Laser enucleation of prostate adenoma. Holmium laser enucleation of prostate adenoma

This disease most often overtakes men over the age of forty.. With age, there is a slowdown in all processes in the body, a decrease in the volume of sex hormones. Among the reasons that contribute to the development of adenoma are hereditary predisposition, a sedentary sedentary lifestyle, bad habits and frequent stress.

Indications for removal

Severely disturbing symptoms and insufficient effectiveness of the prescribed drugs may be the reason for the doctor to suggest surgery.

Direct indications for surgical intervention are the following conditions, which are caused by the development of adenoma:

• hematuria (there is blood in the urine);
• acute renal failure;
• stasis of urine;
• infectious processes in the urinary organs;
• the inability to empty it due to compression of the adenoma of the urinary canal.

Before treatment of prostate adenoma with a laser, the patient is prescribed studies:

• biopsy;
• it is necessary to pass urine and blood for analysis;
• testing for prostate disorders;
• determination of residual urine volume.

"Green Laser"

This method belongs to non-contact photospective vaporization. It has a wide circulation. The treatment is performed using a special device "Green Light Laserscope". The penetration of the beam into the tissue of the adenoma occurs to a depth of 0.1 cm. By heating the affected tissues, they evaporate, which is carried out layer by layer. Under the supervision of a surgeon who monitors all stages of instrument manipulation, the operation is of high quality.

The advantages of this procedure:

• short stay in the hospital;
• the installation of the catheter is performed only for one day;
• improvement of the general condition within a few days after the intervention;
• the likelihood of postoperative complications is minimal;
• preservation of erectile function;
• may be used in patients with diabetes mellitus and high blood pressure.

The disadvantages of this type of intervention include high cost. Expensive equipment is not available for purchase by every clinic, which affects the price of the treatment itself.

Types of surgery with a laser

Surgical treatment can be carried out using traditional methods and with the participation of modern new technologies, including radio wave therapy and laser. Laser removal of prostate adenoma can be of several types, the use of which depends on the capabilities of the clinic, the specialization of the doctor and the patient's condition. This is rarely used interstitial laser coagulation and more common methods that are adopted by modern clinics: burn-based laser ablation and enucleation.

Interstitial coagulation

The introduction of the laser is performed through punctures. The principle itself is based on tissue atrophy. The result is a reduction in the size of the prostate and a decrease in squeezing of the urethra by the adenoma. After this manipulation, the man will be able to empty the bladder completely.

Improvement may be minimal and occur only after a long time. It may be necessary to re-intervention. The low efficiency of the method and the long recovery period affect the fact that this method is rarely used.

enucleation

Manipulation is to remove the tumor. The likelihood of complications is thus minimized. This technique is often chosen in cases where removal of a large prostate adenoma is required.

Resection is carried out by inserting the device through the penis. Removal of the adenoma is performed in small parts. At the moment, this method is considered obsolete and is used infrequently.

Enucleation has an advantage over the previous method. The use of special hardware makes it possible to grind the adenoma and then remove the tissues. Upon completion of the treatment with an antiseptic, laser work is performed through the transurethral access. The detachable lobes are excreted into the bladder. With the help of a morcellator, these parts are divided into smaller ones and removed.

This complex manipulation must be performed by a doctor with extensive experience and qualifications. Reputable medical institutions with the appropriate base specialize in such interventions.

Laser ablation

In this way, the tumor is eliminated by carefully calibrated burning.

Laser ablation of prostate adenoma can be performed in two ways:

• Evaporation-based photosensitive laser vaporization.
• Pulsed holmium laser ablation

With photosensitive laser vaporization, the method of evaporation of the adenoma itself is taken as the basis. Under the control of the endoscope, such operations can be performed only if the size of the tumor tissue is less than 30 cm3.

Heating tissues and their subsequent evaporation makes it possible to minimize blood loss. This option is most often recommended for young men to maintain fertility.

Holmium laser ablation is carried out using a special apparatus, the impulse from which conducts a contact resection. The Auriga apparatus is used not only for the treatment of prostate adenoma, but also for the removal of tumors and kidney stones, and for the treatment of the bladder.

Efficiency and scope are limited by the small size of the adenoma. Otherwise, other methods are used. The operation to remove prostate adenoma with a laser relieves squeezing of the urethra and contributes to the restoration of functions.

Preparation for surgery and rehabilitation

Before removing the adenoma, some procedures are performed.

Among them:

• cleansing enema;
• stop eating at least 8 hours before.

The intake of any drugs should be agreed with the doctor, especially when it comes to drugs that affect blood clotting. It is important to provide the doctor with information about chronic and recent diseases, allergic reactions.

Some of the laser surgeries are performed under local anesthesia. This makes it possible to use for the treatment of adenoma in patients with an allergic reaction to anesthesia and those who do not want to create an additional load on the heart. Depending on the size of the adenoma, the doctor decides on the choice of the most suitable method for the patient to perform the operation.

Recovery after laser treatment of prostate adenoma has been carried out takes about 14 days. Despite the low invasiveness, the patient must adhere to some medical recommendations and observe restrictions.

During this period, the patient who has undergone the procedure is recommended:

• drink enough liquid;
• engage in physical therapy;
• limit physical activity;
• rational nutrition (a minimum of salty and fried foods, the complete exclusion of alcoholic beverages);
• monitor the regularity of the chair, avoid constipation;
• the first time the use of urinary catheters;
• exclude heating of the inguinal region;
• avoid sudden movements.

In some cases, an additional course of antibiotics is prescribed. The recovery process after surgery should be under medical supervision

Advantages and disadvantages of adenoma removal

Advantages of laser treatment of adenoma:

• rare occurrence of complications and relapses;
• preservation of sexual function;
• the ability to live without symptoms for more than 10 years after surgery;
• less than with traditional operations, soreness;
• makes it possible to remove an adenoma of various sizes;
• no age restrictions;
• fairly quick recovery.

Flaws:

• high price;
• possible complications in the postoperative period (painful urination, scarring, the presence of blood in the urine, urinary incontinence, urinary retention, infection, etc.);
• retrograde ejaculation, in which sperm enters the bladder;
• Not every clinic provides the possibility of laser treatment.

In the vast majority of cases, the resulting complications are eliminated without intervention within a short period of time. If they are preserved, a doctor's consultation is necessary.

Side effects of adenoma treatment also include:

• possible drop in libido;
• erectile dysfunction;
• recurrence of the disease;
• narrowing of the urethra.

Prices for operations

Prices for laser removal of prostate adenoma vary depending on the specific medical institution, city and country.

Ukraine

Removal of the prostate in Ukraine can cost from 15 thousand hryvnia. In the capital of the country, Kyiv, prices are higher than in cities of regional significance.

Russia

In large medical centers of the country, the lower limit of the cost of laser intervention ranges from 20 thousand rubles in Rostov and Samara. In cities such as St. Petersburg or Novosibirsk, pricing starts at 20 thousand rubles. In Moscow, the cost of treatment can reach 150 thousand rubles, but on average it will be about 50 thousand.

Far Abroad

Treatment of adenoma in foreign clinics is much more expensive. In Israel - from 16 thousand dollars, in Germany - from 14 thousand euros. On average, treatment abroad will cost from 5 thousand dollars.

Conclusion

Surgery is the most effective way to eliminate the symptoms of prostate adenoma. Despite the fact that there can be no absolute guarantee of a cure, the likelihood of complications with this method of treatment is minimal. Before deciding on a laser intervention, it is necessary to carefully weigh all the arguments and read the doctor's explanations about the course of the manipulations.

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BPH can be treated in different ways. The most popular and modern treatment among scientists is laser enucleation of prostatic hyperplasia. This is a surgical procedure that uses a holmium laser. The use of such treatment ensures minimal tissue damage.

Preparatory processes before surgery

Blood thinners should be stopped immediately before hospitalization as they can cause bleeding after surgery. It is also necessary to undergo an examination in the clinic: it will help to find out about the general condition of the patient and about the results of the tests.

Shortly before surgery, the patient's blood pressure is measured and the state of health is checked again.

The attending physician needs to know if the patient has had diseases, operations on the heart or blood vessels, and also whether there is an allergic reaction to the components in the medicines.

How is surgery performed?

