Surgical Options For Prostate Adenoma

Prostate adenoma (also known as benign prostatic hyperplasia) is a complex disease, during which nodules form in the structure of the glandular organ. In most cases, doctors take wait-and-see tactics. Dynamic observation is designed to determine the development of the pathological process.

Since conservative methods of therapy for the most part are intended only to stop symptoms, the main method of treatment was and remains surgery. However, this is the collective name of a whole group of specialized manipulations.

Prostate adenoma – a disease in which nodules form in the structure of the prostate gland

Indications for surgical treatment

Despite the fact that surgical intervention is the main method of therapy, they resort to it last. There is a clear list of indications for surgical treatment:

    • The discovery of severe bleeding . Bleeding with prostatic hyperplasia is possible as a result of ischemia of the adenomatous node. Since the glandular organ is well supplied with blood, an abundant exit of blood from the urethral canal is possible. This is dangerous for health and life, and is also fraught with obstruction of the urinary tract with a clot.
    • Chronic infectious and inflammatory processes caused by hyperplasia. These are prostatitis, cystitis, pyelonephritis and other diseases of the urinary system of a secondary nature.
    • The development of calculi in the bladder.
    • Stenosis of the urethral canal with the inability to exit urine (chronic urinary retention). In this case, a complex operation is performed to remove hypertrophic nodes of the prostate gland and expand the urethra.
    • Acute urinary retention . At the developed stages of the pathological process, iron grows to a significant size, interfering with the normal evacuation of urine from the body. This condition is urgent and requires urgent medical correction.
    • Renal failure caused by stagnation in the urinary tract.

In all other cases, dynamic observation is shown.

General contraindications

Not always an operation can be performed. Contraindications include:

    • Atherosclerosis of the cerebral vessels.
    • Diseases of the cardiovascular and respiratory systems in the stage of decompensation. In this case, the risks associated with the introduction of the patient into a state of anesthesia.
    • Acute inflammatory diseases of the urinary tract: kidney, bladder. It is also not recommended to conduct surgery during the course of acute prostatitis.
    • Infectious diseases.
    • Acute current renal failure.

Surgical intervention is delayed until the correction of the underlying disease or condition that made it impossible to carry out the operation.

Operation Options

There are many options for surgery. Classical techniques are recognized:

    • Transurethral resection (TUR).
    • Open operation.

Both methods have their own indications, especially the conduct. All other methods are considered modifications of these two.

Open operation

Such surgery is considered universal, because it allows you to remove the formation of any size and localization. An important issue, however, remains the appropriateness. A few decades ago, there were no alternatives to open adenomectomy. At the moment, the operation is performed according to the following indications :

    • Significant size of the adenomatous node (over 8 cm in diameter).
    • The presence of stones in the bladder.
    • The likelihood of malignancy (malignancy) of the tumor structure.

Adenomectomy is a highly traumatic operation. The duration of the manipulation is from 40 minutes to 2-3 hours. During the intervention, the abdominal wall and bladder are dissected. Through such access, the removal of nodal education is carried out. At the end of the manipulation, excised tissues are necessarily sent for histological examination to the laboratory.

The benefits of surgery:

    • Radicalism. Volumetric formations are removed completely, the risk of relapse is minimal.
    • Efficiency.

Cons :

    • The likelihood of complications.
    • Long term rehabilitation.
    • The complexity of the execution.
    • The need for a long stay in stationary conditions.

Complications :

    • The main thing is prolonged bleeding. They are dangerous not by the risk of blood loss, but by the likelihood of thrombosis. A blood clot can cause obstruction of the urethra. This condition does not go away on its own.
    • Postoperative wound infection.
    • The possibility of developing secondary infectious cystitis.
Thus, radical abdominal adenomectomy is an extreme measure that doctors resort to only in advanced cases.

Transurethral resection

It is considered the most preferred method of treatment of prostatic hyperplasia, the “gold standard” of urology. At the same time, such an intervention is very complex and requires impeccable skills from the surgeon. The main indication for TUR is adenomatous nodes of small size (up to 8 cm in diameter). In all other cases, especially when the doctor has doubts about the origin and nature of the formation, abdominal surgery is indicated.

Transurethral resection involves the introduction of instruments through the urethra to the prostate gland. Then the tumor is excised and removed. As in the previous case, the tissues are sent for histological examination.

The advantages of the method:

    • Minimally invasive. The surrounding tissue does not suffer.
    • Short rehabilitation period.
    • Lack of postoperative sutures.

The duration of the operation is about an hour.

Cons of the technique:

    • The impossibility of radical removal of large nodes.
    • High complexity of the intervention, huge requirements for the qualification of the operating surgeon.
    • The need to use expensive equipment.

Likely complications :

    • Narrowing of the urethral canal (stricture).
    • Slight bleeding from the urethra.
    • Pain syndrome.

Can prostatic hyperplasia be cured by non-surgical methods?

Conservative therapy can normalize the outflow of urine and inhibit the growth of adenoma, however, such treatment is considered symptomatic, i.e. the root cause does not disappear. For treatment in the early stages, the use of medications is indicated:

    • Alpha blockers. They relieve spasm of smooth muscles of the bladder and urinary tract, normalizing the outflow of urine. Alfuzosin, Doxazosin, Omnic, etc.
    • 5 alpha reductase inhibitors. They suspend the process of tumor growth in size. Stabilize the course of the pathological process. Proscar, Dutasteride, Alfinal.
    • Herbal medicine. They are used exclusively at the initial stage of the process. Afala, Speman, Gentos, etc.
Important! In no case should you take diuretic (diuretic) drugs. This is fraught with the development of acute urinary retention and rupture of the bladder.

In addition, non-drug methods are practiced . But they can not be called completely surgical. Among the procedures to eliminate adenoma:

    • Electrocoagulation of the tumor.
    • Cryodestruction.
    • Laser ablation
    • Thermotherapy.
    • Vaporization.

Tumor access is also transurethral.

Rehabilitation period

Regardless of the type of surgical intervention, a number of recommendations should be observed in the rehabilitation period:

    • Refuse from intense physical exertion for a month and a half.
    • Perform selected complexes of medical gymnastics.
    • Exclude sexual contact for 30-40 days, until the wound is completely healed.
    • Rationalize your own menu: as little as possible food of animal origin and, conversely, as much as possible vegetable products on the table. Spices, salt, coffee and strong tea should be discarded.
    • Take enough fluid, regularly empty the bladder (every two hours), avoiding stagnation of urine.
    • Visit a surgeon or attending physician regularly to process postoperative sutures (if abdominal surgery is performed).

The treatment of prostatic hyperplasia is a difficult task. As a rule, in the early stages, a comprehensive drug approach is chosen. In the future, simply can not do without surgery. The method of surgical intervention is chosen by the doctor, based on the size and nature of the tumor. In any case, you cannot delay the treatment. If alarming symptoms appear, consult a urologist.