Transurethral resection of the prostate

From the sexual health of a man depends not only his reproductive function, but also the quality of life, self-esteem, psycho-emotional and physical condition. Some sexual problems may occur in men of any age, but there are some that are very common among men 40 years and older. These are the infamous prostatitis and prostate adenoma, which not only negatively affect a man's sexual function, but also create an obstacle to a normal outflow of urine from the body. And since this condition creates a noticeable discomfort for the stronger sex and, moreover, causes dangerous conditions for health, the need for treatment of the above pathologies is obvious, and resection of the prostate is one of the most effective methods if drug therapy does not produce the expected results.

Prostatic gland and methods of its treatment

The prostate gland is one of the few internal organs that a man has, but is missing from a woman. Iron refers to the reproductive system and is responsible for the production of fluid, which is the nutrient medium for spermatozoa - male seed. The secret of the prostate is mixed with sperm and ensures the viability of small "tadpoles", thanks to which the birth of a new life is possible.

Prostate (and this is another name for the prostate gland) helps a man become a father and does not cause any unpleasant symptoms until he begins to increase in size. An increase in the size of the prostate can occur as a result of a prolonged course of the inflammatory process in the organ ( prostatitis ). Many men are not in a hurry with their problem to the doctor, which leads to the transition of the disease to a chronic form. A long-flowing inflammation in the absence of effective treatment leads to the growth of the tissues of the affected organ (prostatic hyperplasia or prostate adenoma).

Prostatitis and prostate adenoma are not the only pathologies in which there is an increase in organ size. As we know, a similar situation can be observed with uncontrolled division (proliferation) of malignant cells within the organ. In this case we are talking about oncology, i.e. Malignant tumor.

If  prostate adenoma  is a benign tumor that during its growth only squeezes nearby organs causing a disruption of their work, prostate carcinoma is already a malignant process in which not only tumor growth occurs due to active division of malignant cells, but also poisoning of the body toxic substances and death of healthy cells.

But anyway, both prostatitis, and adenoma or carcinoma of the prostate cause an increase in the size of the body. And the location of the prostate gland is such that it surrounds the urethra, through which the urine and seminal fluid out of the male organism (a secret of the prostate mixed with spermatozoa). It is clear that an increase in the prostate in size leads to a contraction of the urethral canal. Hence the problem is not only with erection, but with urination.

What is the threat of this situation and what symptoms may indicate an increase in the size of the prostate gland? Most often, men complain of difficulties at the beginning of the act of urination, i.e. There is a feeling of fullness of the bladder, there is a desire to urinate, but there is no urine or it is painful. Moreover, the desire to visit the toilet for a small need arises quite often, but the amount of excreted urine is much less than expected. Even worse is that at night, the amount of urge to urinate increases, while the likelihood of false urges is also increasing.

If the act of urination turned out to be productive, a man can be stuck in the toilet for a long time, since urine will be excreted in a thin trickle or completely by drop. Over time, you can observe more and longer episodes of hematuria, when blood is found in the urine.

The retention of urine in the body, as one of the variants of stagnant phenomena, can lead to irritation of the walls of the bladder and infectious inflammatory processes in it, the formation of urinary stones ( urolithiasis ), inflammation of the kidneys and the development of kidney stone disease, which, after all, renal failure ( renal failure ).

As you can see, the consequences of prostate growth are quite deplorable for men, therefore, before the emergence of dangerous complications, everything must be done to avoid squeezing the urethra. To stop the inflammation causing an increase in the size of the prostate gland, medication is used, but if it does not help, you have to resort to removing some part of the prostate that causes compression of the urethra, or even the entire organ. This operation is called prostate resection. If it is a question of complete removal of the prostate gland, a radical resection or prostatectomy is prescribed .

Indications for the procedure

Since the removal of part of the prostate gland, and especially all of its tissues, is a serious and responsible operation that can later affect the reproductive function of a man, the operation is prescribed only in severe cases, when drug treatment has not yielded results, and the patient's condition raises fears, for possible or already developing complications.

Surgery on the prostate gland is shown in the following categories of patients:

• men suffering from chronic prostatitis, causing compaction of prostate tissue,
• patients with a chronic course of the inflammatory process in the prostate, in which stones are found inside the organ, in the bladder or in the kidneys,
• Patients with prostate adenoma, i.e. Benign prostatic hyperplasia, which is usually a consequence of prostatitis,
• those who have been diagnosed with prostate carcinoma or prostate cancer (to alleviate symptoms and prevent the spread of malignant process).