Before the start of the operation, the anesthesiologist selects the drug for local or general anesthesia. Local anesthesia gives temporary anesthesia of a certain area, and general anesthesia immerses you in a deep sleep. The intervention itself is carried out using a laser. The endoscopic camera helps the surgeon to observe and control the operating process. The holmium laser is connected to a camera and slowly inserted into the urethra. This technique helps to carry out the operation without incisions, only a few punctures are made. The capsule surrounding the gland is not damaged.

Surgery takes place in 2 stages. First, the operating surgeon separates the lobes of the prostate, then, using special equipment, they are crushed to facilitate extraction.

After laser enucleation of prostate adenoma, the attending physician gives recommendations in which the recovery will accelerate and go smoothly.

There are a number of general instructions for the patient:

• listen to and follow the recommendations of the doctor;
• some time not to engage in physical activity;
• come for preventive examinations to the doctor;
• to have sex when the doctor decides it is safe for the prostate gland.

The first month a person will feel unwell, there will be a great need to rest. Residual tissue may appear in the urine. If the patient does not feel acute pain and there are no complaints, it is most likely that the operation was successful.

The cost of such a procedure

The cost of the operation will be different, depending on where it will be carried out. It may change from the region in Russia, as well as different costs in the CIS countries.

The smallest limit is 35-40 thousand rubles. Abroad, it ranges from 5 to 18 thousand dollars.

The price varies depending on the techniques used, quality equipments, clinics. The most modern equipment is a holmium laser, which qualitatively removes the tumor, the risk of complications during and after the operation is minimized. Such a laser has been used and tested for a long time. Surgical instruments have improved, this has expanded the capabilities of the laser, and also helped to attract patients who have successfully experienced effective treatment.

Pros and cons of this procedure

Such an operation is becoming more and more popular, it has many advantages, but there are also some disadvantages.

Advantages of laser enucleation of prostate adenoma:

• this method removes both the small and large prostate. The doctor is able to remove the gland up to 200 grams or more;
• the procedure is performed for people who have impaired blood clotting;
• the development of infection is minimized;
• such an operation can be performed at different ages, the risk of earning complications is minimal;
• the use of laser enucleation of prostate adenoma helps to avoid the syndrome of water intoxication, since at the time of surgery, solutions are used to cool the surgical field;
• after a successful procedure, the patient recovers quickly;
• due to the fact that the tissues are practically not disturbed, it is easier to examine microscopic fragments, therefore prostate cancer is excluded;
• the catheter is worn for a short time;
• short hospital stay and recovery process.

Disadvantages of laser enucleation of prostate adenoma:

• an expensive operation, this is due to the use of expensive and high-quality equipment;
• the complexity of the procedure, it must be carried out by a highly qualified and experienced doctor;
• duration of surgery.

Laser enucleation of prostate adenoma is a proven, effective procedure for the treatment of prostate hyperplasia. She pleases with the practical absence of side effects, a short period of hospitalization and recovery.

For the treatment of prostate adenoma, various methods are used: the use of a urethral stent, adenectomy, drug treatment. Laser enucleation of prostate adenoma is considered the most modern treatment method: the prostate is removed using an endoscope and a laser. In order for the operation to take place with the least harm to the body, a holmium laser is used.

How does a patient prepare for surgery?

A week before the date of the operation, the patient should stop taking medications, especially blood-thinning ones. You can start taking permanent medication again 10 days after you are discharged.

Before the operation, the patient undergoes an outpatient examination

The day before, an outpatient examination is carried out: the patient's pressure is measured, the general state of his health is assessed. He must tell the doctor about the medications he has taken before; whether he had operations on the blood vessels and the heart, infectious or chronic diseases, bypass surgery; whether there are allergic reactions to certain drugs. The following factors can affect the quality of the operation and the patient's condition: prostheses of blood vessels and joints, artificial heart valves, implants, coronary artery stent, CSF shunts, intolerance to various drugs, staphylococcus aureus.

How is the operation going?

Before the operation, the patient is examined by an anesthesiologist and prescribes a suitable premedication. Such operations are performed under general anesthesia: the patient is conscious, but does not feel anything below the waist. If desired, you can ask for a full anesthesia: in this case, the person is in a state of deep sleep. Antiseptics are also used.

The operation can take up to 1.5 hours on average. The laser involves minimal intervention in the patient's body. With it, the adenoma is carefully cut off from other tissues, then transferred to the bladder and crushed. The rest is carefully removed from the body.

Operation technique

1. First, a thorough examination of the ureters, bladder, prostate gland is performed. The surgeon determines the area for the operation.
2. The prostate tissue is dissected in the direction from the bladder neck to the seminal tubercle on the left and right sides of the middle lobe. If we conditionally imagine the dial, the dissection is carried out at 5 o'clock. This is how a furrow with clear outlines is formed, which is especially important for large adenomas. The same size is done at 7 o'clock.
3. The enucleation of the middle lobe is performed, connecting the formed grooves with the help of a laser fiber and movements from the seminal tubercle towards the bladder. The tissue of the middle lobe is lifted with a resectoscope and gently displaced into the area of ​​the bladder.
4. Then the enucleation of the lateral lobes is carried out, moving from the midline along the surgical capsule.
5. After completion of the enucleation, a thorough stop of bleeding is carried out by coagulation of the vessels. To do this, the tip of the laser fiber is retracted by 2-3 mm. from the vessel.
6. Tissues from the bladder are removed using a morcellator (crushes tissues).

Postoperative period

After the patient returns to consciousness, he is informed of the results and checked for well-being. If a person feels discomfort in the pelvis or pain, he should definitely report it.

During the day or two, the person still wears a catheter, then it is removed. The patient should be prepared for the fact that at first he will visit the toilet more often and urination will be painful - special drugs are prescribed for pain relief. Involuntary urination is possible, but the process is getting better after the restoration of the working capacity of the pelvic muscle tissues. After a few days, the body recovers.

The patient is issued a medical extract, which indicates information about the operation performed, the state of health and the results of the tests.

Side effects

After prostate surgery, the following side effects may occur:

• The appearance of blood in the urine;
• Burning sensation after going to the toilet;
• Frequent trips to the toilet;
• Pain when going to the toilet for a short time;
• Urethral injury;
• The spread of infection in the bladder, testicles and kidneys, which leads to surgery.

After the operation, the patient is given recommendations on how to eat better in order to recover faster. At first, drinking plenty of fluids is shown - this will help get rid of tissue remnants and clean out the bladder. You can start eating by the evening after the operation.

You should not allow physical activity during the period indicated by the doctor, and at first you should refrain from sexual intercourse. Erection in case of successful operation will return gradually and naturally. The normal period for the restoration of sexual function is one month.

At first, a person may feel unwell, feel the need for rest, observe tissue remnants in the urine. After the operation, a sick leave is issued for a period of two weeks. If the work is associated with physical exertion, the period can be doubled. The attending physician will prescribe a sick leave to the patient in accordance with his lifestyle.

After the operation, the doctor gives recommendations on how to restore the body and explains how normal recovery should occur. Unpleasant side effects at this time are common operating consequences. But there are a number of cases when you need to contact a specialist for additional help immediately:

• The presence of severe and long-lasting pain. If the pains are tolerable and subside with time, this is a normal symptom, but if they are very strong and do not subside with time, you should definitely see a urologist.
• The resulting bleeding is a reason to immediately go to the hospital.
• Absent erection for more than a month. Usually in a month the patient fully recovers; if this did not happen within the specified period, the help of a specialist will be required.

The cost of laser enucleation of prostate adenoma

The cost of the operation depends on the place of its conduct: it varies depending on the region of Russia, it costs differently in the CIS countries. The lower limit is 30-40 thousand rubles. Foreign treatment is within the cost of 4.5-18 thousand dollars.

The price depends on the used technology, equipment, clinic. The most modern at the moment is a holmium laser. It effectively removes a small tumor and at the same time avoids many complications and consequences after surgery. This type of laser has been successfully used for more than a decade. Surgical equipment has also been significantly updated, which has expanded the scope of the laser and increased the number of patients successfully treated with it.

