• laser resection (excision with a laser scalpel).

Within one operation or complex treatment, the doctor can use several properties of the laser, depending on the prevailing circumstances.

Important!

If a patient is diagnosed with stones in the bladder, as the most common complication of prostate adenoma, then during the operation the stones are crushed using a holmium laser.

Surgical treatment of prostate adenoma with a laser is in other words called photovaporization. Vaporization involves the evaporation of prostate tissue, which is provided by a stream of laser radiation. Depending on the attachment of the laser-emitting device, the operation may also involve excision (laser scalpel).

It has been established that after surgery to remove an adenoma, there are no complications in the course of concomitant diseases of the heart, lungs, etc. The use of a diode laser in the surgical treatment of prostate adenoma is considered one of the promising techniques for BPH surgery.

The laser method makes it possible to remove large prostate adenomas: 100-140 cm³.

Source: https://prostatitaid.ru/adenoma-prostaty/lechenie-adenomy/lazernoe-udalenie.html

Laser ablation of the prostate

The most advanced methods of surgical treatment of prostate adenoma are laser surgery. This technology uses a high-energy laser to destroy overgrown prostate tissue, i.e.

tissue necrosis occurs.

Modern leading clinics use holmium-niodymium lasers from Lumenis (USA), which allow radical operations to be performed with “jeweller’s” precision and reduce the patient’s hospital stay to three days.

All types of laser treatment are carried out via transurethral access, i.e. The laser energy is delivered to the prostate using endoscopic equipment inserted through the external opening of the urethra.

An endoscope is an instrument equipped with lighting elements and micro-cameras that allow the surgeon to see the manipulations being performed on a monitor or with the eye.

Through a special port in the endoscope, a laser fiber that usually has a bright green or red glow .

Benefits of laser surgery

The main advantages of laser surgery include:

• Low risk of bleeding;
• low invasiveness (intervention) and good tolerability of the operation
• Short period of bladder catheterization after surgery (no more than 24 hours);
• short period of hospitalization (1-2 days) and quick rehabilitation (no more than a week);
• rapid onset of effect after surgery;
• high efficiency of the method

Types of laser prostate surgery

• Laser ablation is the burning of overgrown prostate tissue to enlarge the urethra that runs through the prostate.
• Laser enucleation is the removal of all obstructing tissue, similar to open surgery (adenomectomy), but with a lower risk of complications.

The advantage of laser enucleation is the ability to remove large prostate adenomas, as with open adenomectomy, but with minimal consequences.

• Holmium laser enucleation of the prostate (HoLEP). During the procedure, an instrument (morcellator) is used to crush the tissue into small fragments. HoLEP can be used for any size of prostate adenoma. HoLEP has the best results of any existing method. However, this method is complex, requires a highly qualified surgeon and is used only in large clinics.

The clinical advantages of laser enucleation methods are as follows:

• The removed prostate tissue can be examined. It is possible to make sure that there are no signs of prostate cancer.
• No need for re-treatment. (This is a controversial statement, since the technologies are quite new and not time-tested).

The advantages of the laser described above give every reason to believe that laser treatment of prostate adenoma can become the new “gold standard” .

Things to think about

Surgical treatment is the most reliable way to eliminate the symptoms of prostate adenoma. But surgery does not guarantee complete relief.

Still, there are risks of surgical complications, including erection problems (erectile dysfunction).

 Other complications may include urinating voluntarily (urinary incontinence) and semen ejaculating into the bladder rather than out through the penis (retrograde ejaculation). Complications depend on the type of surgery used.

The reason why this technology is not so widespread is the high cost of the equipment.

Source: http://laparo-urology.ru/lazernaya-ablyaciya-prostaty

Types and performance of prostate ablation

Prostate ablation is an operation to destroy the part of the prostate affected by the tumor.

It is carried out transurethrally, which avoids infection and bleeding using laser, plasma or high-frequency radiation.

The method differs from classical excision of the prostate in that it has fewer contraindications, safety and quick recovery.

The essence of the procedure

Prostate ablation involves removing the top layer using various methods to remove the tumor. It is an alternative to transurethral resection, but is more modern, has fewer contraindications, the recovery period is shorter and complications are less likely, however, the cost of its implementation is 2-3 times higher.

The duration of hospitalization for ablation does not exceed 2 days, rehabilitation - no more than 7 days, catheterization - no more than 24 hours. The procedure is performed under local or general anesthesia and lasts about one and a half hours.

The operation is performed transurethrally by inserting an endoscope into the urinary canal. The impact is carried out only on those tissues that need to be removed; the nearest vessels are cauterized, which avoids bleeding. After this, the affected tissue dies and is excreted in the urine.

Indications for testing

The procedure is prescribed when signs of acute renal failure appear due to urinary retention, severe pain, the development of an acute infection, or poor effectiveness of drug therapy.

Kinds

There are several types of ablation, depending on the technology used:

1. Laser.
2. Plasma.
3. Needle-shaped.

The choice of method depends on the size of the tumor, individual parameters and contraindications.

Laser

Laser ablation of the prostate gland is the most commonly used method. Used for relatively small tumors, it allows you to reduce its size to insignificant or completely remove it.

Laser ablation of prostate adenoma can be carried out in 2 modes:

1. Low energy. The beam penetrates deeper, forming necrotic cavities along the contour of the tumor, after which this area gradually dies and is removed by urination.
2. High energy. With it, the beam acts superficially, gradually burning out the affected area.

Laser ablation is contraindicated for cardiovascular diseases, as well as for people with metabolic disorders, diabetes, hypertension and cardiac ischemia.

Plasma

Plasma ablation of prostate adenoma is practically no different from laser ablation, except for the method of exposure. During the operation, targeted plasma is used, which does not have a thermal effect on healthy tissue.

Unlike laser, it can be prescribed to patients with cardiovascular diseases, however, it is contraindicated in cases of impaired renal function. After it is carried out for 2-3 days, general intoxication is observed; small amounts of dying tissue may enter the blood.

Needle

The method was originally invented at the beginning of the 20th century, but has now been refined due to the development of medical technologies.

Transurethral needle ablation of the prostate (TUIA) is performed as follows. Needles with bipolar electrodes are passed through the urethra to the prostate gland, after which it is exposed to high-frequency waves. The affected tissue is briefly heated to a temperature of 110 °C, nearby vessels are cauterized, which prevents bleeding.

The full rehabilitation period is 2-3 months. During the first 2-6 weeks, symptoms of adenoma may continue to be observed.

Possible complications

Destruction of the affected tissue is performed using a relatively gentle method, however, in some cases, postoperative complications may still occur.

First of all, this happens due to the fact that the excised tissue is not removed from the body, which causes intoxication of the body. Minor bleeding may also occur, which will be observed at first when urinating, but this symptom goes away within 2 days.

The most dangerous complication occurs in 10-15% of cases – recurrence of tumor development within several years after surgery.

Postoperative period

Complete rehabilitation after surgery occurs within a week, but the bulk of the tissues and functions are restored in the next 2 days. After the rehabilitation period, in 80% of cases, complete remission is observed, sexual function is restored and the process of urination is normalized.

After the operation there are no visible traces or scars.

In terms of safety and effectiveness, the method is somewhat inferior to laser vaporization, but superior to classical transurethral resection.

Source: https://prostatity-net.ru/prostata/lechenie/ablyatsiya-predstatelnoy-zhelezy.html