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Prostate adenomectomy
Last reviewed: 04.07.2025
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Adenoma is a benign neoplasm localized in the prostate gland. This is a fairly common pathology that affects patients over 50 years of age. The risk of developing the disease is especially high in men who suffer from chronic inflammatory diseases of the urinary tract, kidneys, and bladder. The risk also increases in the presence of infections and impaired urodynamics. The disease manifests itself as intense pain. Blood may appear in the urine. Often the bladder is not completely emptied, and urinary retention is observed. The main method of treatment is adenomectomy.
Most often, surgical methods are used when other, conservative methods are ineffective. Also, surgery cannot be avoided if there is a pronounced urination disorder. Urgent surgery is performed in case of complete urinary retention. Many doctors first try to catheterize the urinary tract. But this method is often ineffective and ultimately, surgical intervention is still required.
Indications for the procedure
If a patient has prostate adenoma, this does not necessarily mean that he needs surgery. Many cases are quite effectively treated conservatively. Surgery to remove the adenoma is performed only if there are indications for it. And this is approximately 2-3% of cases.
In most cases, surgery is performed if the adenoma has reached a sufficiently large size and if it is rapidly increasing in size. Usually, the indication for removal is the mass of the adenoma exceeding 80-100 grams. First of all, they try to perform transurethral resection of the prostate gland. If for some reason this procedure cannot be performed, surgery is prescribed. This is the main indication.
There are also additional indications that indicate the need for surgery. Thus, additional indications for adenomectomy include the presence of chronic diseases of the genitourinary tract that are severe and have frequent relapses. If a person has a blockage of urine outflow, surgery must also be performed urgently. The appearance of blood in the urine, pathological changes in the bladder, pathologies and inflammations in the kidneys and ureter under various circumstances can also be considered as an indication for surgery.
Preparation
Preparatory activities begin with a consultation with a urologist. First, a digital rectal examination is performed, after which in most cases there is a need to conduct a PSA test - prostate-specific antigen. The patient's blood serves as the biological material for the study. It is often prescribed when cancer is suspected. A negative result allows you to exclude prostate cancer. An additional research method that allows you to exclude a cancerous tumor is TRUS - transurethral ultrasound examination, during which biological material is collected for further histological examination.
It is also necessary to conduct a comprehensive examination of the pelvic organs. It is important to pass mandatory clinical tests, a biochemical blood test, and specialist consultations. These are planned measures used in preparation for any operation. A consultation with a surgeon and anesthesiologist is mandatory; an electrocardiogram may be required.
Specific research methods include urofluorometry and measurement of residual urine in the bladder. A chest X-ray or fluorography is required, especially for patients over 60 years of age.
Technique adenomectomies
After all the necessary preparatory measures have been carried out, the patient is put under anesthesia. Spinal and epidural anesthesia are most often used, which imply intensive regional anesthesia. This allows to significantly reduce the risk of complications. First of all, such anesthesia allows to overcome pulmonary embolism and prevent the risk of developing deep vein thrombosis. General anesthesia is used extremely rarely, mainly in the case where there are contraindications to regional anesthesia.
Adenoma removal is performed through incisions. In this case, retropubic or suprapubic access is most often used. In some cases, open transvesical adenomectomy is used, the essence of which is penetration through the incision of the bladder, during which the hyperplastic gland is enucleated. In this case, the patient's position should be spinal. Before the beginning of manipulations to remove the adenoma, a special catheter is inserted into the bladder, which will ensure reliable outflow of urine from the bladder. After this, a longitudinal incision is made, which provides access to the bladder.
After access to the bladder is obtained, special holders are installed along the edges to hold the bladder and allow the surgeon to perform the necessary manipulations. In this case, to ensure reliable fixation, the bladder is usually stitched in several places. After the enucleation is performed, the bleeding is stopped. It often occurs in the area where the prostate adenoma was localized. Then the bladder is sutured. A small tube is left in it, which will act as a drainage system and ensure the necessary outflow of substances to the outside. In addition, with the help of this tube, it is possible to wash the prostate. For washing, a furacilin solution and other means are used to prevent bacterial infection. A catheter should remain in the bladder for about a week. This is necessary so that a new section of the urethra can form around the catheter (since during the operation a small section is simply removed).