TUR-operation is prescribed for those who previously had open-ended operations, patients with diseases in which cavitary operations are contraindicated, for young men, for whom the preservation of sexual functions is important.

What are the symptoms, in addition to the formation of stones, should be present in the patient, so that such a cardinal method of treatment of the above-described pathologies could be appointed:

• symptoms of urine retention (intoxication, disturbance of water-electrolyte balance, change in color and odor of secreted fluid, presence of sand in urine),
• severe pain at the beginning of the act of urination,
• frequent urge to urinate, some of which did not end with urine,
• frequent night trips to the toilet for a small need, the number of which exceeds that in the daytime,
• a slow and prolonged act of urination, when urine is excreted in a thin trickle or drip,
• presence in the urine of the blood, recorded for some time.

If these symptoms can be stopped with the help of medication, the prostate can not be used to remove the enlarged parts of the prostate.

It should be understood that resection of the prostate is not a full-fledged method of treating the above-described diseases. It only allows you to remove the dangerous symptoms of urinary retention and to prevent the associated complications. And when hyperplasia of the prostate tissue helps also prevent the transition of the process into a malignant form.

In prostate cancer, prostate removal helps to avoid metastasis to other organs if performed at an early stage of the disease.

[1], [2], [3], [4]

Preparation

Operations to remove part of the body or all of its tissues are rarely performed without prior preparation, and resection of the prostate is no exception. The main part of the preparatory process is a complete examination of the patient by a therapist, urologist, andrologist, including the necessary laboratory and instrumental studies.

Mandatory analyzes are:

• a clinical blood test and urinalysis,
• a detailed (biochemical) blood test,
• a study of blood clotting, called a coagulogram,
• sowing on the microflora, as well as determining the sensitivity of the causative agent to antibiotics (this is necessary, since an anti-inflammatory therapy with antibacterial agents is administered before the operation)
• study of biomaterial for syphilis ( blood test for RW ), hepatitis, HIV infection (tests can be taken individually or as part of a complex that many laboratories offer),

Additionally, venous blood may be taken to determine the blood group and Rh factor. This is especially true if these indicators were not previously studied or the patient was given a blood transfusion procedure.

In addition to the tests, the therapist prescribes ultrasound of the pelvic organs ( bladder, prostate ), fluorography or lung X-ray, electrocardiography. The last two studies are important in terms of the introduction of anesthesia, which can be both local (spinal) and general. Obligatory consultations are with the urologist and anesthesiologist.

If the inflammation of the prostate is caused by a bacterial microflora, an effective course of antibiotic therapy is preliminarily carried out , which will prevent the spread of infection during the operation and the generalization of the inflammatory process.

In patients with an increased risk of bleeding, the operation date may be delayed by 1-3 months, during which the course of treatment with corticosteroids ("Fina- satride", "Dutasteride", etc.), necessary to reduce the blood supply of the blood vessels of the prostate. This should reduce the likelihood of complications such as bleeding during surgery.

As for the preparation for the operation itself, the patient is warned in advance that, 1.5-2 weeks before the scheduled date of the operation, he should stop taking any medications, especially anticoagulants, which make the blood less viscous and capable of provoking bleeding during resection. If a person can not refuse medicine (there are vital drugs for various diseases, interrupt the reception of which is unacceptable), he must necessarily notify the doctor about this.

From the evening before the operation you need to conduct hygienic procedures, make a cleansing enema and prepare (shave) the pubic area. Dinner on the eve of the operation should be early and loose. After 12 o'clock in the morning, the use of food and drinks will have to be limited, which is due to the need for anesthesia.

Before the introduction of invasive techniques, the course of antibiotic therapy is prescribed to all as the prevention of infectious infection. Immediately before the operation, premedication is performed, i.e. The introduction of sedatives to prevent somatovegetative reactions.

[5], [6], [7]

Technique Transurethral resection of the prostate

Since the prostate is the internal sex organ of a man and access to it is limited, the patient and the doctor face the question of choosing the method of surgery. Previously, all operations were performed by the suprapubic method (transvesical adenomectomy), which was carried out almost touch. The operation of resection of the prostate is a rather popular method for solving the problem of the enlarged prostate gland, and surgeons once practiced removing the organ or parts of it through a cut in the anterior abdominal wall under general anesthesia, after which the wound was sutured without coagulation of the blood vessels.

It is clear that such a surgical intervention meant a long rehabilitation period and adversely affected the sexual functions of men. In addition, there was always a risk of postoperative bleeding.

