Prostate adenoma: surgery and methods of performing it using different methods

Surgery for prostate adenoma is an effective treatment method that allows you to cope with the pathology and normalize the functioning of the male body. Surgical intervention helps to avoid the degeneration of a benign tumor into a malignant tumor. To get good results and avoid complications, you need to follow your doctor's recommendations.

The essence of the operation

The use of medications to combat adenoma does not always give the desired results. Often only surgery can help cope with the pathology. It is a safe and effective method of combating this disease.

The choice of a specific technique depends on a number of factors. Only a doctor can make a decision on the use of one type of operation or another, taking into account a number of features. These include:

• patient's condition;
• the presence of other pathologies;
• capabilities of the medical institution;
• patient's age;
• patient consent or disagreement;
• severity of pathology;
• the presence of malignant processes.

Indications and preparation

There can be many reasons for surgery. Thus, adenomectomy - complete removal of overgrown tissue - is needed when the volume of the adenoma is more than 80-100 cubic centimeters. The operation is also indicated for the following diseases and conditions:

• violation of urination - manifests itself in the form of urinary retention, bloody impurities in it, incontinence;
• chronic urethritis;
• swelling of the genitals;
• severe pain in the pelvic area;
• chronic form of prostatitis.

Carrying out such an operation requires a number of preparatory procedures. So, it is necessary to take urine and blood tests. Be sure to determine blood clotting and do a biochemical study. Determining the blood group is of no small importance. In addition, renal function and urodynamics need to be assessed.

It is forbidden to eat any food 12 hours before the operation. Liquids and medications are also prohibited.

Removal of prostate adenoma is necessary to prevent compression of the pelvic organs. This helps improve the functioning of the bladder.

Contraindications

Resection of prostate adenoma may not always be performed. The main limitations to such an operation include:

• pelvic inflammation;
• infectious pathologies;
• inflammation of the abdominal organs;
• malignant formations;
• adhesions in the pelvic area after surgery;
• leukemia;
• complex forms of diabetes;
• allergic reactions;
• heart failure at the stage of decompensation;
• complex forms of arrhythmia;
• problems with blood circulation in the brain;
• disruption of the respiratory organs at the stage of decompensation;
• kidney failure.

If there are serious contraindications to the procedure, palliative interventions are performed. They help restore urine excretion. Embolization of prostate vessels may also be performed or conservative therapy may be prescribed.

Types of operations

Surgery to remove prostate adenoma can be performed in different ways. The attending physician must choose the procedure. Each method has certain advantages and disadvantages.

Transurethral resection

This term refers to endoscopic intervention, which implies minimally invasive removal of an organ. Moreover, the prostate adenoma can be removed completely or partially. The manipulation is carried out transurethrally - this avoids making a continuous incision.

A resectoscope is used for surgical intervention. It is a high frequency electrical generator that is placed in the urethra. Using a loop located at the end of the device, the doctor grasps the affected area and applies high frequency current to this area. This allows you to carefully cut off the adenoma.

The manipulation is performed under general anesthesia. Spinal anesthesia may also be used. How long does this operation take? The procedure takes about half an hour. After the session is completed, the resectoscope is removed and a temporary catheter is placed in the bladder. After a week it needs to be removed.

Through transurethral resection it is possible to cope with significant blood loss. This is a significant advantage of the method compared to open intervention. The recovery period is minimal - the patient is discharged after 5 days. After about 60 days, sexual functions are completely restored.

Transurethral radiofrequency thermal destruction

During the operation, the doctor inserts an active electrode into the urethra. In parallel, passive electrodes are attached to the lower back and a high frequency current is supplied to them.

After passing through the prostate, the current produces a large amount of thermal energy. This leads to thermal destruction of the damaged areas. The operation takes place within 1 hour. It is not accompanied by damage to the external sphincter, which helps minimize the likelihood of urinary incontinence.

Laser treatment

A more harmless and modern method of removing prostate adenoma is laser exposure. The most effective options include the HOLEP and HOLEPR methods. They provide targeted impact on damaged areas, which helps minimize all risks and threats.

Another innovative treatment method is the use of green laser. With its help, you can remove all overgrown prostate tissue and avoid blood loss. This is achieved by sealing the vessels in the area of ​​damage.

The laser beam penetrates only a few tenths of a millimeter. Therefore, the removal of abnormal tissues involves layer-by-layer evaporation. The duration of the operation does not exceed 1 hour. The patient is discharged from the hospital after 3-4 days.

This surgical technique helps preserve nerve fibers and restore potency after the intervention. Any laser method is gentle, therefore it is used only in the initial stages of the pathology.