Advantages of laser enucleation

• This technology allows you to quickly and efficiently remove prostate adenoma of any size, it is popular in all clinics in the world.
• Suitable for patients with poor blood clotting, as little blood is lost during the operation.
• The possibility of developing an infection is reduced to a minimum risk.
• There are practically no contraindications for laser adenoma removal.
• Thanks to the method (incision of adenomas, moving parts to the bladder and their further removal), such an operation can be performed at any age, and it will not have complications.
• You can remove an adenoma of any size. Laser enucleation allows you to remove glands up to 200 g in size.
• After a successful operation, the original male health and sexual function are quickly restored.
• After it, the TUR syndrome does not develop, since aqueous solutions are used during the operation for cooling.
• This operation does not involve the complete destruction of prostate tissue. This allows microexamination of individual areas to rule out prostate cancer.
• The catheter is worn for a very short time: the maximum period is up to two days.
• Short hospitalization and fast recovery.

Cons of laser enucleation

• This is a rather expensive procedure, as the latest equipment and technologies are used.
• Difficulty in performing the operation from a technical point of view. Great skill of surgeons is required.
• The work is painstaking: the removal of diseased tissue occurs at a rate of one gram per minute.

Otherwise, laser enucleation of prostate adenoma is a modern, effective and reliable procedure that gives excellent results and is well tolerated by the patient. Side effects are minimal, hospitalization and recovery are short. The patient must follow all the recommendations during the recovery period, in case of severe unpleasant side effects, immediately seek help and maintain contact with the attending physician until complete recovery.

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Laser vaporization of prostate adenoma or otherwise holmium laser enucleation of prostate adenoma (holep) is one of the advanced methods of surgical treatment of this disease. Every third man suffers from benign prostatic hyperplasia. Efficiency and success in the treatment of adenoma depends on a quick visit to the doctor, as well as on the correct choice of the method of therapy.

What is the essence of this method?

Currently, the laser is boldly included in the list of the most commonly used methods of surgical treatment of various pathologies. Its main advantages are that this method has few postoperative complications, and there is no blood during the operation.

During the operation, a resectoscope is inserted through the urethral canal, which is a tube in which the main systems for the operation pass:

• electric loop;
• laser;
• optical system.

During surgical treatment, the prostate parenchyma is eliminated by evaporation, while pathological areas are irradiated with their subsequent destruction. Under the influence of the laser, the cytoplasm of the adenoma cell is heated, then it is brought to the boiling point and destroyed. Now laser enucleation of prostate adenoma is carried out using a green beam laser system (fiber-optic tube).

In order to minimize injuries to healthy tissues surrounding the adenoma, this organ is constantly irrigated with liquid, which is injected through a special system inside the resectoscope, and it is also removed through it. Parts of the destroyed adenoma tissue are also removed with the liquid. Evaporation is carried out by the doctor in layers at the same depth level (1 mm).

The prostate gland has three lobes, during surgery, the impact occurs sequentially on all three parts of the prostate, starting with the middle one, since it is located closest to the bladder. The operation is carried out quickly, on average it takes one and a half to two hours. Despite the speed of implementation, laser vaporization of prostate adenoma is a minimally invasive and relatively low-traumatic operation.

Due to the fact that laser removal of prostate adenoma is a bloodless method, the doctor can stop the operation at any stage. The bloodlessness of the method ensures that the blood vessels are sealed in parallel with the removal of adenoma tissues.

To summarize, laser removal of prostate adenoma can be described as the removal of fluid from the prostate tissue.

Indications for surgical treatment

Laser vaporization of prostate adenoma has strict indications for implementation. The main ones are:

• an increase in the volume of the prostate from 30 to 80 ml (if the size is larger, then the ablation of prostate adenoma is combined with transurethral resection of the prostate);
• ineffectiveness of conservative therapy;
• pain during urination;
• urinary dysfunction.

It is worth noting that the treatment of prostate adenoma with a laser has three varieties:

• contact evaporation (if the adenoma exceeds the volume of 30 ml);
• contact laser removal;
• interstitial laser coagulation.

Who can't do it?

As with any laser surgery, there are contraindications. It is prohibited in patients with malignant neoplasms, and a patient with a recovery process in the acute period will not be able to remove it either. Also, laser enucleation of prostate adenoma is not done for those men whose prostate volume exceeds 120 ml. Patients with pathology of the heart and liver are also selected with caution.

Preparatory stage

Preparatory measures consist of a detailed conversation with your doctor. He must tell the patient in detail about all the intricacies of this operation, about the possible risks and consequences, after which the patient signs the consent. Next, the doctor gives him a list of required tests.

Mandatory are a general analysis of urine and blood, a biochemical blood test, Rh factor and blood group, it is recommended to do a blood coagulation test (coagulogram). An electrocardiogram and an ultrasound examination of the heart are also needed. These two examinations are performed five days before ablation. In case of violations in the work of the cardiovascular system, an examination by a cardiologist is necessary.

Anesthesia

Laser removal of prostate adenoma requires anesthesia. In a conversation with an anesthesiologist, based on information about the presence of concomitant diseases, the type of anesthesia is determined. The type of anesthesia is influenced by the patient's tolerance of one or another drug from the group of anesthetics, a factor of psychological discomfort in certain types of anesthesia.

Distinguish between local and general anesthesia. In a local anesthetic, a local anesthetic is injected into the epidural space in the lumbar spine. In this case, the person is conscious, but he does not feel his body below the waist. This type is definitely better, as it does not have such an extensive list of consequences as general anesthesia.

But with general anesthesia, the anesthetic is injected into a vein or is fed using a special inhalation mask. The person is in an unconscious state, the artificial lung ventilation machine breathes for him.

Advantages of this method

Treatment of the prostate with a green beam has a number of obvious advantages:

• enucleation can be performed under local anesthesia, which excludes severe consequences from general anesthesia;
• there is no bleeding at the time of the operation and its minimal risk after the resection has ended;
• positive dynamics is visible immediately after the end of surgical treatment (no pain, normal urination, erection);
• the risk of recurrence is minimized;
• low load on the cardiovascular system;
• low risk of water intoxication syndrome;
• the minimum period of rehabilitation;
• possibility of use in elderly patients;
• You can not refuse to take blood thinners.

Perhaps one disadvantage of this type of cure is that the adenoma tissue cannot be subjected to histological analysis.

Possible Complications

Despite the fact that the operation to remove prostate adenoma with a laser is considered the most optimal and safe method of eliminating the disease, it can also have some complications. The main ones are:

• reflux of sperm into the bladder (almost every intervention on the prostate can form the wrong flow of sperm during sex, it flows into the bladder, and not out);
• impotence may occur (however, the probability is much lower compared to other methods);
• there is a possibility of recurrence of the disease, and there is also a possibility of the need to repeat the treatment;
• stricture of the urethra (laser treatment, like any other, can cause narrowing of the prostate gland due to scar formations).

Strict adherence to all doctor's recommendations after the operation will help reduce the likelihood of these negative consequences. The following will outline the main ones.

Recovery period

After the completion of surgical procedures, the patient is under constant supervision of the medical staff for some time, then he is allowed to go home. He is forbidden to eat for a day, but you can drink, while the amount of drinking should be increased to three liters a day, so the risk of forming a narrowing of the urethra will be reduced. Also, for some time, the patient must take antibiotics and anti-inflammatory drugs.

It should be mandatory to flush the bladder, if the patient has a catheter, then this manipulation is carried out quite quickly. Washing is carried out with furacilin or chlorhexidine, after such manipulation, a change of the urinal is necessary. But if there is no catheter, then washing is done using a special nozzle.

Sexual life can be resumed after 14–21 days. Intense physical activity is not recommended for two months.

Conclusion

Laser ablation is undoubtedly one of the most gentle methods. Patient reviews about this method are mostly positive. Remember that prostate adenoma requires timely treatment. The possibility of performing laser vaporization covers Moscow and the Moscow region, as well as other large cities of Russia. Therefore, the operation is available to every citizen of the Russian Federation.

What are the consequences of an operation to remove a prostate adenoma?

• erectile dysfunction;

• urine leakage;
• painful sensations;
• difficulties in the process.

Feedback about the operation

Treatment of prostate adenoma with surgery

Prostate adenoma is a benign tumor. In other words, prostatic hyperplasia. This is one of the most common urological diseases in men. Of course, it is not worth equating prostate adenoma and cancer. However, she delivers big troubles, including in the intimate sphere. Surgery for prostate adenoma is not the only way to get rid of the disease. It all depends on the degree of progression of the disease. So prostate adenoma of 1 and 2 degrees is treated with medication. The operation is prescribed for prostate adenoma 3 degrees.

