Treatment methods for prostatitis: therapeutic and surgical

Prostate adenoma is a more harmless disease than prostate cancer, but no less insidious. According to statistics, this is the most common pathology of the genitourinary system that awaits men after 45 years. Prostatic hyperplasia (BPH) causes a lot of pain. Effective treatment of prostate adenoma in men is medicinal medications.

What is prostate adenoma and its symptoms

Prostate adenoma is expressed in the uncontrolled proliferation of gland tissue. As a result, a new formation occurs. Moreover, this is not “native” tissue, but foreign, modified.

The tumor forms and grows without any hint of its presence for quite a long time.

The direction of development of this neoplasm can be different: both inside the prostate and from its outer walls. Depending on the direction of growth, the adenoma may or may not cause problems with urination.

The statistics are as follows:

• More than 60% of men over 60 years of age have histological signs of adenoma;
• More than 40% have its clinical signs;
• 20% of men experience a decrease in quality of life due to urinary disorders.

For a complete recovery, you need to know exactly what to treat. The symptoms of adenoma and prostate cancer are largely identical. In order to exclude oncology, it is necessary to go through several studies:

• Take a total and free PSA test;
• Undergo a digital rectal examination;
• Get an ultrasound;
• Perform a biopsy to collect biomaterial for histology.

Symptoms of prostate adenoma

The first signs of developing pathology are difficulties in the process of urine outflow. They can manifest themselves in different ways, but most often - in numerous false urges to urinate throughout the night. In this case, pain may be present. A characteristic symptom of adenoma is repeated trips to the toilet at night.

In some cases, men have to wake up at least 7 times.

All this has a detrimental effect on the emotional and physiological state of the patient. Chronic lack of sleep provokes depression and causes systematic fatigue. The patient may experience increased irritability, which directly affects the quality of communication with others.

The most serious complication of a developing adenoma is acute urinary retention, expressed in the inability to spontaneously urinate, despite a strong urge to do so. As a result, urine begins to accumulate in the bladder. Its quantity can reach 3 liters. There are two options: catheterization, and if this is not possible, a puncture in the lower part of the abdominal wall.

As the disease progresses, a man begins to experience severe pain in the lower abdomen, and blood may appear in the urine and semen. All this cannot but frighten, and the person begins to intensively search for an opportunity to get rid of the disease. At the same time, men often ignore the need to visit the clinic and turn to the doctor in the most extreme and advanced cases.

Treatment methods for prostate adenoma

There are only three options to get rid of an adenoma.

1. Drug therapy;
2. Operative (surgical) intervention;
3. Herbal medicines.

When self-medicating, there is one danger: you can choose the wrong recipe or it will be incorrect, with distorted data on preparation, dosage and administration schedule (applies to traditional medicine). During treatment with such a drug, the pathological process will develop. And precious time will be lost.

It is better not to tempt fate, but to immediately start with proven medications. However, there are pitfalls here too.

In order to avoid complications, you should consult a doctor. To make an accurate diagnosis, it is enough to do three things:

• Visit the nearest laboratory yourself and get tested for PSA;
• Visit the nearest medical center and get an ultrasound of the prostate;
• Come to the clinic at your place of residence or visit a commercial medical institution and get a consultation with a urologist, providing the doctor with research data.

Most men are put off by the idea of ​​going to the doctor because of the possibility of a rectal palpation procedure. According to medical standards for urological examination, it is a mandatory method of examination in case of suspected pathology of the prostate gland.

But there are many doctors who, realizing that palpation is not very informative, refuse it and immediately refer the patient to TRUS (sampling of biomaterial with simultaneous ultrasound examination). The data obtained as a result of this procedure allows us to make an accurate diagnosis.

Drug treatment of adenoma

Prostate adenoma is a steadily progressive pathology. The growth of a benign neoplasm is constant, but the speed of the process may vary.

As the patient ages, the risk of a variety of complications increases. At the beginning of the development of the disease, drug treatment is most effective, consisting of taking medications prescribed by a doctor.

It is guaranteed to eliminate problems with urination.

At the moment there are three groups of drugs for the treatment of prostate adenoma:

• Alpha adrenergic blockers;
• 5-alpha reductase inhibitors;
• Products based on natural ingredients: herbal remedies.

The choice of therapeutic technique depends on two characteristics of the disease: its stage and the complexity of the course. The action of medications is aimed at eliminating the cause and symptoms of this insidious disease.

