Inflammatory diseases of the prostate gland in men, which have not been given enough attention in the early stages of their development, lead to severe complications. The prostate ceases to function, its changes become irreversible, and the only way to save the life and health of the patient is an operation to remove it – adenomectomy .
Features of surgical intervention
Adenomectomy – what is it? This is the removal of an adenoma (a benign tumor) on the patient’s iron prostate organ. Modern surgery includes several techniques of surgical intervention, differing in the way of access to the main male gland. It:
- retropubic operation;
- suprapubic or transvesical ;
- transurethral .
Each type of surgical intervention has its own disadvantages and advantages, which will be discussed in detail by the attending physician at the stage of preparation for surgical therapy.
Retropubic technique
This method is also known as retropubic adenomectomy . The surgeon gets access to the prostate by cutting the skin below the navel, while the integrity of the bladder is not violated. With retropubic In adenomectomy , the operation technique involves suturing the capsule in which the prostate is located, above and below the proposed incision site.
Next, the surgeon gently pushes the epidermis apart (with scissors or manually) and excise the tissues that hold the iron in the prostate organ. At the same time, the components of the urinary system (urethra, bladder) are not violated. As soon as the gland is removed, the doctor stops the bleeding from the damaged vessels and sutures the incision in layers.
suprapubic method
With transvesical adenomectomy , the patient is placed horizontally and the pelvic region is slightly elevated. An incision is made on the body below the navel. Immediately before the operation, physiological saline is injected into the bladder through the catheter, after heating it to a certain temperature.
The walls of the bladder are fixed with two holders and an incision is made, in which all layers are dissected. The next step is to examine its inner layer and search for the mouths of the ureters and the urethra. The urinary mucosa, located near the mouth of the urethra, is incised with a special electrosurgical knife that cauterizes the blood vessels, which prevents bleeding.
If the prostate cannot be visualized, the doctor inserts a finger into the anus, slightly squeezing the prostate upward. This is followed by excision of the gland and a careful examination of the bed where it was located. The final stage: hemostasis (drying of tissues from excess blood) and layer-by-layer stitching of tissues.
Transurethral method
This type of surgical intervention does not involve the removal of the prostate itself, but only tissues affected by benign changes. The operation is performed using a diathermocoagulator , which simultaneously cauterizes the edges of the incision, which reduces blood loss. The intervention is carried out under visual control carried out by the endoscope.
During the intervention, the patient is in a horizontal position on the back, the legs are bent at the knees, the pelvis is raised. An obligatory stage of the procedure is the constant irrigation of the incision site with saline for cooling. Transurethral resection has several varieties:
- total, in which more than 80% of the organ is removed, which corresponds to an open form of surgical intervention;
- partial, when from 30 to 80% of the tissues of the organ are excised and a channel is formed in the part of the urethra passing through the prostate;
- radical, used to treat the early stages of prostate cancer.
Adenoma is a benign neoplasm that occurs not only in urology. So, the removal of hyperplasia of the pituitary tissues, related to the field of neurosurgery, is also carried out using adenomectomy , only transsphenoidal .
Indications for carrying out
Surgery on the pelvic organs is indicated for patients who have a persistent tendency to progression of the existing disease. The formation of an adenoma is not a one-time process, it develops for a long period, it is preceded by symptoms and pathologies that make a man see a doctor much earlier.
If the previously prescribed treatment did not give the expected results and the disease continues to affect new cells, surgery is indispensable.
The main indications for adenomectomy are:
- an increase in the size of the iron prostate organ, despite ongoing drug treatment;
- change in urodynamic parameters ;
- dysfunction of accumulation and excretion of urine;
- the presence of a residual volume of urine due to a malfunction of the muscle responsible for pushing out the fluid;
- difficult emptying;
- expansion of the cavities of the genitourinary system due to pathological processes;
- ejection of urine from the bladder back into the ureters;
- urinary retention of an acute or recurrent nature;
- constant inflammatory processes in the bladder, urethra, kidneys;
- development of renal pathologies.
All these processes can become a threat to the patient’s life, so the only way to save a man’s health is to remove the prostate or part of it.
To whom the operation is contraindicated
In some cases, surgery may not be possible. Resection is prohibited if the patient’s body has inflammation of any nature or he is in the stage of decompensation of diabetes mellitus. The presence of serious pathologies of the cardiovascular system is also included in the list of contraindications, for example, the operation is prohibited if the man is diagnosed with myocardial infarction, vascular pathologies caused by the formation of blood clots, strokes.
IMPORTANT! Resection of prostate tissue is possible no earlier than six months after the end of treatment for diseases of the heart and blood vessels.
Adenomectomy is not repeated, as well as for patients with respiratory diseases in the stage of decompensation. The intervention can be canceled if the analyzes the day before showed the transition of hyperplasia to a malignant state.
Rehabilitation treatment
In the postoperative period, pain may occur in the area where the incision was made (if the intervention was open) or slight discomfort in the urethra. Painkillers in tablets or administered intramuscularly by injection will help eliminate discomfort.
The first three days there is hematuria – the presence of blood in the urine. This phenomenon is quite normal and does not require any treatment. The patient will be under the supervision of doctors for at least a week, during which time the doctors will monitor the well-being of the operated person, the functioning of the organs of the urinary system, and the condition of the sutures.
IMPORTANT! A prerequisite for successful rehabilitation is the rise and the first steps the next day after resection. This is the prevention of stagnation of blood – adhesions.
The recovery period begins after the patient is discharged from the hospital. He receives a list of recommendations that help him quickly restore his health, return to his usual rhythm of life and minimize the risk of possible complications.
The first rule is limiting physical activity. You can expose yourself to them no earlier than a month after the surgical treatment and only after the permission of the attending doctor.
IMPORTANT! Physical activity is not only lifting weights, but also intense sports, long periods of standing upright, long distance travel, etc.
The second rule is diet. It should not be too strict, it is enough to exclude fatty, spicy and salty foods from the menu, giving preference to baked or steamed meat, gifts of nature, sour-milk products. Alcohol is strictly prohibited!
Daily walks in the fresh air, moderate physical activity, positive emotions and morale for recovery are important. It is possible to take medications as prescribed by the doctor, regular monitoring of the state of health.