If malignant organ damage is suspected, such exposure is contraindicated.

Laparoscopy

This technique is considered the best option for the treatment of prostate adenoma. It is minimally invasive but provides excellent results. During this prostate surgery, the surgeon makes small holes in the man's abdomen and inserts instruments and a small camera into the holes.

Through the use of high-tech devices, the doctor can monitor his actions and visualize the abdominal cavity and pelvic organs on a monitor.

The tumor formation is treated using an ultrasonic knife. This helps minimize tissue damage and blood loss. After the operation is completed, the person is given a catheter for 6-7 days, which connects the bladder to the urinary canal.

Abdominal surgery

Surgical treatment of prostate adenoma also includes abdominal surgery. In such a situation, the doctor selects an anesthesia that does not pose a danger to the patient. When performing this type of operation, the specialist dissects tissues that prevent full access to the operated areas.

After this, the doctor uses special instruments to remove the affected areas. After removal of the adenoma, a catheter is placed in the urethra.

Abdominal prostate surgery can lead to serious complications, which include:

• infectious complications;
• stool disorders in the form of constipation;
• serious blood loss;
• problems with urination.

Surgery to remove the prostate must be performed by a qualified surgeon. This manipulation is planned, so the patient can prepare and undergo the necessary examinations in advance.

Rehabilitation

After the operation, an important stage of rehabilitation begins. The patient gradually returns to his normal lifestyle. In the first 2 weeks after the intervention, you must strictly adhere to the doctor’s advice.

After prostate surgery, the following rules must be followed:

• avoid sudden movements and serious physical activity: they can cause damage to scar tissue;
• drink something else;
• eat right - exclude pickles, smoked foods, fried foods;
• take antibiotics if necessary;
• regularly visit your doctor;
• adhere to the principles of a healthy lifestyle - give up alcohol, walk a lot in the fresh air;
• give up sex for 1-1.5 months.

To speed up the recovery process, you need to perform special exercises. The attending physician will select an individual complex. To achieve good results, you need to adhere to the following recommendations:

• do exercises in the morning;
• do exercises daily;
• increase the load gradually.

Complications

Any operation can cause unpleasant health consequences. Specific complications depend on the type of manipulation. Surgical treatment of adenoma leads to the following consequences:

1. TUR syndrome is caused by the penetration of lavage fluid into the vessels. This can happen when flushing the bladder, leaving the vessels open. This complication is associated with the time of the procedure.
2. Bleeding . When removing a prostate adenoma, the surgeon may damage a large vessel. If blood loss is severe, a blood transfusion may be necessary.
3. Urinary dysfunction . This complication is caused by various pathologies of the bladder. It also depends on the age category. Errors during surgery often lead to complications. In the latter case, it may be necessary to repeat the procedure.
4. Organ infection . This is due to the activation of a man’s microflora or the penetration of pathogens from the external environment.
5. Inflammatory lesion of the bladder . The operation is also associated with a risk of damage to the bladder, intestines, urethra, etc.
6. Urinary incontinence. The cause of this problem is neurogenic disorders, problems in the functioning of the urethra, which is responsible for holding urine.
7. Problems in the sexual sphere . Many men experience retrograde ejaculation after such an operation. As a result, the seed does not come out, but enters the bladder. There is also a risk of deterioration in sexual activity and weak erection. This is due to the age of the patient, the influence of medications or the influence of instruments.
8. Narrowing of the urethra. This condition is often observed after transurethral resection. It may be associated with incomplete removal of prostate adenoma or exacerbation of the pathology.

Surgeries to remove prostate adenoma help to cope with the pathology and improve the patient’s health. To achieve optimal results and avoid negative consequences, you must follow all the doctor’s advice on preparation for the intervention and rehabilitation after it.

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Removal of prostate adenoma - indications for surgical treatment, methods and consequences

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There are special indications on the basis of which men require removal of prostate adenoma through surgery, without which serious complications on the prostate gland may develop.

The main reason for resection is the rapid progression of the tumor. At the initial stage, the disease is amenable to conservative therapy.

If it does not help, then surgical treatment of prostate adenoma is required, which is carried out using various effective methods.

What is prostate adenoma

A neoplasm in the prostate of a benign nature is how the diagnosis of adenoma is interpreted. This male pathology occupies one of the first places among urological diseases. With a normal volume of the prostate gland, it is comparable to a chestnut.

It can increase due to the proliferation of fibromuscular tissue. One of the reasons for the occurrence of adenoma is the patient’s advanced age. Due to the enlargement of the prostate, the lumen of the ureter decreases. This leads to problems with urination.

