Treatment of prostate adenoma: surgery TUR and laser

Laser treatment is more like transurethral resection( TUR) and is an alternative way to remove an enlarged part of the prostate or a simple dissection of the opening to expand it. There is a method called vaporization( electric evaporation), which uses a slightly modified resectoscope, used for transurethral resection.

Of these new treatments, the most promising one may be one of the types of laser, but it must take some time before it replaces the tried and tested transurethral resection.

Surgical treatment of prostate adenoma: operation

Methods of surgical treatment are performed for emergency indications for acute urinary retention or in routine order. Scheduled surgery is performed only after a complete examination of the patient. Surgical treatment( planned operation) is performed only in the presence of absolute indications:

1. Delayed urination( inability to urinate even after a single bladder catheterization).
2. Urinary tract infection, which is repeated many times due to prostate adenoma.
3. Stones in the bladder that appeared due to prostate adenoma.
4. Massive and repetitive hematuria( presence of erythrocytes in urine), which occurs due to prostate adenoma.
5. Large diverticulum in the bladder.
6. Renal failure, which develops due to prostate adenoma.

Similarly, surgical treatment of prostatic adenoma is indicated in patients who have significantly increased the average proportion of the prostate or those with a large amount of residual urine in the bladder.

An emergency operation is an operation that should be performed within 24 hours from the moment of complications development. During such an operation, adenomectomy( prostate removal) is performed.

Emergency operation is indicated:

1. If bleeding is present in a life-threatening patient.
2. With acute urination retention.

Preparation for operation treatment of prostate adenoma

1. A general blood test is performed to determine anemia( reduced amount of hemoglobin and erythrocytes), leukocytosis( indicating an inflammatory process).
2. Before the operation, it is necessary to check the function of the kidneys using a biochemical blood test. In the event of the presence of impaired renal function, creatinine and urea in the blood will be increased.
3. Blood coagulation studies are necessary to eliminate the risk of thromboembolism or bleeding, both during and after surgery.
4. ECG( electrocardiogram) - in order to exclude possible complications from the heart during the operation.

Methods of surgical treatment: types of operations

TOUR

Transurethral endourologic treatment of the prostate( TUR) is a method of operation in which special endoscopic equipment is used. The operation is performed transurethral( i.e., in the urethral cavity).The endoscope is guided through the urethra directly to the prostate, then the hypertrophied prostatic site is removed. This method of surgical intervention has a number of advantages over open surgery:

1. Allows patients to be operated on with concomitant diseases.
2. No soft tissue damage when accessing the prostate, which speeds up recovery time after surgery.
3. Well-controlled hemostasis( stopping bleeding), which significantly reduces the risk of bleeding after surgery.

TUE - electric evaporation

Transurethral electrovaporization( electric evaporation) of the prostate - this method of treatment is similar to the endourological method and differs from it only by using a roller electrode. When the electrode touches the prostate tissue, the tissues are burned with drying and coagulation. This treatment significantly reduces the risk of bleeding during surgery. This method of treatment is most effective at small and medium sizes of the prostate.

Electroencephalus

Electroincidence of prostate adenoma - this method of treatment differs from other methods in that in this case, prostate tissue is not removed, but only produces longitudinal dissection of the prostate and bladder neck. Most often this method of treatment is used in the following cases:

1. Intravesical( in the lumen of the bladder) the growth of prostate adenoma.
2. The patient's young age.
3. Small prostate size.

Treatment methods using laser

There are two main directions of laser therapy:

1. Laser vaporization.
2. Laser coagulation.

And the treatment with these methods can be carried out by contact or non-contact method. When contactless( remote) endoscopic laser coagulation is used, fiber optic fibers with a special tip directing the laser beam at an angle to the longitudinal axis of the fiber. The non-contact technique is different from the contact energy density in the prostate tissues.

The advantage of evaporation over coagulation is the ability to remove the prostate under the control of vision. The evaporation procedure can take from 20 to 110 minutes.

There is also a method of interstitial laser coagulation of the prostate. This method involves placing the tip directly into the prostate tissue. During the operation, the location of the tip is changed several times. The average operation time is 30 minutes.

Transurethral microwave thermotherapy

Transurethral microwave thermotherapy is a method in which the influence of high temperatures on prostate tissue is used. The threshold of temperature tolerance( tolerance) of prostate cells is 45 degrees Celsius. This method involves the use of temperatures from 55 to 80 degrees Celsius. This temperature is created by using non-focused electromagnetic energy, which is conducted to the prostate with a transurethral antenna.

Transurethral radiofrequency thermal destruction

Transurethral radiofrequency thermal destruction - this method involves the use of a hard temperature effect( 70-82 degrees Celsius).In this method, electromagnetic energy is also used.

The main advantage of thermal destruction is its high efficiency in the treatment of prostate adenoma with severe sclerotic changes and calcification of the prostate. This procedure lasts about an hour on average.

Balloon dilatation

Balloon dilatation - the method is based on the mechanical extension of the prostatic section of the urethra.

Urethral stents

Urethral stents( internal drainage systems).With the implantation of a urethral stent, the problem of bladder drainage is solved. Most often, stents are used in the second or third degree of the disease( when obstructive symptoms are strongly pronounced).