Gradually, with the development of medicine, preference was given to transurethral resection of the prostate (TURP) and laparoscopic method, which are classified as minimally invasive and have fewer side effects than surgical prostatectomy.

The laparoscopic method is classified as innovative. For the first time they started talking about him in 2002. In theory, this is the same surgical operation, but it is carried out without large incisions on the body. On the abdominal wall, 3 or 4 punctures (no more than 10 mm) are made from the front, through which surgical instruments are inserted through the trocars, a video camera sending images to the computer monitor, lighting, air to improve visibility. The surgeon controls the instruments remotely, monitoring the progress of the operation on the monitor. Shredded parts of the prostate are removed by means of a drainage tube inserted into one of the punctures. The duration of the operation is about two and a half hours.

Advantages of the laparoscopic method are:

• the possibility of removing large prostates (more than 120 cm ³ ),
• visualization of the surgeon's actions, providing a lesser risk of damage to healthy tissues and incomplete removal of overgrown,

• low risk of bleeding and complications during surgery,
• a relatively small intensity of pain,
• The catheter after laparoscopic surgery is put on for a shorter period than after the intervention of the suprapubic method,
• a quick return to the motor activity (walking is allowed already the day after the operation),
• shorter periods of hospitalization compared with the traditional method,
• absence of ugly large scars,
• low risk of reoperation,
• almost complete disappearance of symptoms of the disease
• In many cases it was possible to avoid urinary incontinence after surgery.

Transurethral resection does not belong to the category of new techniques. It has a rather long history. The prototype of the resectoscope, with which the TUR operation was carried out, was invented back in the late 19th century. We are talking about the cystoscope of Max Nietz, with the help of which the diagnosis of urological diseases and cauterization of tissues, preventing the normal outflow of urine.

The first resectoscope was released thanks to Max Stern in 1926. Its highlight was the electric loop, which was later improved many times under the current of high frequency, allowing not only to remove tissue, but also to coagulate (seal) the blood vessels, which began to bleed heavily. This markedly reduced the risk of dangerous complications.

Transuretral resection of the prostate is a special kind of operation that leaves no traces on the patient's body, because for carrying out the procedure of inserting the resectoscope inside, it is not necessary to make incisions or punctures of tissues on the surface of the body. The fact is that access to the prostate is through the urethral canal.

Resectoscope is a tube 7-10 mm in diameter and about 30 cm in length with an optical system (telescope), valves for the liquid used for washing the operation area, and a set of instruments for removing and cauterizing tissues (coagulators, loops, curettes, electron knives) . As in the case of laparoscopy, the physician is able to visualize his actions, and not to cut the touch.

First, the resectoscope is moved to the bladder cavity through the urethra, and the organ and the area between the bladder and the urethra are examined, where the prostate itself is located.Then, the prostate gland tissue is removed, or the adenoma itself is inside it with an electric loop or knife, which work like an excavator , that is, remove the organ by parts.

The small parts of the prostate enter the bladder, where they are washed out with a special tool. At the end of surgery, the doctor examines the bladder and prostate. If there are bleeding vessels, they are sealed with a coagulator. When the doctor is satisfied that there is no risk of bleeding and all prostate tissue is removed from the bladder, the resectoscope is removed, and a tube with a balloon at the end called the Foley catheter is inserted into the urethra.

When the balloon is inside the bladder, liquid is pumped into it, thereby realizing the tamponade of the prostate site, which prevents bleeding and ensures rest for the place where the operation was performed. The filled catheter can no longer fall out.

The Foley catheter has not one, but three outlets, two of which provide an uninterrupted washing of the internal tissues of the bladder, and the third is designed for filling-emptying the balloon at the end of the catheter. The duration of washing the urea depends on the presence of blood in the withdrawn liquid.

In our country, operations on TUR-technology have been actively conducted since the seventies of the last century. First, it was a question of monopolar transurethral resection. The electrodes were located at the two ends of the resection loop. The voltage applied to them heated the knife to 400 degrees, which made it possible to simultaneously excise the tissues and coagulate the vessels. The main drawback of this method was considered to be the danger of passing current during the operation through the entire body of the patient. It is clear that such an operation had many contraindications, and in the first place it was banned in cardiovascular pathologies.

Later, the technology was revised in favor of a new technique - bipolar transurethral resection of the prostate. It is characterized by the presence of both the cathode and the anode at one end of the loop, which means that the current passes strictly between them, reducing the risk of burn of healthy tissues and other complications and enabling men with a sick heart to get rid of the discomfort associated with enlarging the prostate, the most popular and effective non-invasive method.