If the cells are malignant, then we are talking about prostate cancer.

Indications for surgery for prostate adenoma

The feasibility of complete or partial removal of prostate adenoma is determined for each patient individually. Indications for surgical intervention are:

1. Ineffectiveness of drug therapy. Benign prostatic hyperplasia (BPH), i.e. an increase in prostate volume can develop regardless of even adequate treatment. If there is no effect from the medications within six months, then excision of the adenoma through surgery is prescribed.
2. Accelerated proliferation of prostate tissue. This means that the tumor develops very quickly, so only complete removal of the hyperplasia will help stop the process.
3. Pain syndrome. To eliminate pain in the initial stages of the disease, antispasmodics and analgesics and even novocaine injections are used. If the pathology is advanced, then the unpleasant symptom remains even after taking medications.
4. Patient's age. Surgery is indicated only before the age of 65-70 years. In each case, the patient's condition is considered individually.

Methods for removing prostate adenoma

If there are indications, surgical removal of prostate adenoma is prescribed. Today there are several ways to carry out this procedure. It can be open or minimally invasive.

In the first case, manipulations are carried out through an incision in the lower abdominal region. Due to the large number of contraindications and consequences of removal, abdominal surgery is rarely performed, but it is considered a classic method of treatment along with transurethral resection.

In advanced cases, open prostatectomy is required - surgery to remove the prostate.

Adenomectomy

Previously, the only method of surgical treatment of prostate tumors was open adenomectomy. It is performed under general anesthesia. The doctor removes the tumor like this:

• the surgical area is treated with an antiseptic solution, the hair is removed;
• the surgeon makes an incision in the skin and subcutaneous tissue;
• Next, an incision is made in the anterior wall of the bladder, the doctor carefully examines the organ for the presence of stones;
• then the surgeon removes the tumor itself by entering the urethra with his index finger and tearing its mucous membrane;
• then a catheter is inserted into the bladder to allow the wound to be washed with saline.

Open surgery guarantees permanent removal of the tumor, but the patient’s rehabilitation after it lasts a very long time, up to 3 months. In addition, there is a risk of complications in the form of suppuration and bleeding.

An equally serious issue is the transfer of general anesthesia. Also, judging by the reviews, scars remain after the operation. The cost of such removal ranges from 20 to 50 thousand rubles.

It is carried out free of charge at the public clinic at your place of residence.

Transurethral resection (TUR)

This is the name for eliminating a tumor without incisions. Tumor cells are removed through the urethra. In this case, even local anesthesia can be used. The technique is complex and therefore requires a highly qualified surgeon. The procedure is carried out as follows:

• A resectoscope is inserted through the urethra;
• using a special loop on this instrument, the overgrown epithelium is scraped until it is completely removed;
• then the bladder is washed and another examination of the operated area occurs;
• then a special catheter with an inflating balloon is inserted there, which is filled with liquid;
• After a few days, if there are no postoperative complications, the catheter is removed.

After such an operation, the prostate recovers in about 2 months. In the first days after it, there may be pain when urinating, but over time they go away.

The operation lasts no more than an hour, which is its advantage. The absence of scars after tumor removal can be considered a plus. In addition, the procedure itself is virtually painless.

The cost of such removal is about 20 thousand rubles.

Removal of the prostate gland using minimally invasive techniques

Traditional methods of treating adenoma have a large number of possible negative consequences. Minimally invasive methods help reduce the risk of complications. This is predominantly laser resection. In modern surgery, such modern techniques are:

• embolization of prostate arteries;
• laser vaporization;
• laser enucleation of adenoma;
• interstitial laser therapy;
• needle ablation;
• laparoscopy;
• endoscopic resection.

Prostate artery embolization (PAE)

The essence of this technique is to block the arterial vessels that supply blood to the enlarged prostate. The procedure is performed under local anesthesia. The endovascular surgeon monitors his actions using an angiographic machine.

The doctor’s task is to find the endings of the blood supply to the prostate. A microcatheter is inserted into them, and through it the intravascular substrate of the embolus is inserted. The advantage is that the patient is discharged 6 hours after the procedure. Its price is about 180 thousand rubles.

Laser vaporization Green Light Laserscope

Of all treatment methods, laser vaporization of adenoma is characterized by fewer complications. In addition, it is approved for patients with bleeding disorders. The equipment is inserted through the ureter.

Benign areas of the prostate are dissected with a laser beam, and the blood vessels are “sealed.” Vaporization is carried out when the tumor size is 60-80 cubic meters. cm.