Stages of adenomectomy
Adenomectomy is performed in several stages. The first stage involves preliminary preparation for the operation. It includes consultations with doctors, taking tests, and selecting the optimal anesthesia. The preparatory stage ends with the administration of anesthesia.
The second stage is to provide surgical access. Various types of incisions may be used, depending on the type and kind of surgery. At the third stage, the necessary manipulations are performed to remove the adenoma. At the fourth stage, the wound is closed and sutures are applied. The postoperative stage includes additional patient monitoring, suture removal, bandaging, and rehabilitation treatment.
Retropubic adenomectomy
Retropubic adenomectomy requires making an incision along the anterior surface of the prostate capsule. Then further enucleation of the adenoma is performed with a finger. Before starting the operation, a cytoscopic examination is performed. To perform this procedure, the patient must lie on his back. He is placed on the operating table. After this, the patient takes the Tredelenburg position, in which the legs are located above the head.
The surgical field is then processed. A catheter is inserted into the bladder, and the area from the navel to the pubic bone is cut. After the rectus abdominis muscles are isolated, a retractor is inserted to widen the incision. The localization of the venous plexus is then determined, and the neck of the bladder is isolated. It contains the main artery that supplies blood to the prostate gland. After this, the surgical capsule is dissected in the area closest to the adenoma. Then digital enucleation is performed. After the adenoma is completely removed, hemostasis is performed and the wound is sutured layer by layer.
This method of adenomectomy has its advantages. In particular, it allows to examine prostate adenomas, the urethra is cut pointwise. As a result, the probability of complications is significantly reduced. It is possible to avoid urinary retention. In addition, this technique allows to perform complete hemostasis after the adenoma is removed, the bladder is not injured.
Transvesical adenomectomy
It provides a different surgical approach. In this case, the lower part of the anterior surface of the bladder is cut. This technique has a number of advantages over other methods, in particular, it is possible to directly examine the neck of the bladder and its mucous membrane. In this regard, transvesical adenomectomy is an ideal option for patients who suffer from a complicated form of prostate adenoma, which is associated with complications from the bladder.
The procedure is not without certain disadvantages, in particular, it is quite difficult to perform hemostasis. The incision is made along the midline of the abdomen in the area from the navel to the pubic bone. The bladder is opened and examined. In particular, the mucous membrane is examined. The adenoma is removed and the prostate capsule is dissected using an electrocautery and special scissors. In order to perform hemostasis, the bed of the adenoma is stitched after its removal. Then the incision is sutured layer by layer through the anterior surface of the abdominal wall.
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Laparoscopic adenomectomy
One of the main methods that allows you to quickly and effectively remove an adenoma is laparoscopy. This is a universal method that is used in many areas of medicine. It does not require large incisions. Several punctures are made through which special instruments are inserted. They allow you to fully examine the internal organs, assess the scale of the operation. You can also display the image on the screen. The method allows you to remove an adenoma as accurately and precisely as possible, practically without damaging adjacent organs and tissues, directly through the incisions.
The recovery period after this operation is quite short. This method is convenient for removing large adenomas. It has a number of advantages, which are mainly achieved due to the fact that a large, open surgical approach is not made. In this regard, the risk of infection, bleeding and other complications is significantly reduced. There are practically no scars after the operation, since 4 small incisions are made, the diameter of which does not exceed several centimeters. After the operation, these areas are simply sealed with adhesive tape, often there is no need for stitches. The postoperative period ranges from 3 to 5 days, and often even painkillers are not used. This is due to the fact that the scale of the damage is insignificant, tissue restoration occurs very quickly. Some manage to recover even in 1-2 days. The patient can get up on the day of the operation or the next day. Blood loss is insignificant, which is very important for people with blood clotting disorders, for the elderly.
During laparoscopy, in most cases, such methods of surgical access as the suprapubic and retropubic method are used. Contraindications to laparoscopy include the presence of urolysis, diverticulosis of the bladder, inguinal hernia and pathological conditions of the joints and lower extremities.