Probiotics (preparations and dietary supplements containing live microcultures) are often prescribed as a concomitant treatment. These remedies will help restore the intestinal microflora, which will lead to increased immunity.

It is important to understand that alpha blockers can only eliminate the symptoms of BPH. And 5-alpha reductase inhibitors affect the cause of this pathology. Therefore, drugs of the first group quickly provide help, eliminating pain in the lower abdomen and cramps. And drugs of the second group eliminate the cause and treat.

Alpha adrenergic blockers in the treatment of prostate adenoma

Alpha blockers are effective medications that can quickly eliminate the symptoms of pathological processes in the prostate. But it is the symptoms that are eliminated, not the cause of the disease.

These medications are prescribed for sluggish, intermittent, painful urine flow.

The help of these drugs is expressed in relaxing the muscles of the prostate and bladder, which promotes the free flow of urine. At the same time, alpha blockers have no effect on the tumor itself. They are not able to reduce the size of the tumor or stop its growth.

Action of Alpha blockers

A significant role in the functioning of the male genitourinary system is assigned to alpha-adrenergic receptors in the bladder neck and proximal urethra. There are three types of receptors:

1. Alpha-1A adrenergic receptors. Located in the prostate, prostatic urethra, and bladder. The function of these receptors is to regulate the activity of the smooth muscles of the prostate, the base and neck of the bladder, seminal vesicles and ejaculatory ducts.
2. Alpha-1B adrenergic receptors. They are located in blood vessels and control the tone of the arteries during blood redistribution. The number of receptors increases with age.
3. Alpha 1D adrenergic receptors. Located in the bladder, spinal cord and nasal sinuses. The purpose of these receptors is not fully understood, but it is known that they play a significant role in the functioning of the bladder muscles.

Alpha adrenergic blocking drugs

The drug CARDURA "Cardura"

Release form: round tablets of small diameter. Available in doses of 1.2 and 4 mg. The 1mg tablets have CN 1 on one side and Pfizer on the other. The 2 mg tablets have CN 2 and Pfizer. The 4 mg tablets have CN 4 and Pfizer.

The active substance is doxazosin mesylate. The drug affects all groups of alpha-adrenergic receptors and normalizes the functioning of the genitourinary system. The initial dose is 1 mg per day, taken in the morning or evening, at night. Based on urodynamic parameters, the dosage can be up to 2 and 4 mg per day.

Analogues:

• Artesin;
• Doxazosin;
• Kamiren;
• Urocard.

The drug "Omnic"

Most popular in blocking alpha-1 receptors. Relieves antispasmodic effects, normalizes bladder function. Available in yellow-green capsules in a dose of 400 mg. Take 1 capsule 1 time per day before meals. One pack can contain 10 or 30 capsules.

Possible side effects such as nausea, vomiting, itching. diarrhea, headaches and dizziness.

Analogues:

• Alfater;
• Tamsulosin;
• Cornam;
• Bazetam;
• Adenorm;
• Setegsiz.

The drug "Dalfaz Retard"

The active ingredient is alfuzosin hydrochloride. It has a pronounced effect on adrenergic receptors, helps normalize the functioning of the genitourinary system, and eliminates the symptoms of BPH. Effective for grade 1 and 2 prostate adenoma.

Daily dosage 10 mg. Take the drug twice: morning and evening. Release form: capsules.

Analogues:

• Urorek;
• Alfuprost;
• Sonizin.

5-alpha reductase inhibitors: how they work and why they help

The second group of drugs for the treatment of prostate adenoma are 5-alpha reductase inhibitors (blockers). This is a protein compound and there are two types of its enzymes (ioenzyme): 5-alpha reductase type I and type II.

Ioenzymes of the first type are concentrated mainly in liver tissue, hair follicles, and skin. Ioenzymes of the second type are in the prostate. Specifically: in the nuclei of its stromal cells. To influence benign prostate growth, type II 5-alpha reductase inhibitors are needed.

The pharmacological industry offers several types of drugs for the treatment of adenoma. Among them:

• Avodart;
• Proscar (analogues of Finasteride, Propecia);
• Prosteride.

Long-term urological practice has shown that Finasteride and Dugasteride have the most effective action. Each of these drugs has its own pharmacological and clinical characteristics.

The recommended duration of taking the drugs is 5-6 months. Comparative analyzes of the effectiveness of these drugs have not been conducted. It is noted that the effectiveness of taking Finasteride and Dugasteride is almost the same. One of the positive effects: a decrease in PSA levels.