The advantages are a short postoperative period and minimal complications, but such laser removal lasts twice as long as TUR. The price of the procedure is from 50 thousand rubles.

Enucleation of adenoma

Removal of prostate adenoma by this method is the “husking out” of prostate tissue using a laser. After surgery, they can be checked for the presence of malignant cells. Its advantages are:

• the ability to remove the tumor even when the gland grows up to 200 g;
• short recovery period;
• the possibility of performing surgery in patients with a pacemaker, metal devices in the skeleton or bleeding disorders.

After endoscopic enucleation, tumor tissue is transferred to the bladder, crushed using a laser and removed using a drainage catheter.

The presence of inflammatory processes or the inability to insert a catheter into the ureter is a contraindication to surgery. The same applies to the patient’s severe general condition and a shriveled bladder.

The cost of removing an adenoma in this way is about 30-40 thousand rubles.

Interstitial laser therapy

The essence of this tumor removal procedure is to pass a narrowly directed laser beam through punctures in the mucous membrane of the bladder or prostate itself. Several such introductions are required.

Using a beam, the gland is treated from all sides, resulting in necrosis. The disadvantage of this method is that for some time the symptoms of the disease may even worsen.

The cause is wounds deep in the prostate.

Needle ablation

Atrophy of glandular tissue during this operation occurs through heating due to high-frequency radio waves. They reach the prostate through needles that are inserted into the gland. The disadvantage of the procedure is its ineffectiveness for large tumor sizes. The advantage is that it is performed on an outpatient basis, i.e. the patient can go home immediately after removal.

Laparoscopic removal of prostate adenoma

This technique is indicated when the volume of the prostate gland is more than 100 cubic meters. cm. It is carried out through special tubes that penetrate inside through small incisions in the skin - trocars. A camera is placed inside, showing the progress of the procedure on a monitor.

Removal of prostate adenoma lasts about 2 hours under general anesthesia. Finally, a catheter is inserted into the urethra. The advantage is a short rehabilitation period. The patient is discharged from the hospital after 2-4 days. The disadvantages include small scars from the incisions.

The cost of the operation is 120-165 thousand rubles.

Endoscopic removal

This technique also does not require a cavity opening. This significantly reduces blood loss. The gland is excised with surgical instruments, which are inserted through a tube 1-1.5 cm thick.

The advantage of the procedure is that it does not affect erectile function, as it is a nerve-saving technique. In the absence of stones, inflammation and a small size of the adenoma, this operation is more preferable.

The advantage is the short recovery period. The price of the operation is 50-60 thousand rubles.

Consequences of surgery to remove prostate adenoma

Rehabilitation after removal of prostate adenoma may not go so smoothly. Health problems appear even more often compared to the treatment of prostatitis. There may be blood in the urine, incontinence, or pain when urinating for several days.

These side effects do not last long. If they drag on, then you should contact a specialist. Each patient reacts differently to surgery, so depending on the type of operation, different consequences may occur, including relapse of the disease.

In this case, repeat surgery will be required.

Possible complications

Any removal of prostate adenoma is potentially dangerous. Every patient is at risk of blood loss and infection. Anesthesia is a serious burden on the cardiovascular system. After the operation, complications of the following nature arise:

• lack of sperm during sexual intercourse;
• inflammatory processes of the pelvic organs;
• urinary incontinence;
• erectile disfunction;
• infertility.

Potency after surgery

Restoration of erectile function occurs after a certain period after the operation, but it is recommended to begin sexual activity not before complete tissue regeneration. The average duration of such a period is approximately one month.

This period can be extended depending on the condition and age of the patient. With full restoration of potency, some men stop releasing sperm after sexual intercourse. The reason is partial damage to the seminal canals.

Reproductive function is preserved, but a puncture is required to extract sperm.

Rehabilitation after prostate adenoma surgery

After the operation itself, it is important to follow all the recommendations of the urologist for a faster recovery. They relate to nutrition, physical activity and the patient’s sexual activity.

These recommendations are also important for eliminating possible complications after surgery. The early rehabilitation period is the first 5-7 days. At this time, the patient returns to normal urination.

In general, the recovery period can be 3 months or more.

Lifestyle adjustments

Immediately after surgery, careless actions must be avoided, as they can lead to worsening of the condition and cause inflammation. You cannot do the following:

• sit on a chair for a long time;
• take a hot shower or bath;
• drinking alcohol;
• drive a car independently;
• lift a load weighing more than 3 kg.