There are several types of surgery. Operations can be avoided in case of timely detection of prostate adenoma of the prostate gland.

Indications for surgery for prostate adenoma

Normal and enlarged prostate

Prostate adenoma is a disease caused by hormonal changes in the stronger sex after 50 years. At this age, the production of testosterone is significantly reduced, and progesterone, on the contrary, begins to behave more actively. As a result, the prostate undergoes rapid growth of the epithelium. As a result - the occurrence of tumors. Most often this is an adenoma. The problems from this benign neoplasm are very noticeable - the prostate, which has grown due to epithelial cells, presses on the bladder, closes the exit from the urethra. As a result, all this overshadows the normal existence of a normal man.

A person likes to delay the trip to a specialist until the disease begins to actively manifest itself. With timely access to a doctor for prostate adenoma in men, treatment with various medications is prescribed. If drug therapy has not brought the expected results, it is necessary to carry out treatment by surgical intervention.

Absolute indications for surgery for prostate adenoma are:

1. Obvious problems with urination. A man cannot go to the toilet for a small need, although strong urges are present.
2. Urinary tract infections, chronic or intermittent.
3. Traces of blood in the urine are a symptom of possible bleeding in the genitourinary system.
4. Pathology in the work of the kidneys.
5. Bleeding of the prostate due to its enlargement. The operation is prescribed if the bleeding cannot be stopped with special drugs.
6. Protrusions of the walls of the bladder, which have reached a large size.
7. Stones in the prostate or bladder.

When surgery is contraindicated

With prostate adenoma in men, surgery is contraindicated in the following cases:

• with renal and heart failure;
• pyelonephritis and acute form of cystitis;
• pathology of the cardiovascular system;
• cerebral arteriosclerosis

Types of operations in the treatment of prostate adenoma in men

Modern medicine uses several methods of surgical interventions for prostate adenoma.

Transurethral resection of the prostate (TURP)

Transurethral resection

Doctors consider this method "golden" when removing prostate hyperplasia. Only TUR guarantees you the removal of the prostate gland without a single incision. Its action is based on the complete or partial removal of the affected organ by introducing a special apparatus through the urethra. The treatment is carried out with a high-frequency current that passes through a wire loop. Control over the operating process is carried out through a cystoscope.

After this intervention, the patient stays in the clinic for about 2 days. All this time he walks with a catheter.

Statistics say that more than 80% of men operated in this way notice a clear improvement in their condition. How much the operation costs depends on the clinic and conditions.

Adenomectomy

An operation that is gradually becoming a thing of the past, giving way to more modern methods. The treatment is carried out under general anesthesia. An incision is made in the abdominal cavity, the anterior wall of the bladder is separated. During these manipulations, the doctor has the opportunity to broadly consider possible violations.

Such an operation is performed if the prostate has grown quite widely, and its weight has become more than 80 grams.

Removal of the tumor occurs almost manually through the bladder. After the operation, the man is in the hospital under the supervision of doctors for about a week. Full recovery after this method of intervention will take about three months.

Laparoscopy

This method is considered minimally invasive, that is, it does not require large incisions and a complete opening of the abdominal cavity. To perform the operation, it is enough to make several small incisions in the patient's abdomen. A camera and surgical items are inserted into these holes. The entire course of the operation is clearly visible on the monitors. Removal occurs with the help of an ultrasonic knife, which eliminates the affected tissues without touching neighboring organs.

Laser treatment

As a rule, this method of removing prostatic hyperplasia is used if a man is contraindicated in traditional surgical intervention. For example, the patient has poor blood clotting, or age does not allow lying on the operating table. It is effective if the prostate does not exceed a volume of 30 ml.

Laser removal of prostate adenoma

Laser therapy works in the following way. A special fluid is injected into the prostate, which, under the influence of laser radiation, heats up and forms steam. This steam has a detrimental effect on the affected area of ​​the prostate, which, as a result of manipulation, is covered with thrombosed vessels.

Laser treatment is the safest method for removing prostate adenoma. This is a great way to be treated without the risk of serious complications such as impotence, severe bleeding, post-operative urinary incontinence.

Use of prostatic stents

During the operation, prostatic stents are installed, which are placed in the urethra and allow urine to exit freely. These stents have the ability to self-expand at the right time.

This method is as effective as TUR. It does not require a long postoperative recovery and significantly reduces the unpleasant consequences.

Possible consequences after surgery

All of the above methods of treatment clearly bring relief to the patient. Unfortunately, even a timely operation will not guarantee the absence of complications. There are a number of consequences that occur after surgical removal of the prostate gland.

• Bleeding
• Due to the ingress of water into the bloodstream, water intoxication is possible
• Acute urinary retention
• Inflammatory processes
• Complications caused by long wearing of the catheter
• Poor wound healing
• Temporary or permanent erectile dysfunction

Erectile dysfunction after surgical removal of the prostate

Do not think that these complications should be mandatory. Often the operation is successful, and the patient soon returns to a full life: problems with urination disappear, "male" strength returns.

How much does an operation to remove a prostate adenoma cost?

Operations to remove prostate adenoma are carried out in all major cities of Russia, Ukraine, Belarus. The cost of an operation to remove prostate adenoma depends on the method of surgical intervention and additional services, such as a consultation with a urologist.

So, how much does the operation cost in large Russian cities?

In Moscow, more than ten clinics can offer their services for the removal of prostate adenoma.

For comparison, let's see how much the operation costs in Ukraine.

The price of treatment for prostate adenoma depends on the level of the medical institution and the qualifications of the doctor.

The range of prices is determined by the status of the medical institution and the qualifications of the doctor performing the operation. If we take into account Moscow, then the location of the medical institution plays a significant role - the closer to the center, the more expensive.

Additional costs will be required for the prescribed preoperative diagnostics if you arrive at the clinic without them. Thus, how much the operation costs in the final version, you will be told directly at the clinic.

Surgery for prostate adenoma. Reviews

Of course, relying solely on reviews when deciding whether to have an operation or not is not worth it. Everything went well for someone, respectively, and the review will be excellent. And someone will have the exact opposite situation. In each case, everything is individual.

Most positive reviews are left by patients who have undergone surgery by laparoscopy or laser exposure. This is because these types of operations are less traumatic. The patient needs a minimum of time to recover.

What are the nuances worth knowing about the operation to remove prostate adenoma and what is the complexity of the procedure? What do the reviews of those people who transferred it say?

Prostate adenoma, or, in scientific terms, prostatic hyperplasia over the past decades has become one of the most popular diseases of the male genitourinary system. This pathology is found in about one-fifth of men under 40 years of age, in half at the age of 50 years and in 9 out of 10 cases was found in men under 80 years of age. This disease tops the list of urological visits, which are associated not only with urination problems, but also with “sexual health” problems.

Prostate adenoma: causes, symptoms, clinical picture

The prostate gland is one of the most important internal organs that takes part in the male reproductive function. With age, seals, clots of matter, tangles of fibers can form in this organ. These neoplasms are called hyperplasia.

To date, this pathology has been successfully treated both with medication and by direct surgical intervention. The most important thing is to determine the presence of the disease in a timely manner and start therapy, then you can achieve positive results even without the intervention of surgeons.

Since the urethra passes through the prostate gland, due to the increase in the size of the organ, this channel is compressed. This causes the main symptom of this disease - delays in urination. Usually, this becomes noticeable when less urine is excreted at a time, the number of urges increases, and the jet “withers” over time.

Also, over time, you have to make efforts in order to urinate. In this case, the patient experiences discomfort. In sexual life, he becomes less active, an erection occurs with difficulty and not always.

Among the reasons, one can distinguish mainly hereditary predisposition and age. Age is a key factor, it is in men who are over forty years old that adenoma is more common. You should not trust the myths that sexually transmitted diseases that have been transferred earlier can cause the development of a neoplasm. Nor is it an irregular sex life.

Some of the symptoms have already been named, but, in addition to the above, it is worth mentioning the following:

• it seems that after urination the bladder was not completely emptied;
• erectile dysfunction;
• nighttime urge to urinate;
• this process may be interrupted.

Prostatitis test

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Inflammation of the prostate gland has specific symptoms. During the inflammatory process, the gland swells and increases in size, which contributes to increased urination. If a man has such signs, you should immediately take a test for prostatitis. Then you can assess the state of your body and visit specialists in time.