Possible reactions to taking 5-alpha reductase inhibitors:

• Depressive states;
• Decreased libido;
• Potency disorders;
• Cardiopalmus;
• Skin itching.

Side effects of drugs can be expressed in various kinds of disturbances in the functioning of the genitourinary system.

Pain sensations of varying degrees of severity are often observed in the testicles and mammary glands. There are cases of decreased sperm quality, and less commonly, male infertility.

Efficacy of 5-alpha reductase inhibitors

Since these drugs act on the cause of the pathology, a lot of time passes before complete recovery. Depending on the size of the benign tumor and the rate of its progression, it takes from 5 months to 1 year.

At the initial stages of adenoma development, 5-alpha reductase inhibitors are able to completely stop the development of the tumor and subsequently eliminate it. On average, these treatments can reduce the adenoma symptom index by 3 points on the AAU scale.

Herbal medicines for the treatment of adenoma

Herbal medicines are more of a preventive remedy than a therapeutic one. They can help in the initial stages of the disease. So, at the first problems with urination, you can take Prostamol Uno. This is a completely natural product made from saw palmetto. It helps quickly, but is not able to eliminate the cause of the pathology.

Any products that contain pumpkin seeds are guaranteed to help at the initial stage of pathological processes in the prostate.

The most popular is “Tykveol”, which not only normalizes the outflow of urine, but also has an analgesic effect.

Decoctions of hazel or hazel leaves will also help cope with minor disturbances in the functioning of the genitourinary system. It’s simple to prepare a healing remedy: you need to pour 1 tablespoon of the plant with 1 glass of boiling water. Leave for 30-40 minutes. Take 1/3 cup 3 times a day.

Thorn is useful for the prostate. A decoction of this herb can be taken as tea several times a day. The effect will immediately manifest itself: urination will become easy and painless. The sloe decoction is prepared as follows: a tablespoon of the herb is brewed with 1 liter of boiling water. They insist all night. Take during the day.

Stinging nettle is effective against congestion in the pelvic area and the proliferation of prostate tissue. This ubiquitous plant can provide good help in the initial stages of the disease and stop the growth of the tumor.

Combination drugs

A relatively new therapeutic agent is Sonirid Duo. It contains two main active ingredients: finasteride and tamsulosin. This medicine can quickly eliminate the symptoms of BPH while simultaneously addressing the cause of the disease. But there is a wide list of contraindications and side effects, which affects the popularity of this drug in clinical practice.

It is almost impossible to cure adenoma on your own

For a successful outcome, constant therapeutic monitoring is required. It is necessary to undergo studies to determine the degree of impact of a particular drug.

It is impossible to predict how taking pills will affect your body. Only a doctor can correctly assess all the risks. Self-medication is fraught with serious complications. Therefore, at the first signs of prostate adenoma, it is recommended to consult a urologist.

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Surgical and drug treatments for prostate adenoma

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Prostate surgery – surgical treatment of prostatitis

Prostatitis requires complex treatment using not only antibacterial drugs, but also non-steroidal drugs that relieve inflammation. For various forms of the disease, antidepressants with serotonin and microenemas containing chamomile solutions are used as a supplement.

In some cases, drug therapy may not produce the desired results. This often occurs when a man develops chronic prostatitis, as well as against the background of chronic pelvic pain syndrome. Often, antibacterial therapy is powerless when a purulent abscess develops in the gland itself, which requires immediate surgery.

In such cases, surgical treatment of prostatitis becomes the only treatment option. But it is not always effective due to a number of reasons.

Features of the consequences of surgical treatment of prostatitis

Curing a disease surgically does not always have the desired effectiveness. The main reason lies in the fact that after surgery, 77% of men report a number of complications, including:

• complete impotence;
• partial impotence with erectile dysfunction;
• narrowing of the ureter;
• entry of sperm into the bladder during ejaculation.

According to statistics, only 43% of men experience a complete recovery after surgery, and in the remaining 57% of cases the disease manifests itself again. Of these, 40% experience a new relapse of prostatitis, in which the disease resumes its course.

Cases of application of the operation

Indications for surgery for prostatitis in men are particularly strict due to the high risk of recurrence of the disease in the postoperative period. They include:

• the presence of copious amounts of blood in the urine;
• lack of the desired effect in the treatment of prostatitis without surgery (drug treatment, physiotherapy, traditional methods);
• difficulty urinating or stopping it, characteristic of anuria;
• the appearance and spread of pus in the tissue that surrounds the rectum;
• development of urolithiasis and nephrolithiasis with the appearance of stones in the bladder or kidneys against the background of complications of prostatitis;
• the appearance and spread of suppuration in the prostate itself;
• the appearance of benign neoplasms in the prostate in the form of tissue proliferation;
• development of inflammation in the pelvis;
• deterioration of the patient's condition with a chronic form of prostatitis, in which there is a suspicion of the development of a cancerous tumor.