You must abstain from sexual activity for one and a half months after surgery. It is not recommended to go to work right away; it is better to take sick leave for the first few weeks.

After removal of prostate adenoma, it is recommended to walk, and after some time, do light exercises and swim in the morning. After recovery, you should not smoke cigarettes.

The nicotine in them negatively affects blood circulation, which can lead to inflammation.

Diet food

An equally important factor in recovery is proper nutrition. It is necessary to exclude junk food from the diet. This includes fried, salty, smoked and sweet. You also need to give up alcoholic beverages. Meals should consist of:

• fruit;
• vegetables;
• low-fat soups;
• cereals.

Therapeutic exercise and yoga

After surgery to remove prostate adenoma, not all physical activity is beneficial. It is necessary to exclude cycling and exercises with weights. It is better to do swimming and gymnastics with gentle muscle stretching. Doctors recommend paying attention to yoga. Judging by the reviews, the following exercises are useful:

1. Lie on the floor, stretch your arms along your body. Squeeze and unclench the muscles of the perineum for 2-3 seconds for 1 minute.
2. Without changing your position, bend your body in an arc, placing your hands under your lower back and lifting your pelvis off the floor. Freeze for a few seconds, take the starting position. Repeat 4-5 more times.

Drug therapy

Treatment does not end after surgery. To avoid complications, the patient must take a number of medications, which include:

1. Antibiotics. Used to eliminate infection that has developed after surgery. The course of treatment lasts no more than 7-10 days.
2. Painkillers are prescribed to relieve pain for 2-3 days after the procedure. First, the patient takes strong analgesics, and then switches to analgin or No-Shpu.

How much does surgery to remove prostate adenoma cost?

The cost depends on the location, method and complexity of the procedure. Approximate prices for some types of surgery to remove prostate adenoma for different Moscow clinics are given in the table:

Name of operation / Cost, rubles.	European MC on the street. Shchepkina	Best Clinic on Spartakovsky Lane	IMMA on Bogdanov	Family Clinic on Khoroshevskoe Highway	Best clinic on Leningradskoye Shosse
Laser vaporization	177385	57500	258975	60000	57500
Transurethral resection	116398	60000	66195	60000	82500
Transvesical adenomectomy	244924	63250	75195	60000	63250

Video

Prostate adenoma - symptoms, causes and surgery. Treatment of prostatitis

Removal of prostate adenoma

Reviews

Natalya, 31 years old My father had an adenoma removed through the urethra. Immediately after the procedure, the condition was normal, but then urethral strictures appeared. The symptoms turned out to be comparable to the adenoma itself.

Due to the narrowing of the urethra, pain appeared when urinating, so I do not recommend TOUR.
Vladimir, 42 years old I wanted to undergo laser vaporization, but the volume of my bladder turned out to be too large. For this reason, the doctor prescribed endovascular embolization. It doesn't even require local anesthesia.

After the procedure I felt much better. Instead of going to the toilet 7 times a night, I started going to the toilet only 3 times.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment.

Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Source: https://sovets.net/14459-udalenie-adenomy-prostaty.html

Types of operations for prostate adenoma - what type of operation to choose?

The type of benign prostatic hyperplasia determines the choice of surgical intervention in the treatment of the disease, along with the presence of complications, concomitant diseases and the age of the patient.

Types of prostate adenoma

Normal and inflamed prostate

Benign prostatic hyperplasia begins its growth from a kind of starting point - the proliferative center. In the future, it will ensure the speed of development of the clinic and determine the method of surgical intervention.

Depending on the location of the proliferative center of the tumor, the following types of prostate adenoma are distinguished:

• hyperplasia of the middle lobe;
• hyperplasia of the lateral lobes;
• mixed.

BPH is divided according to size:

• small (20-25 g/35-45 cm³);
• medium (25-80 g/45-60 cm³);
• large (80-250 g/60-150 cm³);
• gigantic (250-300 g/more than 150 cm³).

The size of the prostate is determined by ultrasound.

Types of prostate adenoma depending on the form (determined by ultrasound and MRI):

• spherical (infravesical) shape: the adenoma grows into the cavity of the bladder. This type occurs in 40% of cases;
• pyriform (intratrigonal): growth towards the rectum - (35%);
• cluster-shaped (retrotrigonal): uniform proliferation of nodes in all lobes of the gland (20%);
• subtrigonal: hyperplasia of all lobes without pressure on the bladder (5%).