You can take a prostate test at home on your own. With inflammation of the gland, not only problems with the outflow of urine appear, but erectile function worsens, which leads to infertility. Early diagnosis of prostatitis will avoid the development of serious complications.

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1. No rubric 0%
2. Prostatitis test 0%

Everything is fine.

The results of the passed test show that you have moderately pronounced signs of prostatitis. Contact a specialist and get tested. Do not forget that most health problems can be eliminated already in the early stages!

You need to see a doctor urgently!

You have pronounced symptoms of prostatitis. See a doctor as soon as possible!

1. With an answer
2. Checked out

Task 1 of 13

Task 2 of 13

Have you had any discomfort or pain in your scrotum in the past week?

Task 3 of 13

Have you experienced discomfort or pain in your penis in the past week?

Task 4 of 13

Have you experienced discomfort or pain in your lower abdomen in the past week?

Task 5 of 13

Have you had symptoms of prostatitis in the last week, such as pain, burning sensation during urination?

Task 6 of 13

Have you had symptoms of prostatitis in the last week, such as pain or discomfort during ejaculation?

Task 7 of 13

How many times in the past week have you experienced pain or discomfort in the following places:

• This was not
• Rarely
• Sometimes
• Often
• Usually
• Lost count

1. Task 8 of 13

   How would you rate the intensity of the pain when it bothered you on a scale from 1 (no pain) to 10 (unbearable pain).

   Task 9 of 13

   Have you experienced discomfort or pain in your perineum in the past week?

   • Did not have
   • Rarely
   • Sometimes
   • Often
   • Is always

2. Task 10 of 13

   Over the past week, have you often felt the urge to empty your bladder earlier than two hours after your last visit to the toilet?

   • Never
   • Rarely
   • Sometimes
   • Often
   • Is always

3. Task 11 of 13

   How do the above signs of prostatitis affect your usual lifestyle?

   • Do not affect
   • Almost don't interfere
   • Influence to some extent
   • Significant disruption of lifestyle

4. Task 12 of 13

   How often have you thought about your signs of prostatitis during the past week?

   • Didn't think at all
   • Almost didn't think
   • Sometimes
   • Often

5. Task 13 of 13

   How would you live if the above symptoms of prostatitis bothered you throughout your life:

   • Wouldn't pay attention
   • Would normally live
   • Satisfactorily
   • Mixed feelings
   • I would feel unsatisfactory
   • Very bad
   • Terrible

How is the operation and treatment of prostate adenoma?

Usually, at the initial stage of the disease, when the symptoms are of little concern and are expressed to a lesser extent, patients are prescribed drug treatment for prostatic hyperplasia.

But when the disease has reached a level where it is not possible to cure it with drugs, the method of surgical intervention is used. This method is more effective than medication, but it has its drawbacks and certain risks, treatment can be called risky.

The most popular types of operations for prostate adenoma:

1. Transurethral resection of the prostate (TUR).

The bottom line is that a special device called a resectoscope is inserted into the patient's urethra. During the intervention, the patient is in a supine position, with legs apart, which are bent at the knees. With the help of this device, introduced through the external opening of the urethra, surgical intervention is performed.

By means of this device, the procedure for the removal of prostate adenoma is also carried out. He is able to "scrape off excess tissue" and immediately perform "cauterization" of capillaries that begin to bleed. The last manipulation helps to avoid internal bleeding.

One of the mandatory items is the installation of a catheter in the external urethra leading to the bladder. This tube will be removed one week after the surgery.

Transurethral resection of the prostate (TUR) refers to high-tech methods of medicine, it exists not so long ago, but is successfully used in modern medicine to remove prostatic hyperplasia.

All actions are most often performed under general anesthesia. Occasionally, spinal anesthesia may be used in such cases.

An obvious plus is that the dissection of the covering tissues of the body is not used, which means that postoperative rehabilitation will be faster and recovery will be more efficient, the treatment will not last long. In addition, there are no scars after it, since there was no planar incision.

It is also reduced to the minimum length of stay of the patient in the hospital after surgery:

1. Transvesical (transvesical) adenomectomy.

This type of intervention involves a planar incision in the abdominal cavity. It is done in the area between the navel and the pubis. During an open operation, the surgeon cuts out all benign outgrowths with a special scalpel. Just like after a transurethral resection of the prostate, a catheter is placed in the urethra.

The pluses include the fact that the procedure is often much more effective than TUR. The disadvantages include a longer recovery period and postoperative observation in the hospital.

What are the consequences of transuteral resection of the prostate (TUR) and transvesical adenomectomy?

Risk of internal bleeding. Among the consequences, this is perhaps the most dangerous. As after any other intervention, after removal of prostate adenoma there is always a risk of bleeding. This risk also depends on the quality of the surgical intervention, as well as on the coagulation properties of the body, that is, the work of the blood coagulation function.

If bleeding occurs during the procedure, a blood transfusion may be used, which can often be the only way to save a patient's life during severe bleeding from dangerous blood loss. There may also be a risk of clogging of blood vessels with clotted blood, which also poses a risk to the life of the patient after transurethral resection of the prostate (TUR) and transvesical adenomectomy.

Statistics show that such cases are quite common, especially among elderly men who have survived the work of a surgeon.

Hydrointoxication. It is also one of the most popular consequences after the removal of prostate adenoma and, in addition, one of the most difficult. Also, this pathology can be referred to in the medical literature as TUR syndrome. A factor in the development of the syndrome is the ingress of fluid into the bloodstream, which is used to cleanse the external urethra during an intervention to remove prostatic hyperplasia. Data on the statistics of such complications may vary in different sources, but usually all figures range from 0.1 to 6.7 percent. As you can see, this percentage is small.

And besides, the most modern technologies that are used during the work of the surgeon make it possible to reduce the likelihood of such a consequence to zero.

Urinary retention. Another popular consequence is urinary retention after the intervention, and many reviews talk about it. This is especially true for men over the age of 60. The factors provoking this consequence most often are clogging of the urinary duct with blood clots. It can also be caused by a mistake by the surgeon during the procedure. To avoid serious health problems, the patient needs to see a doctor to solve this problem. In the conditions of modern medicine, this is easy to do, but the delay in solving this problem can be more serious than it might seem. Do not hesitate to solve pressing problems in order to avoid additional unpleasant consequences.

In 1-2 out of 100 cases, men may experience urinary incontinence as a consequence of an operation to remove a prostate adenoma. Rarely, this phenomenon has a permanent basis, most often it occurs in case of severe overstrain (psychological or physical to the same extent). Also, in more frequent cases, this phenomenon occurs in the first few days after surgery. This is the most common consequence of temporary relaxation of the urethral sphincter muscles. To prevent this, a catheter is used. The use of urethral pads may also be appropriate. Treatment may be carried out by other methods. Other problems with urination.

These problems most often include:

• urine leakage;
• painful sensations;
• difficulties in the process.

Of course, most of these problems go away with time without additional medical intervention. If they do not go away, then most likely the surgeon made a mistake during the operation, and you will need to go to the hospital again to fix the problem.

Infectious diseases. The likelihood of infectious pathologies after surgery is always very high. According to some reports, this happens in 20% of cases. They are usually treated with standard antibiotics.

The danger lies in the fact that inflammatory processes can develop into chronic ones and periodically make themselves felt.

Ejaculation does not occur. This problem is perhaps the most common. Some statistics speak of a figure of 99%. Why is this happening? The answer to this question lies in the fact that the seed after orgasm is thrown into the bladder. In medical literature, such ejaculation is called retrograde. This does not harm the body of a man, but there are problems with his ability to have children.

Violation of potency. Such complications are understandable, but they occur in less than 10% of cases. Of course, this possible consequence instills fear in many patients. However, modern medicine is doing everything possible to reduce this probability to zero. If the operation is prepared and performed correctly, you should not be afraid of potency dysfunction.

Recovery after intervention

After any operation, the patient will need to spend some time in the hospital. This is done, firstly, to control the position of the catheter and the reaction of the body to it, and secondly, to observe the general well-being of the patient after any type of surgery.

Also, the patient takes antibiotics during the entire stay in the hospital. This is a normal procedure after any operation, and is done to reduce the likelihood of developing inflammatory processes, the treatment here is simple.