Advantages of TUR operation:

• low risk of bleeding, because the vessels during the operation are coagulated,
• minimal tissue trauma and-for the absence of incisions,
• the ability to monitor what is happening visually,
• a short period of rehabilitation,
• minimum of contraindications,
•  the possibility of simultaneous solution of various problems: the removal of prostate adenoma, cancer treatment (removal of the prostate gland is carried out exclusively with oncology), removal of stones in the bladder, dissection of strictures of the urethra,
• absence of traces of operation,
• the possibility of using gentle anesthesia,
• a lower risk of impairment of sexual function than in a lumbar operation,
• effective treatment for relapses of adenoma.

Even more effective and safe modern method of treating male problems is laser resection of the prostate, which is carried out by analogy with the TUR operation. The same endoscopic equipment is used, but instead of the electric loop, all the manipulations are performed by a focused beam of light (laser).

By means of the laser it is possible to carry out 4 types of operations:

1. Contact laser (photoselective) vaporization of the  prostate gland. This operation is a complete analog of conventional TUR, but it is carried out using a potassium-titanyl-phosphate and lithium-triborate laser. The tissues are removed layer by layer, but not crushed, but evaporated (dried up). At the same time, the vessels under the action of the laser coagulate, preventing severe bleeding. This method has a minimum of complications, does not affect erectile function and is suitable for the treatment of prostate cancer at any stage.

The disadvantage of the method is considered only high cost, a long procedure (about 2 hours) and the lack of necessary equipment in public hospitals.

1. Laser enucleation. This method is considered the newest (just over 10 years) and advanced for the removal of the organ. To perform the operation, use endoscopic equipment and a holmium laser, which cuts the divided lobes of the prostate into parts that are convenient for extraction, and do not turn into chips, as in the TUR operation. The capsule of the prostate gland is not disturbed, and the extracted parts of the organ can be used for histological examination.

This is also not a cheap method of treatment. The operation can last from 1 to 2 hours depending on the size of the organ.

1. Laser ablation. The method is similar to the previous one, but the prostate is not completely removed. The enlarged parts of the prostate are necrotic (cauterized) under the influence of the same holmium laser. The dead tissue will subsequently be excreted in the urine.
2. Interstitial coagulation. The least common method used to reduce the size of the prostate with the help of incisions in the organ, made with a laser. The incisions will have to heal in the future, but the intensity of the regenerative processes in different men is different. With large prostate sizes, the technique is not applied.

A great advantage of any laser operation is the minimization of the risk of bleeding and infection of the body during surgery, as well as the absence of a negative effect on potency, which is very important in the treatment of young sexually active patients dreaming of heirs.

The choice of a physician regarding the method of conducting an operation is influenced not so much by the patient's desire as by the size of the prostate. So the abdominal operation is carried out at the size of the organ more than 85 cm ³. Laparoscopy is also possible with an excessively enlarged prostate (more than 120 cm ³ ). And with the help of laser enucleation, it is possible to remove the prostate, which has grown to even 200 cm ³.

Among the remaining methods  , only bipolar TUR is suitable for removal of a large adenoma up to 120 cm ³. By means of a monopolar operation it is possible to remove an organ not larger than 80 cm ³, the same applies to laser vaporization. Laser coagulation is rarely used and only at relatively small sizes of the prostate gland (30-60 cm ³ ).

Contraindications to the procedure

Resection of the prostate, like any other serious operation, has its considerable list of absolute and relative contraindications, which can become an obstacle to the operation or postpone it for several days or weeks. So any surgical intervention is not carried out, if the patient has increased body temperature or blood pressure, there are acute infectious (bacterial or viral) diseases. But the operation will be scheduled as soon as the symptoms of the illness go away.

The same applies to smoking and taking medications that affect blood coagulability. The operation will be carried out 2-3 weeks after the patient has smoked the last cigarette or completed the reception of prohibited anticoagulant drugs in this case.

As for absolute contraindications, surgical intervention is not performed for cancer, except prostate cancer at an early stage of development. This is caused by the risk of spread of metastases by hematogenous way, i.e. Through the blood. For laser vaporization, prostate cancer of stage 3 and 4 is not a contraindication, while the usual Tour is performed only in stages 1 and 2 of the disease.