Clinical types of prostate adenoma:

1. Compensated (1 tbsp). It lasts for many years due to the body’s reserve capabilities to resist the process. It is characterized by urinary disorders in the form of increased frequency, inability to restrain the urge, night visits to the toilet, urinary incontinence and weakening of the flow pressure. A bright clinic is characteristic only of infravesical and retrotrigonal tissue proliferation.

Stage 1 prostate adenoma is most suitable for thermal minimally invasive interventions.

1. Subcompensated (2 tbsp). Symptoms of urinary disorder intensify. The bladder loses its ability to push urine out, begins to expand, and after emptying, urine remains in it. Acute urinary retention may develop. Gradually, retrograde reflux of urine into the upper urinary tract occurs with the development of dilation of the ureters and renal pelvis, and renal failure begins.

The most effective methods of surgical treatment of BPH at the second stage are TUR and laser technologies.

1. Decompensated (3 degrees). The tissues of the urinary tract lose their functional ability to contract. The size of the bladder is very large. The symptoms of chronic renal failure are pronounced. In order to urinate, the patient has to install a catheter.

At stage 3 of BPH, abdominal or laparoscopic surgery is performed, and if there are contraindications to it, palliative TURBT is performed. If the clinic is well equipped, X-ray endovascular occlusion of adenoma arteries is considered an effective method.

Manifestation of prostate adenoma - graph

The figure shows that the “insidiousness” of prostate adenoma lies in the maximum manifestation of the symptoms of the disease at a time when complications from the upper urinary tract are present, and surgery is already necessary for health reasons.

Types of operations for prostate adenoma

The main goal of surgical treatment for BPH is to relieve the patient of intravesical obstruction.

Absolute indications for removal of prostate adenoma:

1. Chronization of infectious processes in the urinary tract.
2. Acute urinary retention after catheterization.
3. Persistent hematuria.
4. Formation of stones in the bladder.
5. Bilateral dilatation of the pelvis and ureters.
6. Kidney failure.
7. The amount of residual urine is more than 200 ml.
8. Diverticulosis.

Relative indications for removal of prostate adenoma:

1. Lack of effect from drug therapy.
2. Enlargement of the middle lobe.
3. The patient's age is less than 45 years.

Contraindications:

• chronic pulmonary heart disease;
• infectious diseases in the acute stage;
• aortic aneurysm;
• atherosclerosis of cerebral vessels.

Minimally invasive methods:

• transrectal microwave hyperthermia.

8-10 sessions are carried out every 48 hours. Temperature effects above 45 degrees on the adenoma lead to increased microcirculation, activation of the immune system, suppression of inflammation and cell growth. Eliminates irritative symptoms;

• transurethral microwave thermotherapy.

Treatment leads to the formation of a zone of necrosis in the prostate while maintaining the integrity of the urethra.

The methods are used on an outpatient basis and are applicable in stage 1 BPH. The effectiveness of treatment is 80%, the effect lasts up to a year.

Complications: hematuria, bladder spasm, which resolves without treatment.

Prostatic stents are widely used to widen the lumen of the urethra.

Transurethral resection

Transurethral resection

TUR is a popular and considered standard method of surgical treatment of prostate adenoma.

The intervention is performed using epidural or general anesthesia. Hyperplastic tissue is removed through the urethra using a resectoscope. An electric current is applied to the loop of the resectoscope, thereby excising the tissue and coagulating the blood vessels.

The work is carried out in the environment of an irrigation fluid supplied into the urethra under pressure. The prostatic part of the urethra, part of the bladder neck and prostate tissue are removed in stages.

At the slightest violation of the boundaries of excision, the ureters are damaged, the bladder and urethra are perforated.

• After the operation, a hemostatic balloon catheter is installed in the urethra for a period of 1-3 days, then independent urination is established.
• Types of prostate adenoma for which TUR is applicable: medium-sized, retrotrigonal, stage 2, mixed BPH.
• Modern bipolar plasma TUR makes it possible to relieve urinary disorders in almost 90% of operated patients.
• TUR is easily tolerated by the patient, requires a short period of hospitalization (2-3 days), but is a traumatic and unpredictable method in terms of postoperative complications.
• Indications for removal of prostate adenoma:

• tumor volume is no more than 60 cm³ - most often, but some surgeons are proficient in the technique of removing large tumors using modern equipment;
• diseases of the cardiovascular system in the stage of decompensation;
• a history of surgery on the prostate, bladder, or intestines;
• poor effectiveness of minimally invasive procedures and long-term drug therapy;
• chronic prostatitis.

Contraindications:

• vesicoureteral reflux, ureteropyeloectasia;
• diverticula;
• urinary tract tumors;
• varicose veins of the small pelvis.