After the operation, doctors advise drinking as much liquid as possible in order to speed up the process of rehabilitation and restoration of all functions of the male genitourinary system. At home, the patient is strictly prohibited from any physical activity, especially weight lifting. This is especially true for the first weeks after surgery. You need to be especially careful about your health. Constant consultations with the doctor are necessary.

Feedback about the operation

1. After the operation, there were complications - serious problems with urination. There was pain and urinary incontinence, complete erectile dysfunction. Now urological pads have become salvation, but I don’t know what to do next. Yuri, 56 years old.
2. Father (70 years old) underwent laser surgery abroad. So far, everything is fine, he is undergoing rehabilitation. The disease was discovered at an extreme stage, so the operation was difficult. We look forward to what will happen next. Sergey, 37 years old.
3. I was diagnosed with an adenoma of the prostate gland at the age of 40, at first they treated me with medication, but it didn’t help much. So I finally decided to have surgery. TUR was scheduled a week later. Even according to the description, it’s scary, but after reading about the consequences, now, in general, I’m afraid of the upcoming operation. Anton, 42 years old.
4. He decided to have an operation only when he was threatened with the development of cancer from an adenoma. Fortunately, it was successful and for a year now, without serious complications, the treatment was easily tolerated. Thanks to the doctors for their attention and professionalism. Igor, 55 years old.

BPH test

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The diagnosis of "prostatic hyperplasia" scares many men who have been diagnosed with this disease, patients often equate it with a malignant neoplasm. The disease causes a lot of inconvenience, there is a violation of the process of urination - up to the complete absence of urine. The disease requires timely treatment, so the detection of hyperplasia in the early stages will help to avoid the development of severe complications.

The initial diagnosis of benign prostatic hyperplasia can be done at home. A man needs to be tested.

Some representatives of the strong half of humanity who have been diagnosed with BPH do not pay attention to the disease, believing that these are age-related changes. But this pathology is fraught with serious complications. For men who have doubts about their health, self-diagnosis of BPH will be a good option to dispel all doubts.

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Time is over

• We strongly recommend that you contact a specialist!
  You have severe symptoms. The disease is already running and it is urgent to undergo an examination by a urologist. Do not put off a visit to the urologist, the symptoms may worsen, giving rise to the development of complications.

  Everything is not so bad, but we recommend contacting a specialist.
  You have moderate symptoms of BPH (Benign Prostatic Hyperplasia) and you are strongly advised to visit a urologist or andrologist in the coming month.

  Everything is fine!
  Everything is fine! You have mild IPSS symptoms. On the part of the prostate gland, you are doing relatively well, but you should be examined at least once a year.

1. With an answer
2. Checked out

1. Task 1 of 7

   During the past month, how often have you had the sensation of not emptying your bladder completely after urinating?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

2. Task 2 of 7

   During the past month, how often have you needed to urinate more frequently than 2 hours after your last urination?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

3. Task 3 of 7

   During the last month, how often have you had intermittent urination?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

4. Task 4 of 7

   During the past month, how often have you found it difficult to temporarily abstain from urinating?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

5. Task 5 of 7

   During the last month, how often have you had a weak urine stream?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

6. Task 6 of 7

   During the past month, how often have you had to strain to start urinating?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

7. Task 7 of 7

   During the past month, how often have you had to get out of bed at night to urinate?

   • Never
   • Once a day
   • Less than 50% of the time
   • Approximately 50% of cases
   • More than half the time
   • Almost always

Treatment of prostate adenoma with a laser is a new therapeutic technique widely used in urology. Prostatitis and its formidable complication - prostate adenoma - seriously poison the life of the patient, causing a decrease in potency and a violation of the outflow of urine. Drug therapy can only help in the early stages of the disease, but the insidiousness of this disease lies in the long absence of symptoms. Because of this, it is quite easy to miss the onset of the disease. Widely practiced 10-20 years ago, abdominal surgery to excise hyperplastic prostate tissue is very traumatic and has a long rehabilitation period. Therefore, it was replaced by laser vaporization of prostate adenoma, which is the penetration of an instrument to the affected area through the urethra. Other methods of adenoma removal are also used, in particular laser enucleation of prostate adenoma, which involves laser therapy, the reviews about them are the most positive.

Features of the impact and its benefits

Laser therapy in some branches of medicine began to be used in the 70s of the last century. However, it was not immediately possible to use this technique in urology. Success was achieved after the introduction of the "green laser" technique, in which energy is supplied to the affected area of ​​the prostate using the thinnest fiber-optic cable that easily passes through the urethra. Resection of the prostate in this case is not required.

The prostate is made up of 3 parts. Excision of hyperplastic tissue occurs starting from its middle section, which is closest to the bladder. Under the influence of the laser, pathological tissue growths are removed simultaneously with the sealing of blood vessels. In one minute with its help, the beam is able to remove up to 2 g of affected tissue from any part of the prostate - this is an excellent therapeutic effect. Therefore, laser vaporization of prostate adenoma is indicated even with large foci of pathological growths.

The price of removing prostate adenoma with a laser is quite high.

The advantages that laser therapy has in eliminating prostate adenoma, according to reviews, are obvious. These include:

• No bleeding or scarring.
• Rapid Therapy.
• Short duration of catheterization.
• Short period of hospitalization.
• No need for general anesthesia.
• Rapid improvement in well-being.
• Low risk of relapse.
• Minimum recovery period.

Laser removal of prostate adenoma is allowed for people suffering from type 1 diabetes, hypertension, low blood clotting. This surgical mini-operation does not entail impotence and allows you to get rid of prostate pathologies completely. As for the disadvantages that such a resection has, they include its rather high cost, which is noted by numerous reviews, and the impossibility of examining the histological material removed during the operation. The price of removing prostate adenoma with a laser is quite high.

What are unconditional indications

Treatment of prostate adenoma with a laser is indicated when drug therapy does not give the desired effect and the size of the prostate gland does not exceed 80 ml. Unconditional indications for the removal of hyperplastic tissue will be:

1. Violation of the outflow of urine or its stagnation.
2. Acute urinary tract infections.
3. Hematuria.
4. Acute renal failure.

In some cases, the tumor of the prostate tissue grows to such a size that it completely covers the lumen of the urinary tract, and the man cannot urinate. Like any other operation, laser removal of prostate adenoma requires preparation. It will consist in carrying out such studies as a complete blood count, urine culture, ultrasound of the urinary tract and prostate biopsy. Timely laser therapy of the prostate, as the reviews say, allows you to get rid of the tumor forever, restoring the previous quality of life. The price of this medical service corresponds to the quality.

Treatment must be carried out by a qualified physician.

Methods used

Treatment of prostatitis with a laser today is carried out by private clinics that have modern advanced equipment and high-tech diagnostic facilities. Depending on the individual characteristics of the patient, his age, history and severity of the underlying disease, he may be shown:

• Electro-laser ablation.
• Laser enucleation.
• Interstitial laser coagulation.
• Contact laser vaporization.

Each of the above therapeutic methods has its own characteristics, which we will discuss below. The choice of the most appropriate method of laser removal of prostate adenoma remains with the attending physician.

Laser ablation is the most popular technique for removing prostate adenoma, the essence of which is to burn it with a beam. Carrying out this operation eliminates the pressure of the pathologically overgrown tissue on the urethra, which normalizes the outflow of urine. Holmium ablation is most commonly used as an alternative to transurethral resection. This operation requires the use of Auriga holmium laser pulses, which allow the excision of small adenomas. If the volume of hyperplastic tissue is impressive and holmium ablation cannot cope with it, another method of this micro-operation is used - photosensitive laser vaporization, with the help of which the tumor is effectively evaporated.

Laser enucleation of prostate adenoma is designed to rid the prostate of large tumors. In medical practice, this operation, or rather a mini-operation, is called a holep, it, like holmium ablation, vaporizes the tumor with a laser beam that penetrates to the site of its localization through the urethra. A feature of the holep procedure is the preliminary grinding of the tumor, and then resection of the remnants of its tissue with coagulation of damaged vessels.

Laser enucleation of prostate adenoma is designed to rid the prostate of large tumors.

Interstitial laser coagulation is rarely performed these days. It involves the penetration of the beam into damaged tissues by puncturing the prostate. Despite the fact that urination is restored fairly quickly, the rehabilitation period after this operation may be delayed. At the same time, the risk of relapses, which will also require therapy, remains. And the reviews of patients who underwent removal of an adenoma by this method confirm this.