The use of anesthesia can put limits on patients with heart or respiratory problems, especially in the case of insufficient functions of vital organs. The greatest number of contraindications in the use of general anesthesia, which is relevant for the traditional method of surf surgery and laparoscopy. TUR is carried out mainly under the influence of spinal anesthesia.

Resection of the prostate is not performed in patients older than 70 years, whose body due to physiological deterioration may simply not bear such a load.

It is undesirable to perform a hollow surgery for patients with endocrine disorders, such as hypothyroidism ( thyrotoxicosis), goitre, diabetes, obesity (for TUR surgery these pathologies are not contraindications) because of the danger of various postoperative complications. It is possible to refuse surgery for men suffering from severe intestinal pathologies and those who have problems that do not allow the introduction of endoscopic equipment into the urinary tract (for TUR). It is dangerous to perform operations in the pelvic area and patients who have an expansion of veins in the pelvic region.

Great risk of severe bleeding in patients with hemophilia, which also becomes an obstacle to removal of organs. Nevertheless, laser vaporization makes it possible to help people with bleeding disorders, because coagulation of blood vessels occurs immediately at the time of their damage.

Whatever it was, but the decision on the possibility of carrying out the operation of each individual patient is taken by the attending physician who is responsible for his decision and the life of the person who has entrusted his fate to his hands. Therefore, preference should always be given to professionals who have enough knowledge and experience in this direction.

[8], [9], [10], [11], [12]

Consequences after the procedure

Whichever method is used for resection of the prostate, no doctor can give guarantees that the operation will pass without negative consequences. Most of them after a traditional cavitary operation. The fact that it is practically touching, requires the surgeon to have good knowledge of anatomy, detailed study of ultrasound materials, orientation in anatomical structures, ability to distinguish between healthy tissues and pathologically changed ones without visual control. After all, if the tissues are not removed completely, there is a high risk that they will start to expand again.

The recovery period after open operations is always longer and is accompanied by a palpable pain syndrome requiring the taking of pain medications. If during the operation an infection was entered (and this can not be excluded with open operations), an additional course of antibiotic therapy will be required.

Surgical surgery in the usual way implies the presence of a fairly large incision on the abdominal wall, which will take a long time to heal. If the fresh seam is treated poorly and manipulated, there is also the risk of infection of the wound.

An unpleasant consequence of an open surgery is a decrease in sexual desire. The use of other methods reduces the likelihood of such an outcome, so it is considered more preferable for patients of young and middle age. Complete absence of an erection can be observed after removal of the prostate, if during the operation the nerve fibers responsible for sexual functions were affected. This is an irreversible process.

In most cases, the decline in sexual activity is temporary. Still, any operation, even almost painless, is a trauma to the body, and it takes time to restore some functions. Over time, everything comes back to normal, and the man continues to live a full life. If this does not happen for a long time, you will have to undergo additional research to identify the reasons for the absence of an erection.

Quite a frequent consequence of operations on the prostate, more characteristic for the suprapubic method and TUR operations, is retrograde ejaculation, in which during an erection a man experiences an orgasm, but the outflow of the seed does not occur. This does not mean that there is no semen, it is simply thrown out in the wrong direction (not into the urethra, but into the bladder). Some of the sperm can still stand out during intercourse, but mostly it is found in the urine, which becomes cloudy and whitish.

It must be said that for satisfaction from sexual intercourse for both partners, pathology does not affect, but with the conception of a child there may be problems. Retrograde ejaculation is treated in various ways (drug therapy, reflexology, physical procedures, plastic of the sphincter of the bladder and urethra, etc.). But since sexual dysfunction does not affect the ejaculation, and the desire to conceive a child does not occur every day, during these periods you can try to have sex with a filled bladder, which will not allow the sperm to slip past the entrance to the urethra.

With partial removal of the prostate tissue, a complete cure does not occur in all cases. The frequency of relapses may differ depending on the method of operation. But even with such an effective treatment as laser resection, the probability of relapse is approximately 10%. However, the repeated operation will need to be carried out after several years, when the tissues of the organ will grow so much that the urethra begins to squeeze.

[13], [14], [15], [16], [17], [18]

Complications after the procedure

It must be said that even methods with the least number of side effects, which include laparoscopy of the prostate, as well as complete or partial removal of the prostate gland by the laser, can not completely prevent such complications as postoperative hemorrhages. Even laser exposure, which allows instantaneous coagulation of vessels during surgery, does not exclude possible hemorrhages in the postoperative period, after necrotic tissues begin to peel off a little. This is especially dangerous for people with coagulation disorders.