What are the possible consequences, or complications after surgery for prostate adenoma?

The probability of these or other complications may be different, depending on the operation chosen. Consider the possible consequences of surgery on the example open prostate removal and transurethral resection can distinguish such complications as:

1. Urine retention .It occurs as a result of a malfunction of the muscles of the bladder or because of surgery.
2. Infections of the genitourinary system : acute prostatitis ( inflammation of the prostate), acute pyelonephritis ( inflammation of the renal calyces, pelvis and tubular system), acute orchiopididymitis( inflammation of the testis and its appendage).There are 5-22 men out of 100.
3. Bleeding after surgery .At the same time in the bladder blood clots are formed, which violate the outflow of urine. It is necessary to perform a repeat operation, open or endoscopic.
4. Bleeding during surgery is the most severe complication. According to statistics, it occurs in 2-3 men out of 100. Blood transfusions may be required.
5. Urinary incontinence .This complication occurs in some men. If it is associated with a malfunction of the muscles of the bladder, then it can go by yourself.
6. Insufficient removal of prostate tissue during operation .The remaining tissue can act as a valve and cause micturition disorders that do not go away for a long time, sometimes cause even greater anxiety to a man than before surgery. Complication occurs in 2-10 men out of 100, to cope with it helps to re-operation.
7. Retrograde ejaculation is a condition in which sperm does not go outside during sexual intercourse, but is thrown back in the bladder. This complication is very common.
8. Constriction of the urethra .It develops after a surgery in about 3 men out of 100. It requires endoscopic intervention.
9. Erectile dysfunction .Erection problems occur in every tenth man who underwent surgery for benign prostatic hyperplasia. Many scientists believe that the operation has nothing to do with it - in unprocessed men, violations occur as often.

What is prostate adenoma embolization?

Embolisation is a modern method of treating benign prostatic hyperplasia, which began to be applied in 2009.The essence of the technique is that the doctor enters a special probe into the vessel supplying the adenoma, and injects the embolus through it - the smallest particles that block the blood flow. Adenoma ceases to receive blood and as a result decreases in size.

Embolization is often a good alternative to surgery for benign prostatic hyperplasia. But it can not be performed in all hospitals - this requires special equipment and trained specialist doctors - endovascular surgeons .

After embolization, the prostate gland may decrease by half or more. This procedure allows you to avoid complications that can occur during and after surgical interventions.

How is embolization of prostatic adenoma:

1. The procedure is carried out in a special room( X-ray operating ) under the control of radiography.
2. Thanks to the use of anesthesia, the procedure is practically painless. The man experiences sensations, as during an injection in a vein.
3. The doctor makes a small incision in the region of the radial or elbow joint and inserts the catheter, respectively, into the radial or brachial artery.
4. Under the control of radiography, the catheter is guided into the aorta, the internal iliac artery, and finally into the vessel that feeds the prostate adenoma.
5. The doctor enters the embolus through the catheter - small particles that block the lumen of the vessel and disrupt the flow of blood to the adenoma.
6. In general, the procedure can last up to several hours. After embolization, many men can return home the same day and engage in daily activities.

Typically, embolization is prescribed when the size of the prostate adenoma is 80 cm3 or more.

What is the cost and cost of surgery for prostate adenoma?

The price of the operation depends on the characteristics of the clinic where surgery is performed, the city( in Moscow, as a rule, is more expensive, in regions it is cheaper), the type of operation, equipping the hospital, the doctor's qualification level( if the doctor or the candidate of medical sciences, the head of the department operates- Treatment often costs more).

The operation is performed under anesthesia - its kind also affects the total cost. Not the least role is played by the price policy of the clinic. Management can set the price at its own discretion.

Related videos

Prostate adenoma - symptoms, causes and operation

Benign prostatic hyperplasia( BPH), formerly known as prostate adenoma, prostate adenoma is a benign formation that develops from the glandular epithelium or the stromal component of the prostate. Fragment of the program "On the most important".

Removal of prostatic adenoma? How to remove, keeping the potency?

Prostate adenoma develops frequently. To remove an adenoma it is possible only surgically, if to apply organosohranjajushchuju operation, removal of an adenoma of a prostate can save a potency! In prostate cancer in stage 1-2, removal of the tumor can also be carried out in a gentle manner and the potency will not be affected. Treatment of prostate cancer in stage 1-2 gives the possibility of a complete cure.

If you have prostatitis - you need to properly treat it, because it is prevention of prostate adenoma and cancer at the same time. Potency will not suffer, impotence or erectile dysfunction will not appear.

Source

The information in this article is based on official authoritative sources:

1. Video on the topic.
2. Medvedev BA The second heart of a man. Prostate treatment / Panacea series.- Rostov n / a: Phoenix, 2004. - 320 with.
3. Tkach IS Prostate adenoma, its treatment, questions and answers on the site: http: //www.polismed.com/ articles-adenoma-prostaty-01.html .
4. Nashegov GN The People's Clinic. The best recipes of traditional medicine.- Moscow: Arnadia, 1998. - 352 p./ Medicine for all.
5. G.Nasgov. Official and folk medicine. The most detailed encyclopedia.- Moscow: Izd-vo Eksmo, 2012.