Possible Complications

Removal of prostate adenoma with a laser is a low-traumatic operation. But the risk of complications after it, although minimal, remains. The possible negative consequences that laser therapy of the prostate entails include:

1. The risk of recurrence, the risk of its occurrence persists 5-10 years after removal.
2. The appearance of retrograde ejaculation, a formidable condition in which semen is thrown into the bladder instead of being released naturally.
3. Narrowing of the urethra due to the formation of scars on it.
4. Erectile dysfunction, the risk is minimal, but it persists.

In order to avoid the possible occurrence of complications, throughout the entire postoperative period, you must strictly follow all the recommendations of the doctor. Namely: take drugs, drink plenty of fluids, observe sexual rest for 2 weeks, do not play sports and do not lift weights.

Prostate adenoma can be defeated. And modern therapy, especially such methods as laser treatment and tumor vaporization, will help a lot in this. To find out if you need such a mini-operation, you can ask your doctor. Laser therapy is widely used in many domestic clinics offering quick relief from prostatitis and its complications. The price of its implementation in various clinics and medical centers in Moscow is shown in the table.

Prostate adenoma is a benign formation consisting of the stromal part of the prostate and overgrown epithelium. As BPH grows, the tumor begins to put pressure on the urethra, as a result of which the process of urination is disturbed. To identify its presence helps determine the level of PSA antigen. At the initial stage of adenoma development, treatment is predominantly medical. However, if drug therapy has not given the desired result, the only option is surgery to remove prostate adenoma. Today, there are minimally invasive methods of surgical intervention, which makes it possible for a man to return to normal life.

When is the operation scheduled?

The type of surgical intervention and the method of its implementation is determined individually for each patient. Usually, the doctor pays attention to the symptoms of prostate adenoma and the degree of its development. Surgical treatment is indicated in the case of:

1. The neoplasm is very large and has squeezed the urethra so much that the patient cannot urinate on his own.
2. A man is tormented by too frequent urge to urinate.
3. The patient developed hematuria.
4. Infectious processes in the male genitourinary system are regularly diagnosed.

One reason for surgery is bladder stones.

1. Urinary incontinence.
2. The presence of stones in the bladder.
3. Medical treatment proved to be ineffective.
4. Severe pain that cannot be relieved by medication.
5. progression of hyperplasia.

Surgical removal of prostate adenoma is not performed in elderly patients, since such an intervention is associated with a risk to the life of a man.

Patients often have a question - is it necessary to perform an operation with 2 degrees of prostate adenoma? When diagnosing a disease at this stage, treatment is carried out with a medical method. The indications that doctors pay attention to when prescribing surgical treatment are the following symptoms:

• Difficulty urinating.
• Stagnation in the bladder, which provoke the formation of deposits.
• Detection of blood in the urine.

The urologist-andrologist Alexey Viktorovich Zhivov will tell about the symptoms of prostate adenoma:

• The appearance of intoxication of the body.
• Diagnosis of renal failure.
• Inflammatory or infectious processes in the body.

Training

During the preparation of the patient for surgery, it is necessary:

1. Consult with an anesthesiologist who can determine the appropriate type of anesthesia.
2. Undergo a comprehensive examination of the body, which will help to identify the presence of possible contraindications to surgical removal of the adenoma.
3. Consult your doctor if you have any chronic diseases.

1. Donate blood for biochemical analysis and determination of clotting parameters.
2. During preparation, the patient may be given antibiotics to avoid infection.
3. On the day of the operation, it is forbidden to eat.

Methods of carrying out

Traditional transvesical adenomectomy is performed by the abdominal method. The incision, through which all the necessary manipulations are performed, is carried out in the lower abdomen. Removal of prostate adenoma in this way can cause various complications and has many contraindications.

There are other options for removing an adenoma, each of which has its own characteristics:

• Transurethral resection and incision.
• Enucleation.

Operation of transurethral resection of prostate adenoma

• Vaporization of adenoma by laser.
• Laparoscopic removal.
• Embolization of arteries.

The choice of method for removing the adenoma can be made by the attending physician. It depends on many factors, including the degree of development of the neoplasm and the existing complications.

Adenomectomy

Not so long ago, this was the only way to remove an adenoma. Today, the doctor can prescribe it only in the case when other operating methods are unacceptable. Indications for such an operation:

1. A significant increase in the size of the prostate (exceeds 80 mm).
2. During the examination of the patient, various complications were identified:

• Stones in the bladder.
• The diverticulum in the bladder needs to be removed.

Only a qualified surgeon should perform the operation in this way, since it is associated with a high risk of various, including dangerous complications.

Transurethral resection

This technique is the most common today. Estimated duration of the operation does not exceed 1 hour. The indication for its implementation is the size of the prostate, not exceeding 80 ml in volume.

The operation is performed by endoscopic method. To the place of manipulation, the instrument is delivered through the ureter. Diathermocoagulation is used to remove tissue.

The head of the surgical direction of the Garvis clinic, Robert Molchanov, will talk about the TURP operation:

There is a similar technique for surgical intervention, which is called transurethral incision. Its difference lies in the fact that tissue resection is not performed, but a small incision is made in the prostate gland in the area where the narrowing of the ureter occurs. This manipulation makes it possible to improve the process of passing urine through the urethra. The indication for incision is:

• Small prostate.
• The possibility of developing an oncological process is completely excluded.

A catheter is immediately inserted into the urethra, which is removed 5-7 days after the operation. This is done to remove the remnants of the pathological tissues of the adenoma.

The consequence after removal of the adenoma through the urethra is discomfort in the area of ​​manipulation. After 7-10 days, all discomfort should disappear. If this does not happen, you should consult a doctor.

enucleation

This technique is often used instead of open surgery and intervention through the urethra. During enucleation, adenoma tissues are, as it were, “husked” under the influence of a laser. The advantages of removing prostate adenoma by this method include:

1. The possibility of subsequent examination of the removed prostate tissues for a malignant process.
2. Removal of a large adenoma (over 200 g).
3. A short recovery period.
4. Possibility of carrying out for patients with various pathologies:

• In the presence of metal implants in the skeleton.
• The presence of a pacemaker.
• Violation of blood clotting.

laser enucleation operation

Contraindications for surgery are:

1. Bladder pathology.
2. Inflammatory processes in the body.
3. Severe condition of the patient.
4. The impossibility of inserting the instrument through the ureter.

It should be noted that these contraindications are also relevant for other methods of surgical intervention on the prostate.

Artery embolization

Angiographic equipment is required for the operation. During surgery, the vessels that feed the prostate are blocked. Embolization contraindications include:

• The presence of floating thrombi in the veins of the lower extremities.
• Diagnosis of vascular disease.

The video below details the method of prostate artery embolization:

Indications for removal of an adenoma by embolization include:

1. Violation of the process of blood clotting.
2. Severe forms of diabetes.
3. Kidney diseases.

Laser vaporization

This is a modern technique for removing prostate adenoma, which makes it possible to avoid many complications. It can be performed on patients who have problems with blood clotting.

An adenoma removal instrument is inserted through the ureter. During the procedure using a laser, pathological tissues are evaporated. At the same time, the affected vessels are sealed, which eliminates bleeding.

The surgeon monitors the process of the operation on a special monitor. It is advisable to use a laser when the size of the adenoma is in the range of 60-80 cmᶾ. If its size exceeds 100 cmᶾ, then laser vaporization is combined with transurethral resection.

Removal of prostate adenoma with a laser has the following advantages:

1. High efficiency of treatment.
2. No serious injury.
3. The ability to avoid complications (bleeding, violations of sexual life after removal of the adenoma, etc.).

Laser vaporization of prostate adenoma

1. The operation can be performed on an outpatient basis.
2. Short rehabilitation period.
3. Possibility of carrying out to patients with disorders of blood coagulability.

However, the method also has its downsides:

• The removal of prostate adenoma will take more time than endoscopic removal.
• Not all clinics have the necessary equipment for the operation.

Laparoscopic removal

This method of adenoma removal is considered not only minimally invasive, but also effective. Several small incisions are made to insert the necessary instruments. The surgeon monitors the progress of the operation on the monitor.

An ultrasonic knife is used to remove the tumor. After the end of the operation, a catheter is inserted into the ureter, which is removed after 6 days.