Cases of inadmissibility of surgical treatment

In some cases, surgical methods of treating the disease are unacceptable. Such cases include:

• the man has diabetes;
• development of ARVI in the patient;
• patients taking blood thinning drugs (Warfarin and Heparin);
• the presence of genitourinary system infections in a man in the acute stage;
• old age of the patient (over 70 years), requiring treatment of prostatitis without surgery;
• the patient has a hereditary disease that occurs only in men - hemophilia, characterized by a blood clotting disorder;
• the development of hypothyroidism in a man, in which there is a deficiency of thyroid hormone;
• the patient has concomitant ailments related to the cardiovascular system, lungs, and bronchi.

In these cases, the gland cannot be operated on, and prostatitis must be treated without surgery using alternative methods.

Types of surgical methods for treating the disease

There are several options for prostatitis surgery in men, including:

• resection of the prostate gland;
• prostatectomy;
• circumcision.

Chronic prostatitis over time transforms into another disease - prostate adenoma, called benign prostatic hyperplasia. In such cases, certain methods of treating prostate adenoma are used, including:

• laser enucleation;
• adenomectomy;
• embolization of prostate arteries;
• operations without an incision.

In general, treatment for the prostate is characterized by two main methods: invasive and minimally invasive. Invasive methods include prostatectomy, and minimally invasive methods include prostate incision, in which a small incision is made in the prostate.

Prostate resection as an invasive method

Resection of the prostate is the partial removal of a certain fragment of the gland. Surgery can be performed in three ways:

• laparoscopic method, in which the patient is punctured in the anterior part of the peritoneum and an endoscope with a camera and surgical instruments are inserted into them, after which part of the gland is removed and the punctured areas of skin are sutured;
• suprapubic method, in which an incision is made in the anterior part of the peritoneum just below the navel towards the pubis, through which an unhealthy fragment of the prostate is removed, after which the wound is sutured;
• transurethral method, in which a special device, a resectoscope, is inserted into the patient through the urethra and cuts off the diseased area of ​​the gland, after which it is removed back.

The latter method of resection is most widespread, since it is less likely to cause injury to internal organs.

With the transurethral method, the integrity of the patient’s skin is not compromised, and the resectoscope itself is inserted smoothly through the urethra without damaging it.

The advantage of the method is that after the operation the patient’s recovery takes no more than 6 hours, and he has the opportunity to be discharged from the hospital on the same day as the surgical treatment.

Recovery after laparoscopic resection takes about 4 days, and the most difficult method for the patient is suprapubic resection. It takes more than a week for the incision to recover and heal, and in some cases 14 days.

Prostatectomy as an invasive method

Prostatectomy is a radical method in which the entire prostate is removed. In addition, lymph nodes and seminal vesicles are removed. This method is used in cases where a patient’s chronic prostatitis transforms into prostate cancer, and there is a high probability of metastases spreading to other organs. The operation is carried out in several ways:

• strip method with dissection of either the lower abdomen or the space between the anus and scrotum, followed by removal of the gland and the application of about 11 stitches;
• a method using an endoscope, which excises the prostate and cauterizes the vessels to avoid bleeding through specially made punctures in the lower part of the peritoneum.

In the first method of operation, the prostate is removed manually by a surgeon, in the second - with a robotic endoscope under the supervision and control of a specialist through a special mechanism and camera. The second method is considered more reliable and accurate, since the patient’s sex life is subsequently restored.

In cases where surgery is performed using an endoscope, the patient's recovery occurs within 24 hours. With strip surgery, the recovery phase can last 7–14 days. With the strip method, 11 stitches or more are applied, and with endoscopic prostatectomy - no more than 4.

Circumcision for prostatitis

This method involves removing the foreskin of the penis. Circumcision is more often used as a preventive measure to prevent the development of the disease, as well as in the development of chronic prostatitis.

The operation can be carried out either manually or using a clamp. During manual circumcision, the foreskin is separated using a scalpel, and further stitching of the inner and outer parts of the skin on the genital organ occurs.

This method has a high risk of injury to the reproductive organ.