During the operation, special equipment is used. Not every clinic has it, so not every clinic can afford to perform the operation using this method. In addition, the operation requires special skills and high qualifications of the specialist who performs the operation. A trocar is used, which is a tube. It has a channel through which instruments are inserted. Also, a special camera is placed at the end of this instrument, which provides a good view. You can also display the image on the monitor. You can even shoot a video. Three trocars are enough to perform the operation normally, but to ensure high quality of surgical intervention, sometimes 5 trocars are used.
The patient is placed on the operating table with his legs raised up, under anesthesia. The legs are placed on special supports, the head end is lower than the legs. This position is called lithotomy. A catheter must be inserted into the bladder to successfully drain urine. Trocars are installed in the required areas, the surgical field itself is processed, then inflated with a balloon. The incisions are small, in the area of the umbilical canal. In this case, the usual dissection of the peritoneum is not performed. What is happening is monitored using video equipment. The adenoma is removed through the trocar channel. After it is completely removed, the instruments are removed from the incision. The duration of such an operation usually does not exceed two hours.
Additionally, other trocars can be used. They can be brought to the surgical access and used when additional measures are required. For example, electrocautery, dissectors and other instruments can be inserted through them. Flushing is performed through a catheter inserted into the bladder using a saline solution.
If necessary, the doctor can leave a catheter in the bladder for about 2-3 days. It provides good drainage. The next day you can get out of bed. And usually after removing the catheter, the patient is discharged home. Usually, antibiotics are prescribed to prevent infections, and it is also recommended to drink plenty of fluids. This will help maintain good drainage of the wound. Also, in the postoperative period, you cannot play sports or do heavy physical work. Upon discharge, the patient will receive a number of recommendations that must be followed in order to quickly recover.
The effectiveness of the operation is quite high. It alleviates the patient's condition by 98% (as assessed by the prostate symptom scale). During the operation, it is possible to eliminate the entire pathological area. Subsequently, there are no relapses and there is no need for a repeat operation.
One-stage adenomectomy
Today, more and more specialists resort to performing a one-stage operation, while the two-stage one is fading into the background. It involves removing the adenoma with subsequent application of a blind suture to the bladder. This operation is often called an ideal adenomectomy.
This method has a number of advantages. For example, after the operation there is no need to install a suprapubic urinary drainage. This is a high-tech method. There are a number of discussions among specialists regarding the advantages and disadvantages of this method. However, most specialists agree that this technique is an ideal option when operating on patients with normal secretory and excretory activity of the kidneys. It is also used in cases where catheterization of the bladder is impossible. It is also used in cases where conservative treatment methods are ineffective. It is recommended to be performed only if the patient feels well, if the level of residual nitrogen in the blood is within normal limits, and if the person does not have genitourinary infections.
The operation by this method is contraindicated if a person is not able to adequately perceive and evaluate the situation. It is not performed if a person suffers from severe mental disorders, senile dementia, severe forms of neuroses. Also considered as contraindications are severe cardiac pathologies in the decompensation stage, with impaired renal and hepatic function. A contraindication is a violation of the norm of urea in the urine and creatine in the blood. Various congenital and acquired defects and anomalies of the urinary tract, tumors, diverticulosis, impaired urine excretion, sepsis serve as a contraindication to the operation.
A blind suture is applied if the person has successfully undergone surgery. In most cases, surgeons use a midline incision, which is made between the navel and the pubic symphysis. An arcuate incision is used, which allows avoiding urinary fistulas and urine leaks, while the innervation is not disrupted.
During the operation, resection of the bladder is mandatory. In this case, concomitant pathologies are often detected - polyps, cancerous tumors, diverticula. The edges of the wound are gradually spread apart. Stones and other possible pathologies are removed, then they proceed directly to enucleation of the adenoma. This is done blindly, so the surgeon's experience is very important here. Bleeding is stopped in the bed of the adenoma. Then the wall of the bladder is sutured.
It is safe to say that the outcome of the operation, prevention of further complications and bleeding depend on how well the operation was performed, as well as on the experience and qualifications of the surgeon. In general, adenomectomy is not a complex operation. Recovery after it is quick, complications are rare.