Some features of transurethral resection:

• the procedure time when using a monopolar electrode should not exceed 60 minutes;
• requires extensive experience and skill of the surgeon;
• during the operation, the true volume of tissue excision is “hidden”;
• Often the resectoscope tube has a larger diameter than the urethra, which forces it to be bougiered before surgery. Damage to the urethral mucosa is difficult to repair;
• the empty bed turns into a pre-bubble, the formation process of which lasts from six months to one and a half years. The pre-vesicle creates ideal conditions for the formation of stones and the inflammatory process.

Complications in the early postoperative period:

1. Water intoxication or TUR syndrome is currently very rare (up to 1% of cases). It results from the use of large quantities of irrigation fluid, which is absorbed into the bloodstream and causes electrolyte imbalances.
2. Bleeding is the most common complication of TUR (up to 80%).
3. Inflammation of the seminal vesicles, bladder, testicles, remnants of prostate tissue: occurs in 16% of cases.

Consequences of transurethral resection:

• retrograde ejaculation (in 70 to 90% of patients);
• strictures (narrowing) of the bladder neck and urethra (up to 15%);
• urinary incontinence (up to 10%)

Abdominal surgery and laparoscopy

Cavitary removal of prostate adenoma

Open adenomectomy is performed in three ways:

1. Transvesical adenomectomy with access through the bladder for middle lobe hyperplasia. The tumor is removed by digitally extracting it through the urethra into the bladder.
2. Retropubic – with the growth of the lateral lobes of the prostate. This preserves the integrity of the bladder and urethra.
3. Transvesical extraurethral surgery, in which the urethra maintains its integrity, is a modern method of abdominal access.

The operation is performed under general anesthesia. In modern urology it is more often used as a method of emergency surgery. After the operation, a hemostatic balloon catheter is placed in the urethra (staying time is 5-8 days); if the postoperative period is favorable, the duration of hospital stay is from one to two weeks.

Types of prostate adenoma for which open access is used: intratrigonal, infravesical, large and medium size, clinical stage 3.

Indications for removal of prostate adenoma:

• any tumor size;
• pathology of the musculoskeletal system (impossibility of positioning the patient on a gynecological chair);
• periodic hematuria;
• inability to urinate independently;
• recurrence of infections;
• renal failure;
• lack of effect from TUR and long-term drug treatment;
• the appearance of stones in the bladder;
• diverticulosis.

Early complications of open adenomectomy in the postoperative period occur in approximately 6% of patients:

• bleeding. In some cases, repeated emergency surgery may be necessary to stop bleeding;
• pulmonary embolism. To prevent pulmonary embolism, take anticoagulants and practice getting out of bed early;
• long-term non-healing postoperative wound, inflammation due to infection: pyelonephritis, urethritis, cystitis, epididymitis, orchitis. Antibiotics are always prescribed after surgery;

Consequences of abdominal surgery:

• urinary incontinence;
• strictures of the urethra and bladder;
• chronic fistula (if the bladder was drained through a surgical wound).

Open adenomectomy is difficult for patients to tolerate, but this method is less traumatic for the urethra compared to TUR, so the risks of future urinary disorders are minimal.

Laparoscopy is used at stages 2-3 of the disease, with gland sizes from 100 cm³. Laparoscopy for BPH is performed only as planned.

Through several small incisions in the anterior abdominal wall, trocars are installed, through which endoscopic and video equipment is introduced, and the tumor is removed.

Types of prostate adenoma for laparoscopy: intra- and retrotrigonal, medium and large sizes, mixed, sub- and decompensation stage.

Indications:

• large tumor size;
• hematuria;
• inability to urinate independently;
• recurrence of urinary tract infection;
• diverticulosis;
• renal failure;
• ineffectiveness of minimally invasive methods and drug therapy.

Laparoscopy for BPH proceeds with minimal risk of bleeding and no future urinary problems.

Average cost of the most popular operations in our and foreign clinics

A country	Analyzes	Ultrasound	Consultation with a urologist specialist	TOUR (with hospitalization)	Laser surgery (with hospitalization
Israel	250$	210$	650$	10600$	10000$
Germany	200€	370€	400€	8000€	12000€
Russia	5000 rub.	2000 rub.	1000 rub.	50,000 rub.	60,000 rub.
Belarus	200 rub.	100 rub.	50 rub.	300 rub.	—
Ukraine	3000 UAH	2800 UAH	1500 UAH	11000 UAH.	16000 UAH.