When using a clamp during circumcision, it is possible to reduce the risk of cutting the organ and get rid of excess blood loss. Thanks to the clamp, which is fixed on the head of the penis, it is possible to accurately and evenly separate the foreskin without unnecessary incisions.

Minimally invasive methods

With these methods, minimal damage to the integrity of organs is ensured and prostatitis is actually treated without open surgery.
An incision of the gland is performed using a resectoscope. The device is inserted through the urethra and excises the damaged area of ​​the prostate, and thanks to the camera installed on it, the surgeon is able to observe the process.

For frequent infections in the prostate and bladder, as well as for chronic prostatitis and adenoma, resection of the prostate is performed by inserting a urethroscope into the urinary canal. The disadvantage of the operation is that after it the patient needs to have a catheter installed for several days to drain urine.

Surgical methods for adenoma

The best and most reliable way to treat prostate adenoma is laser enucleation. With this method, a powerful holmium laser removes the painful area of ​​the prostate and directs it to the bladder, from where it is removed with a special instrument called an endomorcellator.

The technique avoids trauma and tissue incisions, and also promotes rapid rehabilitation of the patient, who can be discharged from the hospital the very next day after surgery.

Adenomectomy is considered a traumatic treatment method, since it involves an incision in the bladder.
But this particular method is indispensable for particularly severe and advanced cases of adenoma. Open adenomectomy provides a high guarantee of complete cure for the patient. Embolization is a complex type of surgery, performed under local anesthesia, unlike all other operations. With this method, a polymer is injected through the femoral artery, reaching the prostate arteries and clogging them. The surgical intervention lasts a short amount of time, and within a day after the operation the patient can be discharged home. Embolization is performed only by surgeons. This type of treatment is not within the competence of a urologist.

Other minimally invasive methods of treating typically male diseases are actively used, in which minimal surgical effects on the skin and internal organs are achieved. During such operations, an endoscope with a camera connected to a monitor is inserted into the patient through the urethra, through which the attending surgeon can monitor the operation process.

Doctor of the highest category, Candidate of Medical Sciences, Diploma in General Medicine, Russian State Medical University named after. N. I. Pirogova (2000) Experience 17 years

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Prostatitis and surgery: surgical treatment, removal of the prostate, consequences

Prostatitis is an infection or inflammation of the prostate gland and is the most common problem in men under 50 years of age.

To treat the disease, in addition to the use of medications, traditional medicine and lifestyle changes, surgical intervention (operation) is often required.

Prostatitis and surgery - let’s take a closer look at surgical methods and their features.

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Indications and contraindications

Some groups of patients do not respond to drug treatment. One of these groups is patients with chronic prostatitis and chronic pelvic pain syndrome .

In addition to the usual symptoms, they experience depression, fatigue, weakness, malaise, irritable bowel syndrome and cognitive impairment.

For such patients, surgery is necessary to relieve these symptoms.

Indications for surgical intervention include:

• Urinary retention , accompanied by severe pain. Sometimes the pain is so severe that the patient cannot take urine tests; urine accumulates, causing pain in the lower abdomen and inability to urinate;
• Urinary tract infections (permanent/recurrent). Rarely, surgery is necessary to treat chronic bacterial prostatitis that does not respond to long-term antibiotic treatment. Surgery may be performed to eliminate infected areas of the prostate;
• Significant hemorrhage , recurrent hematuria;
• Prostate abscess . If antibiotics are not effective in treating the infection, the patient develops a prostate abscess. In this case, its drainage is necessary;
• Surgery is indicated for prostate cancer .

Surgery for prostatitis in men is not a common treatment method. Contacting specialists is a necessary measure (malignant formations).

Any method of surgical treatment of prostatitis has contraindications and consequences . Let's list them:

• Surgery is most often contraindicated in patients with acute bacterial prostatitis due to the possibility of systemic infection, although placement of a small drainage catheter is safe;
• Transurethral resection of prostate abscess is not recommended for patients with acute bacterial prostatitis, the incision may lead to impotence due to nerve damage, resection may affect the spread of bacteria, leading to sepsis;
• In patients with acute urinary retention, insertion of a catheter can cause severe discomfort;
• Laser treatment of prostatitis is not performed on patients with prostate cancer;
• Surgery is contraindicated in patients with cardiovascular disease , as well as in persons who have recently suffered a myocardial infarction ;
• The operation is not performed against the background of low platelets, renal failure, abdominal or thoracic aortic aneurysm, cystitis, pyelonephritis, or the presence of blood clots in the legs/lungs.