Open adenomectomy
Open adenomectomy is also called transvesical. It is used if it is impossible to remove the adenoma by other methods. It is indicated if the adenoma has reached a sufficiently large size, and also if it cannot be removed by transurethral resection. There are no contraindications to this operation. The operation is not performed only if the person is in serious condition, if he has serious concomitant diseases that can prevent any operation. The operation will have to be postponed if the person is sick with an infectious or inflammatory disease. In this case, it is necessary to first cure the disease that prevents the operation, and then proceed directly to the operation.
During open surgery, anesthesia is used. General anesthesia is mainly used in combination with regional anesthesia. The decision regarding which method of anesthesia is more appropriate to choose in each specific case is made by the anesthesiologist. It is based on the results of tests, the conclusions of other specialists, as well as the patient's own objective and subjective examination data.
The operation requires preliminary preparation. The better the preparation, the greater the chances of a successful operation. Several weeks before the operation, you need to follow an optimal diet, take the necessary tests, and undergo an examination by the main specialists. Immediately before the operation, the hair is removed from the pubic area. Usually, the patient does this independently, but if it is impossible to do these manipulations independently, these actions are performed by medical personnel. About 8 hours before the operation, you cannot eat or drink water.
Open surgery carries many risks for young men, as there is a high risk of potency disorders. Therefore, this type of surgery is used by young men extremely rarely, only if drug therapy does not give a positive result, as well as if other methods are ineffective.
The operation is performed in several stages. First, the bladder is cut. This gives the doctor access to the affected part of the prostate. Immediately before the procedure, a catheter must be installed. It will allow excess fluid to flow out of the operated cavity.
The incision is localized in the suprapubic area. After open access to the bladder has appeared, its incision is made using special instruments. The bladder is lifted using surgical forceps. The location of the bladder neck is determined along the catheter. Then another incision is made around the internal opening of the urethra.
The previously performed manipulations provide open access to the prostate gland, which enables the doctor to enucleate the tumor. Immediately after removing the adenoma, the doctor removes the remains of damaged tissue, stops the bleeding, provides aseptic conditions and sutures the bladder. The doctor leaves a small tube in the bladder, which will provide good drainage in the postoperative period. With the help of this catheter, it is possible to wash the surgical cavity, rid it of blood clots and excess exudate. This significantly reduces inflammation, promotes accelerated healing of damaged tissues. Also, in most cases, another incision is made along the internal opening of the urethra and its circumference.
After the operation, the need for a catheter remains for a week. This is an important condition for rapid and successful rehabilitation. The catheter acts as a foreign body through which exudate is removed. It will also allow a new area to quickly form around the urethra. Such areas are formed at the site of the removed part of the bladder. At the same time, such a formation is extremely important due to the fact that during the operation, a part of the bladder is completely removed. It is this intervention that causes erectile dysfunction in most men.
When performing adenomectomy by an experienced doctor, complications occur extremely rarely. Only in exceptional cases does open bleeding develop, which is caused by damage to a blood vessel. An allergic reaction may also occur if the patient has a tendency to allergies.
Possible anaphylactic shock is considered especially dangerous, but this happens extremely rarely, since this is the extreme stage of the development of an allergic reaction and appears at a high level of sensitization and allergization of the body. Usually, such a condition is clearly visible in the test results, therefore, an experienced doctor will always insure himself and take the necessary measures to prevent such complications. The patient is also obliged to observe precautions and be sure to warn the doctor about the tendency to allergic reactions. In the postoperative period, complications can occur in about 20% of cases.
Transurethral adenomectomy
Transurethral adenomectomy is a special technique for performing an operation to resect prostate adenoma, during which endoscopic techniques are used. During the operation, a special tube is inserted through the urethra, with the help of which it is possible to observe the internal state of the cavity being operated.
It is possible to display the image on the monitor screen. This allows the doctor to control the accuracy of the operation and control all necessary manipulations. This makes it possible to remove the prostate adenoma as accurately and precisely as possible, with minimal damage to the surrounding tissues. The risk of developing postoperative complications, bleeding, and infections is also significantly reduced. Recovery and healing occurs quite quickly, pain is reduced to a minimum.