It is impossible to exclude the appearance on the site of the removed prostate and in the urethra area of cicatricial joints, adhesions and strictures. The latter can cause a violation of urination, and relief for the man will be temporary. Subsequently, new surgery to treat complications will be needed. The prevalence of such complications is about 2-5%.

A rather dangerous complication of transurethral surgery is TUR syndrome. It is associated with the need to rinse the area of surgery during surgery. Since at this time there is also damage to blood vessels, some of the water can mix with blood and enter the circulatory system. The smaller the prostate and the shorter the time of surgery, the lower the risk of such a complication, which can affect visual acuity and cause a disturbance of consciousness. In principle, the use of diuretics after surgery helps to quickly forget about such symptoms.

Sometimes complications are caused not by peculiarities of the operation, but by inaccuracy or lack of competence of the surgeon. Usually they are inflammatory and are caused by damage to various organs (urethra, bladder, prostate capsule, intestine) during surgery.

Another can be said as a shameful complication, which occurs in 17-83% of men after resection of the prostate by various methods, is considered incontinence, which is a psychotraumatic circumstance for an adult male. This consequence, associated with a violation of the innervation of the external sphincter of the urethra, is observed after the time after the operation. It can pass independently (a year after the operation the number of patients with this complication is reduced to 5-23%) or require special treatment.

What caused the disruption of the sphincter? With open cavitary surgery, especially if complete removal of the prostate is performed, there is a possibility of damage to the nerve fibers responsible for contraction of the sphincter and bladder muscles. And during surgery with transurethral access, the proximal sphincter stretches, which controls the flow of urine into the urethra. Still, the operation can last 1-2 hours, during which a tube is inserted into the urethra, the diameter of which is large for the entrance from the urethra to the bladder.

Urinary incontinence may occur in patients after surgery by any of the methods, but with laparoscopy, the likelihood of such a complication is lower. A large role in the appearance of such a symptom can be played by the excess weight and age of the patient. There is a correlation between the incidence of the symptom and the size of the prostate gland, concomitant pathologies, episodes of enuresis in the past.

This complication requires special attention. And before taking any steps to eliminate the problem, you need to conduct some diagnostics to exclude the infectious nature of the pathology. Usually the patient passes urine analysis and the tank sowing on the microflora, fills in a special questionnaire, which describes all the nuances of enuresis. In some cases, it turns out that urinary incontinence is the result of stress, in which quality the operation itself can act.

To determine the degree of enuresis, a Pad test is performed using absorbent pads. The volume of lost urine is measured within an hour. If it is less than 10 g, you can talk about mild incontinence. The amount of urine in the range of 11-50 g indicates a moderate degree, above 51 g - about severe pathology.

You may need to see a neurologist, perform a rectal and urodynamic study, a urethrocystoscopy and a descending cystourethrography with a contrast agent to identify urethral strictures and fistulas.

Treatment of secondary enuresis often begins six months or a year after surgery, because in most patients during this time the problem goes away on its own due to the compensatory capabilities of the body. If the restoration of normal urination does not occur during this time, there is no hope for an independent restoration of the sphincter function and various methods of treatment must be applied.

Distinguish the following stages of treatment of urinary incontinence after resection of the prostate:

• Conservative therapy, which is held throughout the year:
  • drug therapy (anticholinergic drugs, normalizing the contractile capacity of the sphincter),
  • Therapeutic exercises for training the muscles of the pelvic floor,
  • electrostimulation of pelvic floor muscles.
• Operative treatment is performed with ineffective long-term conservative treatment:
  • For mild to moderate incontinence, a minimally invasive operation called male sling is performed, which consists in placing special ribbons in front of the hanging section of the urethra to provide mechanical compression of the urethra for stopping the loss of urine between acts of urination.
  • A severe degree of enuresis is treated by implanting an artificial urethral sphincter.
  • It may also require surgery to remove scar tissue, adhesions that adversely affect the functioning of the urogenital system, and this helps restore normal urine output.

It is clear that urinary incontinence is a very unpleasant condition that occurs after the operation of resection of the prostate and requires quite a lot of time to correct the situation. But this is not a reason to refuse surgical intervention, which allows for a long time to solve the problem of urine retention in the body and the complications that arise. It is better to cure the enuresis than to suffer then with diseased kidneys.

At least, there is always a choice of methods of conducting the operation and clinics with personnel of various levels. Nobody interferes with visiting various hospitals and medical centers, talking to doctors, reading reviews on the Internet from people who have already undergone surgery.