Kinds

Prostatectomy

Prostatectomy is a surgical treatment for localized prostate cancer, often performed in combination with radiation/chemotherapy and involves a series of procedures to remove part or all of the gland. There are different types of prostatectomy:

Radical prostatectomy is surgery to remove the entire prostate and lymph nodes. Surgery is indicated for the treatment of localized prostate cancer. Radical prostatectomy is also divided into several types:

• Robotic radical prostatectomy . The surgeon makes several small incisions in the lower abdomen to remove the prostate. The specialist sits on a special console and uses tools attached to a mechanical device (robot). The robotic approach is a more accurate and nerve-saving method that does not affect the quality of sexual life;
• Open radical prostatectomy . The surgeon makes an incision in the lower abdomen (retropubic surgery);
• Laparoscopic radical prostatectomy . The surgeon places a video camera and other instruments in the incision area to remove the prostate.

Open prostatectomy is indicated for patients with severe symptoms and severe enlargement of the prostate.

All types of prostatectomy are performed under general anesthesia or spinal anesthesia, which means the patient is conscious but not in pain. The duration of the procedure is 2-3 hours. Recovery time is from 4 to 6 weeks. The hospital stay is 1-3 days.

Less than 10% of men experience complications after prostatectomy, and they are usually treatable and short-lived.

Prostate resection

Transurethral resection of the prostate (TURP) is a surgical procedure used to relieve symptoms of an enlarged prostate.

During TURP, a special instrument (resectoscope) is placed into the urethra. With its help, the surgeon trims tissue around the prostate that blocks urine, thereby increasing the size of the urethra.

Resection can be performed to prevent complications:

• Cystitis;
• Impaired kidney function;
• Incontinence;
• Urolithiasis disease;
• Hematuria.

The duration of the operation is from 60 to 90 minutes, general anesthesia . The hospital stay is 1-2 days. Most patients require a catheter within 4-7 days. Pain when urinating goes away within 1-4 weeks.

The recovery period is about 4-6 weeks; sexual activity can be resumed after 5-6 weeks.

After resection, most men experience significant relief of symptoms. Most patients do not experience relapses for 7-15 years.

Abscess drainage

Prostate abscess is a rare complication and quite often diagnosis is delayed due to the fact that the abscess mimics symptoms of urinary tract diseases. To treat a prostate abscess (and accumulation of pus), a drainage method .

The procedure is carried out using ultrasound and a special puncture needle, which is inserted into the prostate gland by puncture of the lower abdomen. First, an index finger is inserted into the rectum to determine the area of ​​the prostate. The contents of the cavity filled with pus are sucked out with special instruments and washed with antiseptic agents, then the cavity is drained with rubber tubes.

Small abscesses are opened using the puncture method, large abscesses (more than 6 mm of pus) are opened using perineal access, and the abscess is drained directly through the rectum.

The procedure is performed under general anesthesia and lasts 60-90 minutes. The drainage remains in the cavity for 48-72 hours after surgery. Recovery time is 3-4 weeks.

Important. The consequences of opening an abscess include impotence, infertility . In some patients, the disease often progresses to a chronic stage. Abscess drainage is indicated for patients in whom the risk of abscess rupture is higher than the likelihood of subsequent complications.

Treatment of prostatitis with laser

Laser surgery is a minimally invasive method used to eliminate symptoms caused by an enlarged gland. The surgeon places a “sphere” (laser instrument) into the urethra (without making an incision). The laser removes excess tissue blocking the urethra by:

• Ablations. The laser burns excess tissue;
• Enucleation. The laser cuts the tissue.

Types of laser treatments:

• Photoselective vaporization . Excess tissue is evaporated by laser action;
• Holmium laser ablation . Similar procedure, uses a different type of laser;
• Holmium laser enucleation . The operation uses an instrument called a morcellator, which crushes the prostate tissue into small pieces, which are then easily removed.

Laser surgery has a number of advantages:

• Low likelihood of bleeding . The procedure is suitable for patients with blood clotting problems;
• No need to stay in the clinic after surgery. Laser surgery can be performed on an outpatient basis ;
• Fast recovery – about a week;
• No need to install a catheter. Although sometimes catheter placement is required for up to 24 hours;
• Efficiency . Improvements are noticeable immediately;
• No relapses . Laser surgery permanently eliminates urinary problems, since the removed tissue cannot regrow;
• There are no side effects (sometimes there is incontinence, blood in the urine, burning when urinating), side symptoms disappear within a few days.