Contraindications to the procedure
Adenomectomy may have certain contraindications. Thus, the operation is not performed if there is a history of cancer or fibrous growths of the prostate gland, even if the size of these neoplasms is extremely insignificant. It is also not performed if access to the prostate gland is difficult, if previous operations on the pelvic organs were performed.
Complete resection of the adenoma is also contraindicated if an infectious or inflammatory disease is present in the body, and especially if it is progressing. Usually, in such a case, the operation is postponed until the inflammatory or infectious process is completely eliminated. This is confirmed by laboratory and instrumental studies.
The operation may be contraindicated in case of decompensation of diabetes mellitus, presence of cardiac pathology, especially if it is in the decompensated stage. Also, contraindications to the operation are acute myocardial infarction, thromboembolism, and other acute conditions.
Consequences after the procedure
If the operation is performed correctly and there are no other aggravating factors or concomitant diseases, complications do not occur. However, complications such as bleeding may occur, which occurs as a result of natural fragility, increased permeability of blood vessels, or a tendency to bleed.
An allergic reaction also often occurs with a tendency to allergies. Allergies are especially common when exposed to anesthesia. Mechanical damage to the urethra or damage to surrounding tissues is also considered as a consequence of the operation.
Complications after the procedure
Today, the risk of complications is reduced to a minimum, since the technique of adenomectomy has been improved. The risk of blood loss is reduced to a minimum due to improved incision techniques and special surgical access.
In addition, modern laboratory methods allow you to control the level of allergization of the body and promptly respond to changes. With the help of various monitors and instrumental methods, you can control the indicators of the cardiac system and blood circulation, thereby reducing the risk of developing blood circulation and heart pathology.
For several hours after the operation, there is a risk of blood loss, so the patient remains in the intensive care unit for further observation and control over the condition. However, modern techniques make it possible to reduce the risk of bleeding to a minimum. Also, for several days after the operation, the patient may be bothered by the urge to urinate, sometimes there is a tendency to urinary incontinence, inflammatory processes in the bladder.
The severity of complications depends on the condition of the bladder before the operation, on the severity of the pathological process. Potency and erection may also be impaired. The so-called erectile dysfunction occurs in 3-5% of cases. Retrograde ejaculation is quite common, when sperm enters the bladder during ejaculation. This phenomenon occurs in 50-80% of cases.
The operation is accompanied by neurological complications, which most often affect the circulatory system, bronchopulmonary system. Myocardial infarction, heart attack, deep vein thrombosis may also develop. In many cases, circulatory disorders develop. Cerebral circulatory disorders are considered especially dangerous. Most often, it develops as an increase in blood pressure, ending in a stroke. The frequency of such potentially life-threatening complications is less than 1%.
Reviews
If we analyze the reviews, we can note that patients try to avoid prostate adenoma removal surgery whenever possible. If drug treatment does not help or there are no other treatment options, patients decide to have surgery. Many men doubt, ask the doctor for recommendations in advance, and collect reviews from other men who had to undergo a similar operation.
Overall, the reviews are positive. The operation allows men to noticeably improve their condition, normalize urination, eliminate pain and feel like a man again. The operation is fairly quick, and there is virtually no pain after the operation. If pain does occur, it is quickly relieved with painkillers. Men consider the main advantage of this operation to be the disappearance of pain when urinating and the disappearance of false urges to urinate.
Many men admit that they tried to avoid surgery in every possible way. They used medications prescribed by the doctor, resorted to herbal medicine and traditional medicine. But the effect, as a rule, left much to be desired, so in the end, surgical methods had to be used anyway. At the same time, as most patients note, the preparation is simple and practically no different from preparation for any other surgery. Usually, surgery is resorted to when the natural outflow of urine is completely blocked. Therefore, the surgery has to be done urgently, as a result of which the duration of the preparatory period is reduced to a minimum.
Immediately after the operation, patients experience pain for some time, but it passes quickly enough. The man begins to walk after a few days and feels well. Blood may remain in the urine for the first 3-4 days. In most cases, inpatient treatment lasts about 5-7 days, after which the patient is discharged home. For some time, it is necessary to monitor the condition of the kidneys, liver, bladder, and also assess the condition of the sutures. In general, it can be said that patients are satisfied. It is worth noting that adenomectomy does not require a long recovery.