In elderly and senile patients, in the presence of diseases of the cardiovascular system in the stage of decompensation, abdominal and laparoscopic access is impossible; in this case, a palliative TURBT is performed to make the patient’s life easier.

Occlusion of prostate arteries using the X-ray endovascular method

This modern method is used when the tumor is large and the patient is unable to undergo TURBT, abdominal surgery and general anesthesia.

The effect occurs within 2 months: the volume of the gland is significantly reduced and urination is restored.

In patients with very large tumors, arterial occlusion can be used as a method of preparation for radical removal of the adenoma. Embolization is not used for thrombophlebitis and coagulopathies.

Hospitalization is short: 2-3 days.

Holmium Laser Technologies (HOLEP)

Enucleation, vaporization, resection of prostate adenoma. Surgical access is carried out through the urethra. The operation is effective and low-traumatic, allowing you to remove a large volume of tissue (more than 100 cm³). A spinal type of anesthesia is used. Hospitalization up to 3 days.

Complications (occur in 8% of patients):

• damage to the bladder mucosa;
• perforation of the bladder wall;
• bleeding;
• infectious and inflammatory processes;
• spasm of the urethra and bladder neck.

Modern urologists recognize laser technology as the new standard of surgical treatment for prostate adenoma.

Postoperative period: treatment

1. If bleeding is established, treatment is carried out with medication, by tensioning and fixing the urethral catheter, or emergency open surgery is started.
2. Infectious complications are treated with a course of antibiotics.

3. To treat strictures and urinary incontinence, operations are performed:

• optical urethrotomy;
• laser treatment (incision and ablation);
• recanalization of the urethra;
• installation of urethral stents.

After TUR and open adenomectomy, examination by a doctor is carried out once every three months, after minimally invasive procedures - after a month, three and six months, and then annually.

The duration of the operation depends on the size of the tumor and varies from 1 hour to one and a half hours. During the operation, part of the removed tissue is sent for histological examination.

Clinics near and far abroad use robotics (da Vince robot).

Source: https://prourologia.ru/opuholi-mochepolovoj-sistemy/opuholi-pochek/adenoma-prostaty/vybor-operatsii.html

Modern types of operations to remove prostate adenoma

Prostate adenoma is a benign neoplasm of the prostate that develops over a long period of time and brings significant discomfort to the patient. As a rule, it occurs mainly in old age and leads to disruption of the genitourinary system.

The most effective treatment method is removal of prostate adenoma in varying amounts, which depends on the characteristics of the disease. There are different approaches to prostate surgery, each of which has different indications and contraindications. In this regard, the specific method of surgical intervention is determined only by the doctor individually for the patient.

About the disease

1. At the first stage of adenoma development, a man begins to notice a frequent urge to go to the toilet, while the urine stream is weak, which lengthens the time of emptying the bladder. One of the possible symptoms of the initial stage of the disease is the appearance of the urge to go to the toilet at night, even in cases where the patient did not drink water at night.
2. A further increase in the size of the prostate leads to disruption of bladder emptying - a small portion of urine always remains in it, which leads to its stretching and enlargement. In this regard, a man may constantly feel the urge to go to the toilet, which significantly reduces the quality of life.
3. In the third stage of prostate adenoma, the bladder always contains a large amount of urine. Despite the desire to go to the toilet, very often the amount of urine is minimal or completely absent. Urinary incontinence appears due to dysregulation of urinary function.

As a rule, patients seek medical help at the second stage of the disease, when the attending physician can easily make an accurate diagnosis based on clinical symptoms. After identifying prostate adenoma in men, indications for removal of the tumor are assessed, and a specific type of surgical intervention is selected.

Indications and contraindications

The following situations are identified when any method of adenoma removal is indicated:

• severe pain, which may not be relieved by the use of painkillers or antispasmodics;
• lack of effectiveness from drug therapy for 6 months;
• the patient's age is less than 65 years with obvious clinical signs of prostate adenoma;
• rapid growth in the size of the neoplasm tissue, leading to the progression of all symptoms of the disease.

In addition to the indications for surgery, the attending physician must evaluate the presence of contraindications that limit surgical treatment:

• decompensated diseases of the bronchopulmonary or cardiovascular system, which can cause the development of respiratory or heart failure during the operation;
• bleeding disorders, due to the high risk of developing hemorrhagic complications during the intervention or in the postoperative period.

It is possible to reduce the risks of complications and increase the efficiency of operations to remove adenoma by properly preparing the patient for surgery.

Source: https://prostatitaid.ru/adenoma-prostaty/o-zabolevanii-adenomy/operatsiyi-pri-adenome.html