Attention! Unfortunately, the laser method is not suitable for the treatment of malignant neoplasms of the prostate gland.

Laparoscopy

The operation is performed using special microchambers placed inside the abdominal cavity through small holes. Laparoscopic surgery eliminates the need for a large incision, so the risk of infection is minimized.

The recovery period is 4-6 weeks, the period in the hospital is up to a week (usually 3-4 days). The method is used to remove malignant tumors of the prostate gland that have not spread beyond its borders.

The main side effects after surgery include erection problems and urinary incontinence . The advantages are the absence of bleeding, the non-invasiveness of the method, and minimal damage to nearby tissues. After the procedure, the patient is fitted with a urinary catheter for up to 3 days.

Consequences and relapses

We list some of the negative consequences of surgical intervention in the treatment of prostatitis, including removal of the prostate in men:

• Severe bleeding is a rare but possible effect. Some patients lose large amounts of blood during surgery, although laser surgery and laparoscopy are exceptions;
• Temporary difficulty urinating . In this case, urinary catheters are used;
• Urinary tract infections are a rare but possible complication. Infection most often develops at the site of the catheter, in which case antibiotics are required; Incontinence;
• “Dry” orgasm . Surgery can provoke retrograde (reverse) ejaculation, which means that the sperm released during ejaculation enters the bladder without leaving the penis. Retrograde ejaculation is not a harmful or dangerous condition and does not affect the quality of sexual life. This long-term side effect occurs in approximately 75% of men who undergo prostate surgery and is most often a side symptom of TURP;
• erectile disfunction;
• Lymphedema - soft tissue swelling - is a rare but possible complication after removal of lymph nodes around the prostate;
• A change in the length of the penis is a possible effect after surgery associated with shortening the urethra, when part of it is removed along with the prostate;
• Inguinal hernia – performing a prostatectomy increases the chances of developing the disease in the future.

Need for re-treatment

Relapses most often occur after prostatectomy and drainage of abscesses, less often after resection of the prostate or laser method (extremely rare). In some cases, treatment is required because there is a narrowing (stricture) of the urethra or bladder neck.

Each method has its own advantages and disadvantages. The choice of surgical intervention method depends on the symptoms of the disease, the general health of the patient, and the response to drug treatment; the decision is made only by the attending physician.

In most cases, surgery has a beneficial effect on the course of the disease and eliminates its symptoms.

Video describing the operation

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Surgical treatment of prostatitis

No matter how much one would like to avoid surgical intervention, this is not always possible, and in most cases the man himself is to blame for this. Prostatitis must be treated when only the first symptoms appear.

And many of the stronger sex find themselves weak at this moment, and do not turn to a urologist out of fear. It is precisely the consequences of untimely therapy that you should be afraid of.

Surgical treatment of prostatitis is often the very last way to get rid of this disease, when nothing else will help. It is also impossible to do without surgery for complicated inflammation of the prostate gland.

What complications lead to the operating table?

Complications of inflammation of the prostate gland can be different, depending on the form of the disease. Due to acute prostatitis, the formation of abscesses, that is, pustules, is possible.

You can get rid of them only through surgery. But this type of operation is minimally invasive, that is, there is no need to make an incision in the skin to penetrate to the desired location.

Surgical treatment of chronic prostatitis is an invasive method. In this case, there may be a strong narrowing of the urethral canal, which makes urination impossible. During such an operation, the doctor restores the patency of the canal, and therefore the capacity of the urinary system returns.

How are minimally invasive surgical treatment methods performed?

Most often, if possible, surgeons resort to this method of treatment, because in this case local anesthesia is given, and the likelihood of large blood loss is simply excluded, since there is no need to cut the skin. This means that the patient will not need to stay in the hospital for a long time. Also, the rehabilitation process lasts much less and is easier.

Transurethral incision of the prostate is considered minimally invasive. It is also performed for moderate enlargement of the prostate gland. This operation is an excellent replacement for invasive surgical methods, since in this case it is possible to perform an intervention without harming the patient’s health.

The operation is performed using a resestoscope. It is inserted into the patient’s urethral canal, and the doctor sees the “surrounding environment” on the monitor. For example, if a patient has a narrowing of the urethral canal, an incision is made into the prostate tissue in the area where it adjoins the bladder.

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Pustules are also removed using this method. First they are washed, then the medicine is injected. Likewise with cysts, if they are found.