[19], [20], [21], [22]

Care after the procedure

Resection of the prostate is an operation that can be performed by various methods. But this does not change the attitude to it, as to an operative intervention, after which the body needs some time to recover, some of its tissues were damaged, and the functions of the urogenital system may be violated. This suggests that the patient needs some care and compliance with the doctor's requirements to avoid dangerous complications.

Regardless of the method of conducting the operation, after the procedure for complete or partial removal of the prostate, the patient is put a catheter, which has 2 goals: unloading the urinary organs after the operation and cleaning the bladder from the accumulating blood, particles of necrotic tissue, possible infection. The placement of a catheter after resection of the prostate is considered mandatory. Another thing is that the duration of its presence in the body under different methods of operation is different.

The longest time will have to put up with the presence of a catheter to patients who have had the operation performed in the traditional open way. Within 7-10 days from the wound inside the body, blood can gradually be allocated, which requires constant washing to prevent stagnant phenomena and infection of the bladder. During this time, the catheter will be in the urethra, removing urine and rinsing water out.

After laparoscopy of the prostate, the duration of the catheter is already shorter - from 2 to 4 days, depending on the intensity of the coloring of the withdrawn liquid in red. If the liquid becomes light pink or does not have an unusual color, the catheter is withdrawn.

TUR surgery in this plan is even more pleasant, because with the catheter it usually takes no more than 3 days to tolerate, and after laser treatment with an almost instantaneous coagulation of the vessels and a minimal risk of infection, the tubes can be removed from the urethra after a day.

After the catheter is removed, the patient can go home, although in some cases it is permitted to do so earlier. While the catheter is in the body and after removing the tubes from the urethra, a man may feel some discomfort. The foreign body in the urethra can cause painful spasms and false urge to urinate. After it is removed, it can feel rezi during a visit to the toilet for a small need, urine sometimes has a pink tinge. Such symptoms are not considered pathological and are self-contained within a week.

After removal of the catheter, the men feel a noticeable relief. Peeing becomes much more pleasant, because the liquid begins to stand out with a strong stream. But you need to understand that the internal organs in such a short period of time can not completely recover, and the bladder needs to learn to work normally again. Therefore, in the first days after the removal of the tubes, you do not need to wait for the full filling of the urea, it is recommended to go to the toilet every half hour, and for 3-5 days at least once in 1 hour, especially since you will have to drink a lot.

The need for large amounts of fluid to enter the body is due to various reasons:

• from midnight on the eve of surgery, the patient is not allowed to eat and drink, which means that it is necessary to replenish the fluid, with normal state of health, the patient can be allowed to drink 2 hours after the operation, and only on the next day,
• a small flow of fluid into the body makes the urine more concentrated, which irritates the walls of the bladder and can provoke inflammation,
• there is a need for a natural rinse of the bladder cavity after removal of the catheter, especially if the urine is still colored pink (urine can also induce necrotic tissue after cauterization with laser or current for some time, and their delay in the body is also undesirable).

Drink the patient will have a lot (it's not about alcohol, but about water, tea, compotes), but here in the food will follow some restrictions. At the time of recovery, the body will have to give up fatty, sharp, heavily salted, fried and smoked dishes. But boiled and steamed dishes, any sour-milk products of low fat content, mineral water without gas will only benefit.

If the procedure was performed using an open method or using laparoscopic equipment, the wounds remain on the body from cuts and punctures that require antiseptic treatment with hydrogen peroxide or zelenok, replacement of shepherds and dressings, and removal of the sutures after the wound is well tightened. After an open surgery, the patient can stay in the hospital for more than a week, during which the wound is monitored by medical personnel. After the expiration of the time spent in the hospital for a cicatrizing wound, you will have to monitor yourself. If severe pain is observed, the doctor prescribes pain medication

During this period, the man will have to limit physical activity. Within a few days after the operation, he will not be allowed to get out of bed and strongly strain the pelvic muscles. In principle, the restriction of physical activity (for 1.5 months you can not exercise, actively move, lift weights, have sex) is relevant for all types of surgery. But after laparoscopy, the patient can get out of bed 1-2 days later, and after non-invasive methods even on the same day or the day after the operation.

To prevent infectious complications, patients in the postoperative period are prescribed antibiotic therapy with broad-spectrum drugs. The duration of antibiotic therapy is 1-2 weeks. After laser treatment, which minimizes the risk of infection, the appointment of antibiotics is not necessary, but doctors prefer to be reinsured. In addition, antibiotic therapy reduces the risk of developing inflammatory processes, which in the recovery period is very inappropriate.