Laparoscopic removal of prostate adenoma

The advantages of this method can be called:

1. Minimal injury.
2. High efficiency.
3. Minor bleeding.
4. The possibility of carrying out in case of detection of adenomas of large sizes.

Complications

The operation to remove prostate adenoma is sometimes accompanied by complications, among which most often occur:

• Bleeding from tissues that are damaged during the removal of the adenoma.
• When performing the manipulation, it is necessary to flush the bladder with a liquid that can enter the vascular bed.

The likelihood of complications depends on the duration of the operation. The time required for its implementation directly depends on the size of the prostate.

What are the possible complications after transurethral resection of the prostate? Watch the video below:

After surgery, the patient may experience the following complications:

1. The occurrence of urinary incontinence.
2. Scar formation in the urethra.
3. Violation of sexual function, up to the development of impotence.

According to statistics, about 2% after surgical removal of an adenoma, go to the doctor in the future because of the complications that have arisen. Approximately 5% need a second operation.

In addition, the following consequences of the operation to remove prostate adenoma are possible:

• The occurrence of a urinary fistula.
• Urinary leaks.
• Infection in the wound.
• Violation of sexual function. After an open or transurethral operation, there is often a "dry orgasm", in which no sperm is released.

Effect on potency

Surrounding the prostate gland is a capsule with nerve endings attached to it that affect erection. If during the removal of the adenoma these nerve endings were damaged, then the man may have a deterioration in potency, up to impotence.

The prognosis for the patient will depend on the surgical technique. The highest chances of maintaining normal potency are patients who underwent minimally invasive surgeries that allow preserving the integrity of nerve endings. The preservation of reproductive function is also affected by the presence of a malignant tumor (carcinoma), which has spread to the nerve endings. Sometimes already during the operation, the surgeon reveals such a formation on the nerve plexuses. In this case, they are completely removed.

Carcinoma (cancer) of the prostate gland is a malignant tumor that develops in the prostate gland.

According to the reviews of patients who underwent minimally invasive surgery, erectile and reproductive functions were preserved in full.

Postoperative rehabilitation

In the postoperative period after the removal of prostate adenoma, the main thing for the patient is to follow all the instructions of the attending physician. For this you need:

1. Get checked regularly.
2. Eat a balanced diet and completely exclude fried, spicy, salty dishes and smoked meats from the diet.
3. To drink a lot of water.

1. Avoid strenuous exercise or sudden movements.
2. In order to prevent the development of an infectious process, the patient may be prescribed a course of antibiotic therapy.
3. Refuse sexual intimacy for 1.5-2 months.
4. Lead a healthy and active lifestyle. Take daily walks in the fresh air.
5. Perform special exercises that the doctor will show.

The cost of the operation depends on the type of intervention.

Table 1. Prices for surgery to remove prostate adenoma

Prostate adenoma is a benign neoplasm. In most cases, the pathology requires surgical removal. Previously, this could only be done in a cavity way. Modern medicine offers many safe therapies. One of them is laser enucleation of prostate adenoma.

In the article we will tell:

What is laser enucleation of adenoma?

Laser enucleation is called surgery, which is carried out using a laser beam. This method is quite effective and helps to remove neoplasms, the volume of which is 100 cc. and higher. This means that the operation can be carried out in advanced cases.

Such an intervention refers to minimally invasive treatment, therefore, no incisions are required during the procedure, the integrity of the prostate gland is fully preserved. The operation is performed through the urethra.

Advantages and disadvantages

The main advantage of using a laser is the minimal risk of hemorrhage. Indeed, during the procedure, cauterization occurs not only of the affected tissues, but also of blood vessels. Due to this, the technique is suitable even for those people who suffer from poor blood clotting.

Another advantage of laser intervention is the ability to remove not only small, but also large neoplasms. The operation is performed even if a tumor larger than 100 cc is detected.

In the process of performing enucleation, the risk of trauma to the tissues of the prostate gland is minimal, and therefore the patient does not experience any discomfort. This allows you to abandon general anesthesia, which adversely affects the state of human health.

The positive side of laser treatment is the rapid recovery of the body. 2-3 weeks are enough to return to the usual way of life.

There are many positive aspects of laser enucleation, but there are also disadvantages. First of all, it concerns the professionalism of the surgeon. This treatment requires specialized knowledge.

Not all conventional surgeons have them, the effectiveness of the procedure will depend on the experience of the doctor. If the neoplasm is not completely removed, there will be a high risk of recurrence.

Also, the disadvantage of therapy is its cost. The price depends on the parameters of the tumor, in which region the clinic is located. On average, treatment costs starting from 50 thousand rubles.

Indications and contraindications

Laser enucleation for prostate adenoma is used in the following cases:

1. Violation of the outflow of urine, which is caused by a narrowing of the urethra due to pressure from the grown tumor.
2. Ineffectiveness of the conservative method of therapy.
3. Prostate weight over 80 g.

The procedure is preferred if the patient has poor blood clotting, there is a pacemaker, bone fixators and other devices. In such cases, abdominal surgery is prohibited, so a decision is made in favor of the laser.

It is not allowed to carry out enucleation in the presence of exacerbations of inflammatory pathologies and serious illnesses in the body, when taking anticoagulants, the impossibility of inserting an instrument into the urethra due to the physical features of its structure.

Preparatory activities

When prescribing laser enucleation, the attending physician must notify the patient about how to prepare for it. Doctors advise patients before the procedure to refuse to take medications, alcoholic beverages.

Before prescribing laser therapy, the surgeon conducts a conversation, during which he finds out the following:

1. List of medications taken.
2. The presence of pathological processes in the body.
3. List of previously transferred operations.
4. Having an allergic reaction to any medication.

Then the doctor schedules an examination of the patient to check his readiness for intervention. For this purpose, pressure measurement, a general examination of the body, and laboratory tests of blood, urine, and prostate secretion are required.

How is laser enucleation performed?

The patient is placed on the couch, he is given anesthesia. It is up to the anesthetist to decide which type of anesthesia to use. The choice largely depends on the mood of the patient and the readiness of his body for anesthesia.

After the action of anesthesia, the doctor performs the following manipulations:

1. Inserts an endoscope into the urethra.
2. Assesses the condition of the prostate and urinary organs.
3. Specifies the zone to be deleted.
4. It cuts off the affected tissues, dividing them into small fragments for the convenience of their further removal from the body.
5. It sends particles of the neoplasm to the bladder, inserts a catheter into it and removes the removed parts of the tissues.

Adenoma fragments removed from the body are sent for laboratory testing. It allows you to determine the nature of the lesion, the degeneration of benign cells into malignant ones.

Recovery period

Rehabilitation of the body after laser therapy takes about 4 weeks. Hospitalization of the patient after surgery in most cases is not required, sometimes the doctor may leave the patient for a day in the hospital for observation.

Within a month after the intervention, a man should take special care of his health.

During this time, the following is prohibited:

1. Load the body physically. You must refrain from playing sports, as well as from physical labor.
2. Eat properly. At the time of rehabilitation, the patient needs to provide the body with useful substances, so all harmful products are removed from the diet. These include fried, fatty, spicy, salty foods. The menu should be enriched with plant foods rich in fiber.
3. Refrain from drinking alcohol and smoking. Bad habits can cause complications after surgery.
4. Refrain from intimate life.
5. Increase your water intake. It is recommended to drink at least 2.5 liters of fluid per day.

Possible Complications

Laser enucleation is included in the group of minimally invasive methods of treatment, so the risk of complications is minimal. Usually they arise as a result of the surgeon's mistakes or the patient's non-compliance with the rules of the rehabilitation period.

The following consequences of surgery are possible:

1. Urinary problems: urinary incontinence, frequent urge to empty the bladder, burning sensation during this process.
2. Discharge of blood from the urethra.
3. Penetration of infection into the genitourinary system.
4. Erectile dysfunction.

Also, after laser therapy, there is always a possibility of relapse. The reappearance of adenoma is observed quite often several years after treatment. How high the risk of recurrence is depends on the parameters of the removed neoplasm, the quality of the equipment, and the experience of the doctor.

If at least one pathological cell remains during the operation, the mechanism of tumor development will start again. In this case, it is important to timely detect the re-development of hyperplasia. For this, men are recommended to undergo an examination of the reproductive system every six months after the operation.

Laser enucleation is an effective method of getting rid of prostate adenoma. Therapy has many advantages over open surgery, but is expensive.