Surgical treatment of prostatitis using minimally invasive methods includes transurethral resection of the prostate gland.

Indications for its implementation are constantly recurring urinary tract infections.

This method of therapy is also carried out when blood is noticed in the urine, there are stones in the bladder, the patient complains of long-term urinary retention, and, finally, with a small prostate adenoma.

The idea is to insert a urethroscope into the urinary canal. By the way, this operation is the most popular all over the world, and it is performed with great success by surgeons from different countries. As a result, the symptoms of prostatitis become much less noticeable. Unlike the previous method, after this operation it is necessary to install a catheter in the bladder.

Invasive surgery

This includes open proctectomy, or removal of the prostate gland. This surgical treatment of prostatitis is carried out in cases where there is no other treatment option for the disease. This can be caused by the large size of the gland, various kinds of complications and stones in the bladder. In other words, when there is acute urinary retention or the disease has been advanced.

In general, there are 2 options possible. The first is less traumatic - the skin in the pubic area is pierced with a special syringe, as a result of which the needle penetrates the bladder. This is how aspiration of urine from the bladder occurs, that is, its suction.

The second option is open proctectomy. The operation is quite complicated, both for the doctor and the patient. Usually there is a lot of blood loss. During the intervention, the doctor opens the bladder and completely removes the prostate, which, due to inflammation, has destructive lesions. Stitches are then applied.

In addition to the fact that the operation is complex, the rehabilitation period is not easy. Suppuration of the wounds is possible, and in addition, regular washing of the bladder is necessary, and the patient is kept with a catheter for a week or 10 days.

Source: https://stopprostatit.ru/lechenie-prostatita/v-kakih-sluchayah-primenyaetsya-hirurgicheskoe-lechenie-prostatita.html

What treatment methods for prostate adenoma and prostatitis exist?

Prostate diseases are common, especially in older men.

Their prevalence varies, however, the diagnoses of “prostatitis” and “prostate adenoma” are made most often.

The clinical manifestations of these pathologies are very similar: impaired urination, a feeling of a full bladder and discomfort, as well as pain of varying degrees of intensity.

Such diseases require complex therapy, which should include medications, physical therapy, lifestyle changes, and, in some cases, surgical interventions.

It is important to note that treatment of prostatitis and prostate adenoma should only be prescribed by a doctor. Otherwise, the progression of diseases or the development of unwanted drug reactions is possible.

Necessary diagnostics

Before selecting treatment for prostatitis and prostate adenoma, the doctor must make an accurate diagnosis, as this determines the therapeutic approach. Diagnosis should always be carried out in a medical institution according to the following algorithm:

1. Collection of the patient’s complaints, obtaining information about their duration, as well as concomitant diseases.
2. Clinical examination, which necessarily includes a digital examination of the prostate gland through the rectum.
3. Ultrasound examination of prostate and bladder tissue, which can be performed either through the anterior abdominal wall or transrectally.
4. Each patient with suspected inflammation in the prostate gland needs to have prostate secretions examined, as well as a smear from the urethra to detect leukocytes and pathogenic microorganisms.
5. Urine is subject to general analysis, cytological and bacteriological examination.
6. Determining the concentration of PSA protein (prostate-specific antigen) in the urine can detect tumor growth in the prostate, as well as identify benign hyperplasia (BPH) of the organ.
7. In case of severe disturbance of urodynamics, uroflowmetry or excretory urography is performed.
8. A biopsy followed by morphological analysis of samples is indicated to confirm the diagnosis in the case of adenoma, as well as to carry out differential diagnosis with malignant neoplasms.

The results of each examination should be interpreted only by the attending physician. The patient himself or his relatives are not able to competently analyze the data obtained as a result of research and make a diagnosis.

Treatment approaches

Treatment of prostatitis and prostate adenoma should always be carried out comprehensively and include both non-drug methods and medications. In this case, the means used are selected depending on the indications and contraindications identified in the patient, as well as on the stage of development of the disease, the presence of concomitant pathologies and the capabilities of the medical institution.

It is recommended to use homeopathy and traditional medicine methods, for example, infusions of medicinal plants or fir oil, only under the supervision of a physician, due to their selective effectiveness and the individual characteristics of the patient’s body.

The course of treatment can take place both on an outpatient basis and during hospitalization of the patient in a medical institution. This depends on the general condition of the patient and on the severity of the clinical manifestations of the disease.

Source: https://prostatitaid.ru/adenoma-prostaty/lechenie-adenomy/metody-lecheniya.html