To reduce the load on the muscles of the pelvic floor and prevent bleeding patients will need to monitor their stool, not allowing constipation. Those who have digestive problems may have to take laxatives, which should be prescribed by the attending physician. In general, the administration of any medication within a few days after the operation should be coordinated with the attending physician, especially when it comes to medications that affect blood characteristics.

In the first days after the operation, it is not recommended to make sudden movements, jump out of bed, crouch. But physical inactivity also will not help restore the functions of organs. After leaving the hospital, patients are recommended daily walks in the air, moderate physical activity, special exercises to restore the tone of the urinary organs.

Urinary incontinence is a common complication after a prostate resection operation. To restore the contractile ability of the urethral sphincter, it needs to be trained with special exercises. Perhaps even have to undergo a specialized treatment course or resort to an operation to eliminate the consequences.

To recover was faster and more effective, men will need to adhere to a healthy lifestyle. For many, this is an excellent chance to give up bad habits and start a new life.

[23], [24]

Feedback on the operation

Men with characteristic pride and restraint do not particularly like to talk about their problems, especially when it comes to sexual function and the delicate issue of urination. For this reason, they are not too quick to share their grief with the doctor, until the problem takes on a scale that requires prompt intervention. With this is associated and a small number of reviews on the operation of resection of the prostate on the Internet. Who would want to tell the whole world that you had such a delicate problem, which can affect the sexual life?

Nevertheless, sometimes you can meet posts where men share the results of treatment of their friends. Yes, and former patients of a urologist aged 65-75 years, who have nothing to be ashamed of, can tell something about the effectiveness of surgical treatment.

We must immediately say that both of them speak about the surgical method of treatment very enthusiastically, considering it the most radical method of treating the problem. Despite the possible complications and nuances of the operation, men exhausted by the disease are ready to do anything to get rid of the pain and problems with urination. Even such a complication as incontinence of urine few people stops.

The greatest number of positive reviews about laser treatment (laser vaporization), because it shows a minimal risk of complications such as bleeding and a decrease in erectile function, which is important for young men. And incontinence in this case is infrequent. With laser enucleation, the risk of complications in the form of urinary incontinence, erectile dysfunction, the appearance of retrograde ejaculation and small bleeding is somewhat higher and approaches the TUR operation by means of an electrical loop.

Speaking about the high cost of TUR operations and laser treatment, many former patients argue that medical therapy for several years pumped even more money out of their pockets, while the result turned out to be negative.

The feedback of patients and their friends is confirmed by the opinion of doctors who note an improvement in the outflow of urine and the general condition of patients after any of the operations for treating the prostate. In principle, if all the necessary studies are done and contraindications are taken into account, the operation of the man is tolerated well, no matter how it is carried out. Another matter is the length of the recovery period, possible complications and cosmetic traces on the body.

The most budgetary operation is the suprapubic operation by the open method, but it also gives the maximum number of complications and relapses, has a large number of contraindications, and recovery after it takes several months (up to six months), while after other operations the man completely returns to normal after 1.5 months. Despite the cheapness of a few men are resolved to risk their erectile function, which after an open surgery often remains impaired.

After laparoscopic intervention, side effects are few. Urinary incontinence is usually restored on its own within six months, temporary erectile dysfunction can be observed, severe bleeding happens extremely rarely.

TUR surgery, like laser treatment, shows the best long-term results, although the incidence of urinary incontinence after urethral access is still large. Nevertheless, reviews about complications on the Internet are much less than thanks to doctors for a good effect after the operation, which indicates the high effectiveness of the method. In the end, much depends on the age of the patient (the older the patient, the more difficult it is to restore the tone of the sphincter), the timeliness of seeking help (the size of the prostate increases gradually, and the longer it is, the longer the operation and the higher the risk of complications), the characteristics of the male organism and available pathologies.

Resection of the prostate is considered an exact anatomical operation and requires high competence of the doctor in this field. But even the knowledge of medicine, anatomy and surgery will not help if the doctor does not know how to properly handle the tools necessary to conduct a particular type of operation. For the result to be worthy, and the number of complications to be minimal, it is necessary to take a responsible attitude to the choice of a clinic and surgeon who will perform the operation, because men's health and the perception of themselves as men in the future depend on this. Risk is a noble cause, but not when it comes to the life and health of a person.

[25], [26]